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. 2025 May 16:59:e20240338.
doi: 10.1590/1980-220X-REEUSP-2024-0338en. eCollection 2025.

Health literacy of adults from primary care with type 2 diabetes mellitus: a cross-sectional study

[Article in English, Portuguese, Spanish]
Affiliations

Health literacy of adults from primary care with type 2 diabetes mellitus: a cross-sectional study

[Article in English, Portuguese, Spanish]
Robson Giovani Paes et al. Rev Esc Enferm USP. .

Abstract

Objective: To relate health literacy of adults from primary health care with type 2 diabetes mellitus and sociodemographic and clinical variables.

Method: Descriptive analytical cross-sectional study with 169 participants aged 18 to 65 with type 2 diabetes mellitus, from six primary care units in the Metropolitan Region of Curitiba, Paraná, Brazil. Data collection took place from July 2023 to March 2024, and a sociodemographic and clinical questionnaire was used, as well as subscales six and nine of the Health Literacy Questionnaire, Brazilian version. Data were analyzed descriptively and using Student's t-test, Mann-Whitney, Anova, Kruskal-Wallis, and Spearman tests.

Results: Of the 169 participants, the mean age was 56.5 ± 6.2 years. There was a significant association between the ability to interact with health professionals and male gender (p = 0.057), fasting blood glucose ≤ 130 mg/dL (p = 0.033), and between education and understanding health information and knowing what to do (p = <0.001). A weak correlation was found between understanding health information and knowing what to do and education and family income (r = 0.50 and 0.35, respectively) and significant value with glycated hemoglobin (p = 0.031).

Conclusion: There was a relationship between health literacy and male gender, education, family income, and glycemic values. These results can contribute to the development of educational actions aimed at strengthening health literacy.

Objetivo:: Relacionar o letramento em saúde de adultos com diabetes mellitus tipo 2 da atenção primária à saúde com as variáveis sociodemográficas e clínicas.

Método:: Estudo descritivo analítico seccional, com 169 participantes de 18 a 65 anos com diabetes mellitus tipo 2, de seis unidades da atenção primária da Região Metropolitana de Curitiba, Paraná, Brasil. A coleta de dados ocorreu de julho de 2023 a março de 2024, e utilizou-se questionário sociodemográfico e clínico, e as subescalas seis e nove do Health Literacy Questionnaire versão brasileira. Analisaram-se os dados descritivamente e pelos testes T de Student, Mann-Whitney, Anova, Kruskal-Wallis e Spearman.

Resultados:: Dos 169 participantes, a média de idade foi de 56,5 ± 6,2 anos. Verificou-se associação significativa entre a capacidade de interagir com os profissionais de saúde e o sexo masculino (p = 0,057), glicemia de jejum ≤130 mg/dL (p = 0,033), e entre a escolaridade e compreender as informações sobre saúde e saber o que fazer (p = <0,001). Encontrou-se fraca correlação entre compreender as informações sobre saúde e saber o que fazer e a escolaridade e a renda familiar (r = 0,50 e 0,35, respectivamente) e valor significativo com a hemoglobina glicada (p = 0,031).

Conclusão:: Verificou-se relação do letramento em saúde com o sexo masculino, escolaridade, renda familiar e valores glicêmicos. Esses resultados podem contribuir para o desenvolvimento de ações educativas voltadas ao fortalecimento do letramento em saúde.

Objetivo:: Relacionar la alfabetización en salud de los adultos con diabetes mellitus tipo 2 provenientes de la atención primaria de salud con variables sociodemográficas y clínicas.

Método:: Estudio descriptivo analítico transversal con 169 participantes de 18 a 65 años con diabetes mellitus tipo 2, de seis unidades de atención primaria de la Región Metropolitana de Curitiba, Paraná, Brasil. La recolección de datos se realizó de julio de 2023 a marzo de 2024, y se utilizó un cuestionario sociodemográfico y clínico, así como las subescalas seis y nueve del Cuestionario de alfabetización en salud Versión brasileña. Los datos fueron analizados descriptivamente y mediante prueba t de Student, pruebas de Mann-Whitney, Anova, Kruskal-Wallis y Spearman.

Resultados:: De los 169 participantes, la edad media fue de 56,5 ± 6,2 años. Se encontró una asociación significativa entre la capacidad de interactuar con profesionales de la salud y el género masculino (p = 0,057), glucemia en ayunas ≤130 mg/dl (p = 0,033), y entre la educación y la comprensión de la información sanitaria y saber qué hacer (p = <0,001). Se encontró una correlación débil entre la comprensión de la información de salud y saber qué hacer y la educación y los ingresos familiares (a = 0,50 y 0,35, respectivamente) y valor significativo con hemoglobina glucosilada (p = 0,031).

Conclusión:: Se encontró una relación entre la alfabetización en salud y el género masculino, la educación, el ingreso familiar y los valores glucémicos. Estos resultados pueden contribuir al desarrollo de acciones educativas dirigidas a fortalecer la alfabetización en salud.

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. 2025 May;39(5):e70182.
doi: 10.1111/ctr.70182.

Early Steps of the Kidney Transplant Process: What Are the Experiences of Dialysis Social Workers?

Affiliations

Early Steps of the Kidney Transplant Process: What Are the Experiences of Dialysis Social Workers?

Macey L Levan et al. Clin Transplant. 2025 May.

Abstract

Introduction: Dialysis social workers (DSWs) educate and advocate for end-stage kidney disease (ESKD) patients during the kidney transplantation (KT) process. However, little is known about the barriers DSWs face as they help patients get waitlisted and how to best support their efforts. We interviewed DSWs across New York (NY) State to examine their experiences, supports, and challenges in helping dialysis patients progress through KT education, referral, and evaluation.

Methods: We conducted semi-structured interviews with DSWs in NY State who had participated or expressed interest in a program designed to educate DSWs about KT and used rapid qualitative analysis to identify themes.

Findings: We interviewed 17 DSWs. Seven themes emerged: (1) DSWs report involvement in KT interest assessment, education, referral, and evaluation support, (2) DSWs report varying nephrologist support in helping patients progress to KT, (3) DSWs perceive social support and adherence as key factors in KT centers' eligibility determinations, (4) DSWs have knowledge gaps around living donation and appreciate learning about KT from transplant centers and non-profit organizations, (5) Patients express KT concerns and DSWs counsel them about these concerns, (6) DSWs report solutions to help patients complete KT evaluation appointments, and (7) DSWs report communication deficiencies between dialysis centers and transplant centers, and patients.

Conclusions: Education for DSWs, support from nephrologists, and resources to help patients complete KT evaluation steps facilitated DSW engagement throughout the pre-transplant process, underscoring the need for multi-level, cross-disciplinary programs to support these efforts.

Keywords: dialysis; live donor kidney transplantation; transplant access; transplant education.

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. 2025 May 16;104(20):e42523.
doi: 10.1097/MD.0000000000042523.

Investigation and quality evaluation of Internet videos related to diet therapy for chronic pancreatitis

Affiliations

Investigation and quality evaluation of Internet videos related to diet therapy for chronic pancreatitis

Wan-Shun Li et al. Medicine (Baltimore). .

Abstract

Diet therapy can help alleviate chronic pancreatitis symptoms. The quality of diet therapy content in Internet videos varies markedly. Evaluating and assessing these videos is crucial for providing reliable patient education. This study aims to analyze 102 Internet videos regarding dietary therapy for chronic pancreatitis on media platforms in China (Bilibili, Weibo, and Tiktok) and rate their content, reliability, and quality. Videos were categorized into 3 sources: hospital or university officials, medical doctors, and independent users. An 8-point scale was used to score content (smoking, drinking, eating frequency, overeating, and nutrient intake [high-quality protein, low fat, nutrition, and dietary fiber]). An adapted DISCERN tool was used to assess reliability, with the Global Quality Scale employed to measure quality. Among the 102 videos analyzed, 34 (4, 9, and 21 from hospital or university officials, medical doctors, and independent users, respectively) were rated as low quality, 37 (8, 12, and 17 from hospital or university officials, medical doctors, and independent users, respectively) were rated as moderate quality, and 31 (7, 19, and 6 from hospital or university officials, medical doctors, and independent users, respectively) were rated as high quality. Thus, among 102 videos from TikTok, Weibo, and Bilibili, only 31 (30.4%) were considered high quality based on reliability and quality assessments, and some were misleading. Our findings suggest nearly 70% of health videos fail to meet high-quality standards, highlighting critical needs for improved content moderation across media platforms. Medical professionals and institutions should be encouraged to produce more high-quality Internet videos with comprehensive content to better guide and support patients with pancreatitis in adopting effective dietary therapy.

Keywords: Internet videos; chronic pancreatitis; content score; diet therapy; quality score; reliability score.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

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Randomized Controlled Trial
. 2025 May 16;29(5s):43-50.
doi: 10.29063/ajrh2025/v29i5s.6.

Teach back educational model combined with zinc supplementation improves clinical symptoms and immunity in children with asthma

Affiliations
Randomized Controlled Trial

Teach back educational model combined with zinc supplementation improves clinical symptoms and immunity in children with asthma

Yuexiang Qin et al. Afr J Reprod Health. .

Abstract

This study assessed the impact of teach back educational model plus zinc supplementation on asthma children. Eighty-one asthma children hospitalized in Children's Hospital of Soochow University, Suzhou, China from September 2020 to October 2021 were selected, and randomly allocated to a control group and an observation group. The control group took routine treatment, and routine educational modalities. By contrast, the Teach back mode of health education and zinc supplementation were added to the observation group. The results showed significant improvement in time to clinical symptom relief and immunological levels in both groups. However, asthma knowledge score, medication adherence, and asthma symptom control were significantly higher in observation group one month following discharge than in control group. We conclude that teach-back health education improved caregivers' asthma knowledge, children's medication compliance, and asthma symptom control scores in the short term.

Cette étude a évalué l'impact du modèle éducatif de rétroaction et de la supplémentation en zinc sur les enfants asthmatiques. Quatre-vingt-un enfants asthmatiques hospitalisés à l'hôpital pour enfants de l'université de Soochow, à Suzhou, en Chine, de septembre 2020 à octobre 2021, ont été sélectionnés et répartis aléatoirement en un groupe témoin et un groupe d'observation. Le groupe témoin a suivi un traitement et des modalités éducatives de routine. En revanche, le modèle de rétroaction, composé d'éducation sanitaire et de supplémentation en zinc, a été ajouté au groupe d'observation. Les résultats ont montré une amélioration significative du délai de soulagement des symptômes cliniques et des niveaux immunologiques dans les deux groupes. Cependant, le score de connaissances sur l'asthme, l'observance du traitement et le contrôle des symptômes étaient significativement plus élevés dans le groupe d'observation un mois après la sortie que dans le groupe témoin. Nous concluons que la rétroaction en matière d'éducation sanitaire a amélioré les connaissances sur l'asthme des soignants, l'observance du traitement par les enfants et les scores de contrôle des symptômes à court terme.

Keywords: Teach back, short video, health education, nursing, zinc supplementation, clinical symptoms; immunity.

Conflict of interest statement

The Authors declared no conflict of interest

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. 2025 May 2:13:1587163.
doi: 10.3389/fpubh.2025.1587163. eCollection 2025.

Assessment of eHealth literacy among cardiovascular disease patients and analysis of influencing factors

Affiliations

Assessment of eHealth literacy among cardiovascular disease patients and analysis of influencing factors

Wei Wang et al. Front Public Health. .

Abstract

Objective: This study aimed to comprehensively evaluate the eHealth literacy of patients with cardiovascular diseases and uncover the associated influencing factors. The findings are intended to lay a solid foundation for formulating targeted strategies to enhance the health literacy of this patient population.

Methods: Between October 2023 and June 2024, a purposive sampling approach was employed to recruit patients with cardiovascular diseases visiting the cardiology department of a tertiary hospital in Shandong Province. The eHealth Literacy Scale (eHEALS) was utilized to assess the eHealth literacy levels of the participants. Based on the assessment results, the subjects were classified into qualified and unqualified groups. Subsequently, logistic regression analysis was conducted to identify the influencing factors underlying eHealth literacy.

Results: The eHealth literacy score among cardiovascular disease patients was 20.46 ± 9.54, with a passing rate of 38.6%. The overall mean score across all items was 2.5 ± 1.19. Specifically, for the sub-domains of internet health information service capabilities and application abilities, evaluation capabilities of internet health information and services, and decision - making capabilities of internet health information and services, the mean scores were 2.49 ± 1.18, 2.67 ± 1.32, and 2.66 ± 1.35, respectively. Findings from binary logistic regression analysis suggest that education level, sleep quality, residing in close proximity to a medical institution (distance < 5 km), prior utilization of medical information websites or search engines, as well as the interaction between proactive health awareness and utilization of medical information websites or search engines, were all influencing factors for the qualification of e - health literacy (p < 0.05). These results underscore the complex interplay of multiple factors in determining patients' eHealth literacy levels, which has important implications for the design and implementation of effective health information dissemination and patient education strategies in the digital age.

Conclusion: Our findings reveal that the eHealth literacy among cardiovascular disease (CVD) patients remains at a relatively low level. This situation underscores the urgent need for interventions aimed at enhancing patients' proactive health awareness and delivering targeted eHealth training programs. Specifically, such initiatives should be designed to enable patients to accurately access, comprehensively understand, critically evaluate, and effectively apply health information in the digital realm. By doing so, we can empower CVD patients to better manage their health in the context of the digital age, ultimately leading to an improvement in their eHealth literacy levels. These efforts are not only crucial for individual patient care but also have broader implications for optimizing health outcomes at a population level.

Keywords: cardiovascular disease; eHealth literacy; health education; health literacy; influencing factors.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Randomized Controlled Trial
. 2025 Apr;43(1):e14.
doi: 10.17533/udea.iee.v43n1e14.

Nursing Intervention "EducaTHE" to Improve Knowledge and Self-care Behaviors for Hypertensive Disorders in Pregnant Women: a Randomized Controlled Pilot Study

Affiliations
Randomized Controlled Trial

Nursing Intervention "EducaTHE" to Improve Knowledge and Self-care Behaviors for Hypertensive Disorders in Pregnant Women: a Randomized Controlled Pilot Study

Iliana Milena Ulloa Sabogal et al. Invest Educ Enferm. 2025 Apr.

Abstract

Objective: This work sought to determine the feasibility, acceptability, and potential effect of the nursing intervention "Knowledge and self-care behaviors of pregnant women in the face of hypertensive disorders of pregnancy - EducaTHE".

Methods: This study is a pilot randomized controlled trial. Sixty pregnant women who were enrolled in the antenatal care program of a health institution participated. They were selected via simple random sampling and assigned to the experimental group (n = 30) and control group (n = 30). The intervention consisted of four educational sessions once a week, while the control group received usual antenatal care. Recruitment, follow-up, and dropout rates were assessed, as well as participant satisfaction. Both groups completed the "Knowledge and Self-Care Behaviors - CoNOCiTHE" and "Determinants of Behavior" scales before and four weeks after the intervention to assess impact.

Results: The recruitment rate was 75.94%, 90% at follow-up and 10% dropouts. Overall satisfaction was 4.82 out of 5. The effect of the intervention showed a significant increase in the level of knowledge and behaviors in the experimental group compared to the control group (77 vs. 69; p< 0.001) and in the determinants of behavior (159 vs. 154; p=0.066), and a large effect size (d-Cliff = 0.7517). These changes were not significant in the control group (p≥0.05).

Conclusion: This study shows the feasibility and acceptability of the intervention in the maternal population, as well as the potential ef-fect of improving knowledge and self-care behaviors in the face of hypertensive disorders of pregnancy. Therefore, it is rec-ommended to use these types of educational interventions in maternal and perinatal nursing care.

Objetivo.: Determinar la factibilidad, aceptabilidad y efecto potencial de la intervención de enfermería “Conocimientos y comportamientos de autocuidado de la mujer embarazada ante los trastornos hipertensivos del embarazo - EducaTHE”.

Métodos.: Este es un estudio piloto controlado aleatorizado. Participaron sesenta mujeres embarazadas inscritas en el programa de atención prenatal de una institución de salud, seleccionadas por muestreo aleatorio simple y asignadas al grupo experimental (n = 30) y grupo control (n = 30). La intervención consistió en cuatro sesiones educativas una vez por semana, mientras el grupo control recibió la atención prenatal habitual. Se evaluaron las tasas de reclutamiento, seguimiento y deserción, así como la satisfacción de las participantes. Ambos grupos diligenciaron las escalas “Conocimientos y comportamientos de autocuidado - CoNOCiTHE” y “Determinantes del comportamiento” antes y cuatro semanas después de la intervención para evaluar el impacto.

Resultados.: La tasa de reclutamiento fue del 75.94 %, 90 % en el seguimiento y deserción del 10 %. La satisfacción global fue de 4.82 sobre 5. El efecto de la intervención evidenció un aumento significativo en el nivel de conocimientos y comportamientos en el grupo experimental en comparación con el grupo control (69 vs. 77; p<0.001) y en los determinantes del comportamiento (154 vs. 159; p=0.066), y un tamaño de efecto grande (d-Cliff = 0.7517).

Conclusión: . Este estudio evidencia la factibilidad y aceptabilidad de una intervención de enfermería en la población materna, y el efecto potencial de mejorar los conocimientos y comportamientos de autocuidado ante los trastornos hipertensivos del embarazo. Por lo que se recomienda utilizar este tipo de intervenciones educativas en el cuidado de enfermería materno perinatal.

Objetivo.: Determinar a viabilidade, aceitabilidade e potencial efeito da intervenção de enfermagem “Conhecimento e comportamentos de autocuidado de gestantes frente aos transtornos hipertensivos da gravidez - EducaTHE”.

Métodos.: Este é um estudo piloto controlado randomizado. Participaram sessenta gestantes cadastradas no programa de pré-natal de uma instituição de saúde, selecionadas por amostragem aleatória simples e distribuídas em grupo experimental (n=30) e grupo controle (n=30). A intervenção consistiu em quatro sessões educativas uma vez por semana, enquanto o grupo controle recebeu cuidado pré-natal habitual. Foram avaliadas as taxas de recrutamento, acompanhamento e abandono, bem como a satisfação dos participantes. Ambos os grupos diligenciaram as escalas “Conhecimentos e comportamentos de autocuidado - CoNOCiTHE” e “Determinantes do comportamento” antes e 4 semanas após a intervenção para avaliar o impacto.

Resultados.: A taxa de recrutamento foi de 75.94%, 90% em acompanhamento e 10% de abandono. A satisfação geral foi de 4.82 em 5. O efeito da intervenção mostrou um aumento significativo no nível de conhecimento e comportamentos no grupo experimental em comparação com o grupo controle (69 vs. 77; p<0.001) e nos determinantes do comportamento (154 vs. 159; p=0.066) e um grande tamanho de efeito (d-Cliff = 0.7517).

Conclusão.: Este estudo evidencia a viabilidade e aceitabilidade de uma intervenção de enfermagem na população materna, e o potencial efeito da melhoria do conhecimento e dos comportamentos de autocuidado diante dos transtornos hipertensivos da gravidez. Portanto, recomenda-se a utilização desse tipo de intervenção educativa na assistência de enfermagem materna e perinatal.

Keywords: behavior; hypertension, pregnancy-induced; nursing; randomized controlled trial; self-care; theory of planned behavior.

Conflict of interest statement

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

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. 2025 Apr;43(1):e02.
doi: 10.17533/udea.iee.v43n1e02.

Serious game as an educational tool to promote the health of children and adolescents with cancer

Affiliations

Serious game as an educational tool to promote the health of children and adolescents with cancer

Abigail Victória de Sousa Biró et al. Invest Educ Enferm. 2025 Apr.

Abstract

Objective: To develop and evaluate the usability of a serious game as an educational tool for promoting the health of children and adolescents with cancer.

Methods: The Contextualized Instructional Design (CID) methodology was applied to develop the serious game, structured in five stages: analysis, design, development, implementation, and evaluation. Usability assessment included children and adolescents diagnosed with cancer in a public federal referral hospital in a city in Northeastern Brazil, from April to June 2024. A sociodemographic questionnaire and the System Usability Scale with values ranging from 0 to 100 points were used.

Results: The serious game, entitled Oncoped: on the health journey, is an educational and playful board game that contains eight personalized Paper Toys, 35 houses, and 100 cards divided into multiple-choice questions about cancers, diagnosis, treatments, and challenges; and cards containing information and care tips. The usability assessment was carried out by 12 hospitalized children and 3 adolescents, who after using the game filled out the information on the scale, resulting in a mean score of 95.16 points.

Conclusion: The serious game Oncoped: on the health journey is a fun and playful educational tool that provides effective and active learning. The educational technology received an excellent usability assessment among the game's target audience. Thus, it was found that the tool is innovative and has good acceptability for teaching and promoting the health of children and adolescents with cancer.

Objetivo.: Desenvolver e avaliar a usabilidade de um serious game como ferramenta educativa para a promoção da saúde de crianças e adolescentes com câncer.

Métodos.: Para a construção do serious game, foi aplicada a metodologia do Design Instrucional Contextualizado (DIC), estruturada em cinco etapas: análise, design, desenvolvimento, implementação e avaliação. Para a avaliação da usabilidade, incluiu crianças e adolescentes diagnosticados com câncer, em um hospital público federal de referência de uma cidade do Nordeste do Brasil, no período de abril a junho de 2024. Utilizou-se um questionário sociodemográfico e o System Usability Scale com valores de 0 a 100 pontos.

Resultados.: O serious game intitulado Oncoped: na jornada da saúde, é um jogo de tabuleiro educativo e lúdico, que contém oito Paper Toys personalizados, 35 casas e 100 cartas divididas em perguntas de múltiplas escolhas sobre cânceres, diagnóstico, tratamentos e desafios; e cartas contendo informações e dicas de cuidados. A avaliação de usabilidade foi realizada por 12 crianças e 3 adolescentes hospitalizados, que após utilização do jogo preencheram as informações da escala que resultaram no score médio de 95.16 pontos.

Conclusão.: O serious game Oncoped: na jornada da saúde é uma ferramenta de educação lúdica e divertida, que proporciona o aprendizado de forma efetiva e ativa. A tecnologia educativa obteve ótima avaliação de usabilidade entre o público-alvo do jogo. Assim constatou-se a ferramenta é inovadora e possui boa aceitabilidade para o ensino e promoção à saúde de crianças e adolescentes com câncer.

Objetivo.: Desarrollar y evaluar la usabilidad de un juego serio como herramienta educativa para promover la salud de niños y adolescentes con cáncer.

Métodos.: Para construir el serious game se aplicó la metodología de Diseño Instruccional Contextualizado (DIC), estructurada en cinco etapas: análisis, diseño, desarrollo, implementación y evaluación. Para la evaluación de usabilidad se incluyeron niños y adolescentes diagnosticados con cáncer en un hospital público federal de referencia en una ciudad del Nordeste de Brasil, de abril a junio de 2024. Se utilizó un cuestionario sociodemográfico y la Escala de Usabilidad del Sistema con valores de 0 a 100 puntos.

Resultados.: El serious game titulado Oncoped: en el viaje de la salud, es un juego de mesa educativo y lúdico, que contiene ocho Paper Toys personalizados, 35 casas y 100 tarjetas divididas en preguntas de opción múltiple sobre cánceres, diagnóstico, tratamientos y desafíos; y cartas con información y consejos de cuidado. La evaluación de usabilidad fue realizada por 12 niños y 3 adolescentes hospitalizados, quienes luego de utilizar el juego llenaron la información de la escala que arrojó un puntaje promedio de 95.16 puntos.

Conclusión.: El serious game Oncoped: en el viaje de la salud es una herramienta educativa divertida y lúdica que proporciona aprendizaje de una manera efectiva y activa. La tecnología educativa recibió una excelente calificación de usabilidad entre el público objetivo del juego. De esta forma, se encontró que la herramienta es innovadora y tiene buena aceptabilidad para la enseñanza y promoción de la salud de niños y adolescentes con cáncer.

Keywords: adolescent; child; educational technology; games and toys; health promotion; neoplasms.

Conflict of interest statement

The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

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. 2025 May 17;410(1):162.
doi: 10.1007/s00423-025-03736-2.

Association of health literacy and general self-efficacy with emergency department visits for unclear abdominal pain after bariatric surgery

Affiliations

Association of health literacy and general self-efficacy with emergency department visits for unclear abdominal pain after bariatric surgery

Jenny Angerås-Kraftling et al. Langenbecks Arch Surg. .

Abstract

Introduction: Emergency department visits are common following bariatric surgery and may be partially preventable. Health literacy and general self-efficacy are factors that may influence health-seeking behaviors in these patients. This study aimed to assess whether health literacy and general self-efficacy are associated with an increased frequency of emergency department visits after bariatric surgery.

Methods: Patients who underwent bariatric surgery at a single hospital from 2018 to 2020 were evaluated for their health literacy and general self-efficacy levels before surgery. Data on emergency department visits within the patient's residential region were evaluated over a three-year period, with repeated emergency department visits for abdominal pain as the primary outcome.

Results: During the follow-up period, 69 of 231 patients (29.9%) had at least one emergency department visit for abdominal pain, and 20 patients (8.7%) had three or more visits. Inadequate functional health literacy (OR 5.56, 95% CI 1.80-17.19, p = 0.003) and inadequate communicative and critical health literacy (OR 10.48, 95% CI 3.13-35.08, p < 0.001) were both significantly associated with an increased risk of repeated emergency department visits over the three-year period. No significant association was found between low general self-efficacy and the frequency of emergency department visits.

Conclusions: Inadequate health literacy is associated with an increased risk of repeated emergency department visits for abdominal pain following bariatric surgery.

Keywords: Adverse outcome; Bariatric surgery; Emergency room visits; General self efficacy; Health literacy; Obesity.

Conflict of interest statement

Declarations. Preregistration plan: No preregistration exists for the study reported in this article. Twitter summary: Reduced health literacy associated with higher risk for emergency department visits for abdominal pain up to 3 years after bariatric surgery @ErikStenberg_MD. Competing interests: ES is part of the IFSO-EU Scientific committee and Dept. Managing Director for the Scandinavian Obesity Surgery registry and have received reimbursement for lecture from MSD, and consultant fees from Johnson & Johnson Medical (paid to institution) for work unrelated to the content of this study. None of the remaining authors report any conflicts of interest.

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Randomized Controlled Trial
. 2025 May 15:327:1044-1048.
doi: 10.3233/SHTI250542.

Effectiveness of Online Self-Learning Platforms for Promoting Digital Health Literacy: A Randomized Controlled Trial (RCT)

Affiliations
Randomized Controlled Trial

Effectiveness of Online Self-Learning Platforms for Promoting Digital Health Literacy: A Randomized Controlled Trial (RCT)

Annika Hering et al. Stud Health Technol Inform. .

Abstract

Digital health literacy is a basic requirement for the use of digital health solutions. However, it is not yet sufficiently present among users, so that appropriate programmes are needed to promote it. The aim of this study is to investigate the effect of online self-learning platforms on digital health literacy. In a two-armed randomised controlled trial (RCT) with n = 40, participants were assigned to an intervention group (IG) and a control group (CG). The eHealth Literacy Scale (eHEALS) and an adapted version were used to assess digital health literacy. The effect was compared to before and to the control group after using the online self-learning platform. After the intervention digital health literacy improved in the intervention group (p < .001) in both scores and was higher in eHEALS-Score (p = .047) and eService-Score (p = .000) than in the control group. The results indicate that digital services should become increasingly relevant for promoting digital health literacy in the population.

Keywords: Digital health literacy; eHealth literacy; online self-learning platform; randomised controlled trial.

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. 2025 May;21(5):e70257.
doi: 10.1002/alz.70257.

Co-design of medication management guidance tools for people living with dementia and carers at discharge

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Co-design of medication management guidance tools for people living with dementia and carers at discharge

Mouna J Sawan et al. Alzheimers Dement. 2025 May.

Abstract

Introduction: People with dementia and carers face challenges in understanding and managing medications at discharge. This study aimed to develop user-centered, co-designed medication management guidance tools to enhance medication management literacy post-hospitalization for these populations.

Methods: A four-phase, multi-methods study integrating experience-based co-design: (1) literature review, qualitative study, and survey; (2) expert advisory panels involving people with dementia; (3) focus groups with people with dementia, carers, and healthcare professionals; and (4) quantitative readability and suitability analysis.

Results: Two tools were developed: a simplified medication management guide for people with dementia and a carer-focused guide. Topics included shared decision-making, informed consent, and medications that can affect cognition. Participants valued the use of simple and active language, goal-of-care discussions, and the right to second opinion. Tools were acceptable for use from admission and during hospitalization.

Discussion: This study addresses gaps in medication related health literacy tools for dementia care, offering a framework for developing similar resources.

Highlights: Medication management guidance tools have not included people living with dementia or their carers in their development. This study is the first to describe the co-design of medication management guidance tools for people with dementia. Two tools were generated, one for people with dementia and one for carers to extend their agency. This co-design study can serve as a framework to inform the development of future tools for people with dementia and carers.

Keywords: care coordination; dementia care; health literacy; patient communication; shared decision making.

Conflict of interest statement

All authors have no conflicts of interest. Author disclosures are available in the Supporting Information.

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. 2025;96(5):664-672.
doi: 10.62713/aic.3945.

Effects of Interactive Health Education Combined With Evidence-based Pain Management Nursing on Disease Cognition, Postoperative Pain and Post-traumatic Growth in Patients Undergoing Laparoscopic Salpingectomy

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Effects of Interactive Health Education Combined With Evidence-based Pain Management Nursing on Disease Cognition, Postoperative Pain and Post-traumatic Growth in Patients Undergoing Laparoscopic Salpingectomy

Ye Cheng et al. Ann Ital Chir. 2025.

Abstract

Aim: Laparoscopic salpingectomy has been widely used in the clinical treatment of benign tubal lesions. This study aims to explore the effects of interactive health education combined with evidence-based pain management nursing on disease cognition, postoperative pain and post-traumatic growth in patients undergoing laparoscopic salpingectomy, in order to provide new insights into clinical nursing for these patients.

Methods: In this retrospective study, 360 patients who underwent laparoscopic salpingectomy in our hospital from January 2022 to December 2023 were included. Patients receiving routine care were included in the control group (n = 213) and patients receiving interactive health education combined with evidence-based pain care were classified under the study group (n = 147). General data, disease cognition, postoperative pain and post-traumatic growth of the two groups were collected and compared.

Results: The awareness rate regarding pathogenesis, cardinal symptom, surgical and postoperative precautions, prevention of complications, medication management, diet management, sleep management, and review time and project in the study group were all significantly higher than those in the control group (p < 0.05). The numerical rating scale (NRS) scores of the study group were lower than those of the control group at 6 h, 12 h, 24 h and 48 h post-surgery (p < 0.001). Before discharge, all dimensions of the post-traumatic growth inventory (PTGI) scores like relating to others, new possibilities, personal strength, spiritual change, and appreciation of life of the study group patients were significantly higher than those of the control group (p < 0.05). The time to get out of bed, exhaust time, and hospitalization stay of the study group patients were significantly shorter than those of the control group (p < 0.05). The total incidence of complications in the study group was significantly lower than that in the control group (p < 0.05).

Conclusions: Interactive health education combined with evidence-based pain management nursing is conducive to improving disease cognition, reducing postoperative pain, enhancing post-traumatic growth, and promoting postoperative recovery in patients undergoing laparoscopic salpingectomy.

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. 2025 May 15;20(5):e0322181.
doi: 10.1371/journal.pone.0322181. eCollection 2025.

Navigational health literacy and health service use among higher education students in Alentejo, Portugal - A cross-sectional study

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Navigational health literacy and health service use among higher education students in Alentejo, Portugal - A cross-sectional study

Jorge Rosário et al. PLoS One. .

Abstract

Introduction: The navigational health literacy of higher education students is fundamental to effective health management and successful health navigation, thereby improving health outcomes and overall well-being. Assessing the general and navigational health literacy levels of these students is crucial for developing targeted interventions and facilitating informed decision-making on health-related issues. This study aimed to identify the levels of general and navigational health literacy, characterise access to and utilisation of healthcare services, and analyse the differences between the mean general and navigational health literacy indices and determinants among higher education students in the Alentejo region of southern Portugal.

Methodology: A descriptive and cross-sectional study was conducted between 25 May and 12 September 2023 with 1979 higher education students. An online structured questionnaire comprising the Portuguese version of the European Health Literacy Survey Questionnaire - 16 items (HLS-EU-PT-Q16) and the Navigational Health Literacy Scale (HLS19-NAV), both from the European Consortium, was used. Sociodemographic data, presence of chronic disease, perceived health status, perceived availability of money for expenses, and healthcare access and utilisation variables were included. The study data were analysed using independent samples t-test, one-way ANOVA, and post hoc Bonferroni test, followed by multiple linear regression analyses at a significance level of 0.05. Multiple linear regression analysis was performed to identify factors associated with both general and navigational health literacy. The study protocol was approved by the ethics committee of the University of Évora, and all participants provided written informed consent.

Results: Most students (86.8%) exhibited limited general health literacy, while 13.2% demonstrated adequate health literacy. Inadequate navigational health literacy was observed in 73.4% of students. Students with lower mean general and navigational health literacy were more likely to have utilised health services. Students with chronic conditions, recent use of urgent or emergency services, and difficulties in accessing healthcare had lower health literacy. Conversely, those enrolled in health-related courses, those with good financial resources and those who had not used health services during their course had higher health literacy. In addition, lower navigational health literacy was found among displaced students, those with chronic conditions and those who had recently consulted a doctor. Higher navigational health literacy was associated with enrolment in health-related courses and adequate general health literacy.

Conclusion: The findings highlight the significant influence of demographic and academic factors on general and navigational health literacy among higher education students. The prevalence of limited general and navigational health literacy underscores a significant challenge for students, institutions, and health policy makers. Effective health literacy interventions should take these factors into account. Future research should examine longitudinal changes in health literacy and evaluate the impact of targeted educational programmes.

Conflict of interest statement

The authors have declared that no competing interests exist.

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. 2025 May 15:7334648251338875.
doi: 10.1177/07334648251338875. Online ahead of print.

Dementia Care Partner Health Literacy as a Mediator Between Education and Burden at Hospital Discharge

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Dementia Care Partner Health Literacy as a Mediator Between Education and Burden at Hospital Discharge

Ashley Kuzmik et al. J Appl Gerontol. .
Free article

Abstract

Care partners of hospitalized persons with dementia often experience significant burden at discharge. This study examined whether dementia care partner health literacy mediates the relationship between education and burden at hospital discharge. Data from 277 care partners in the Family-centered Function-focused Care (Fam-FFC) trial were analyzed using mediation analysis to assess indirect effects of education on burden (Short-Form Zarit Burden Interview [ZBI-12]) through health literacy (Rapid Estimate of Adult Literacy in Medicine-Short Form [REALM-SF]). Analyses were conducted using SPSS and AMOS. For medium education (B = -0.012; 95% CI = -0.019, -0.003), the indirect effect accounted for 18.5% of the total effect, while for high education (B = -0.018; 95% CI = -0.026, -0.006), it accounted for 21.4%, indicating partial mediation. Findings underscore the role of health literacy in reducing care partner burden and highlight the need to address education and literacy disparities to provide effective support at hospital discharge.

Keywords: care partner burden; education level; health literacy; hospital discharge.

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. 2025 Apr 30:13:1558772.
doi: 10.3389/fpubh.2025.1558772. eCollection 2025.

Adoption challenges to artificial intelligence literacy in public healthcare: an evidence based study in Saudi Arabia

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Adoption challenges to artificial intelligence literacy in public healthcare: an evidence based study in Saudi Arabia

Rakesh Kumar et al. Front Public Health. .

Abstract

In recent years, Artificial Intelligence (AI) is transforming healthcare systems globally and improved the efficiency of its delivery. Countries like Saudi Arabia are facing unique adoption challenges in their public healthcare, these challenges are specific to AI literacy, understanding and effective usage of AI technologies. In addition, cultural, regulatory and operational barriers increase the complication of integrating AI literacy into public healthcare operations. In spite of its critical contribution in enabling sustainable healthcare development, limited studies have addressed these adoption challenges. Our study explores the AI literacy adoption barriers in context to Saudi Arabian public healthcare sector, focusing on its relevance for advancing healthcare operations and achieving Sustainable Development Goals (SDGs). The research aims to identifying and addressing the adoption challenges of Artificial Intelligence literacy within the public healthcare in Saudi Arabia. The research aims to enhance the understanding of AI literacy, its necessity for enhancing healthcare operations, and the specific hurdles that impede its successful AI adoption in Saudi Arabia's public healthcare ecosystem. The research employs a qualitative analysis using the T-O-E framework to explore the adoption challenges of AI literacy. Additionally, the Best-Worse Method (BWM) is applied to evaluate the adoption challenges to AI literacy adoption across various operational levels within Saudi Arabia's public healthcare supply chain. The study uncovers substantial adoption challenges at operational, tactical, and strategic level, including institutional readiness, data privacy, and compliance with regulatory frameworks. These challenges complicate the adoption of AI literacy in the Saudi public healthcare supply chains. The research offers critical insights into the various issues affecting the promotion of AI literacy in Saudi Arabia's public healthcare sector. This evidence-based study provides essential commendations for healthcare professionals and policymakers to effectively address the identified challenges, nurturing an environment beneficial to the integration of AI literacy and advancing the goals of sustainable healthcare development.

Keywords: AI literacy; Saudi Arabia; Sustainable Development Goals; adoption challenges; artificial intelligence; public healthcare.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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. 2025 May 14.
doi: 10.1111/jocn.17807. Online ahead of print.

Self-Efficacy and e-Health Literacy Among Caregivers of Patients With Lung Cancer: The Chain-Mediating Roles of Negative Emotions and Caregiver Readiness

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Self-Efficacy and e-Health Literacy Among Caregivers of Patients With Lung Cancer: The Chain-Mediating Roles of Negative Emotions and Caregiver Readiness

Jiali Wu et al. J Clin Nurs. .

Abstract

Objectives: To explore the chain-mediating roles of negative emotions and caregiver readiness between self-efficacy and e-health literacy among caregivers of patients with lung cancer.

Background: With the rise of Internet health services, caregivers of patients with lung cancer, who are one of the health decision makers, are encountering new challenges. In order to develop appropriate interventions, it is necessary to explore in depth the various influencing factors associated with them.

Design: A cross-sectional survey.

Methods: A total of 293 caregivers of patients with lung cancer were recruited between November 2023 and April 2024 through a convenience sampling method. These participants completed the demographic data questionnaire, General Self-Efficacy Scale (GSES), Hospital Anxiety and Depression Scale (HADS), Caregivers Preparedness Scale (CPS), and eHealth Literacy Scale (eHEALS). Independent samples t-tests and a one-way ANOVA were employed to identify the primary influencing factors. Structural equation modelling was employed to detect the mediating effects of negative emotions and caregiver readiness.

Reporting method: The STROBE checklist was used for this study.

Results: The total e-health literacy score of caregivers of patients with lung cancer was 29.65 ± 7.11, and there was a correlation between self-efficacy, negative emotions, caregiver readiness, and e-health literacy. The results of the path analysis showed that negative emotions and caregiver readiness had chain-mediating roles between self-efficacy and e-health literacy among caregivers of patients with lung cancer, with the total indirect effect accounting for 31.17% of the total effect.

Conclusions: Caregivers of patients with lung cancer exhibit moderate levels of e-health literacy. This research suggests that self-efficacy not only has a direct and positive influence on e-health literacy but may also amplify it by mediating the interplay between negative emotions and caregiver readiness.

Relevance to clinical practice: Healthcare providers should be cognizant of the negative emotions and readiness displayed by family caregivers in the hospital setting to aid them in cultivating strong health literacy for more efficient management of illness care tasks.

Patient or public contribution: Nurses at the hospitals assisted us in collecting data from family caregivers of patients with lung cancer, and the caregivers actively cooperated in completing the questionnaires.

Keywords: caregiver readiness; caregivers; health literacy; mediation effect; negative emotions; self‐efficacy.

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. 2025 May 14.
doi: 10.1111/jocn.17811. Online ahead of print.

Digital Health Literacy in Patients With Hypertension: A Cross-Sectional Study

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Digital Health Literacy in Patients With Hypertension: A Cross-Sectional Study

Melania Totaro et al. J Clin Nurs. .

Abstract

Aim: To assess Digital Health Literacy (DHL) levels among hypertensive patients.

Design: Cross-sectional study.

Methods: The study, conducted from March to August 2024 among hypertensive patients using convenience sampling, employed a 35-item questionnaire assessing: (I) sociodemographic; (II) physical activity, dietary habits, antihypertensive pharmacological treatment and medical history; (III) online health-related information knowledge and confidence; (IV) DHL, through the HLS19-DIGI questionnaire with subscales on: (i) dealing with digital health information (HL-DIGI), (ii) interaction with digital resources (HL-DIGI-INT), (iii) frequency of digital device use for health (HL-DIGI-DD).

Results: Among 311 participants (mean age 63.9 years, SD = 14.8), 42.1% completed high school, 25.4% held a bachelor's degree and 22.8% were physically inactive. While 49.8% were aware of online health-related information, 28.9% were uncertain and 47.6% lacked confidence in using it for health decisions. On average, participants showed a problematic level of DHL in HL-DIGI, a sufficient level in HL-DIGI-INT, and used digital health devices just over once a week. Older age emerged as a predictor of higher online health-related knowledge and DHL, while higher education level predicted higher knowledge, confidence and DHL. Physical inactivity was associated with lower online health-related information knowledge and confidence.

Conclusions: These findings point to the need to design proactive strategies and implement targeted training and educational interventions to improve DHL in hypertensive patients.

Implications for the profession and/or patient care: Enhancing DHL levels through targeted interventions in patient care allows patients to effectively benefit from digital healthcare, achieve positive health outcomes and reduce disparities in care pathways.

Reporting method: This study adhered to the STROBE checklist for reporting.

Patient or public contribution: Patients were involved as the study population.

Protocol registration: Local Ethical Committee of the University Hospital Company of the Marche Region, Italy (protocol: 2023/279, date: 28/09/2023).

Keywords: blood pressure; digital health literacy; digital technology; hypertension; nursing; patient education; telehealth.

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Randomized Controlled Trial
. 2025 May 14:27:e65309.
doi: 10.2196/65309.

Effect of Gamification on Improved Adherence to Inhaled Medications in Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

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Free article
Randomized Controlled Trial

Effect of Gamification on Improved Adherence to Inhaled Medications in Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Xiting Huang et al. J Med Internet Res. .
Free article

Abstract

Background: Inhaled medication is the preferred route of administration for patients with chronic obstructive pulmonary disease (COPD). The compliance rate of inhaled medication in patients with COPD is <50%, which increases the risk of acute exacerbations. Considering the complex steps of inhaled medication, improving inhaled medication compliance not only requires consistent medication frequency and medical advice but also an evaluation of whether the patient has mastered the inhaler technique to achieve the correct dose.

Objective: This study aimed to explore the effectiveness of an inhaled medication education program (Inhaling-Health website) based on the Fogg Behavior Model and gamification design on inhaled medication compliance and other health-related outcomes in patients with COPD.

Methods: In a randomized, 2-arm, concurrent parallel design, we enrolled 102 patients with COPD from respiratory medicine clinics at 2 hospitals in Zhejiang Province, China, between April and May 2023. Participants were randomly assigned to either the control group (51/102, 50%) or the experimental group (51/102, 50%). All participants completed the intervention, with 94 participants completing 6 months of follow-up. Two independent-sample 2-tailed t tests and the Mann-Whitney U test were used to analyze group differences, and generalized estimating equations were used to analyze repeated measurements.

Results: After the intervention, all outcome measures improved compared to baseline. The generalized estimating equation showed that, compared to the control group, the Inhaling-Health website led to a gradual improvement in total adherence-to-inhaler scores starting from 2 months after the intervention (median 51.00, IQR 49.00-52.25 vs median 50.00, IQR 47.00-51.00; Z=-2.014; P=.04). It had a separate positive effect on inhaler technique. In addition, the website was more effective in reducing the modified Medical Research Council score than routine inhaled medication education, starting from 4 months after intervention (median 1.00, IQR 1.00-2.00 vs median 1.00, IQR 0.00-2.00; Z=-2.260; P=.02). The website was also more effective than the conventional intervention in improving Chronic Obstructive Pulmonary Disease Knowledge Questionnaire scores, beginning at the end of the intervention (mean 6.14, SD 1.83 vs mean 7.06, SD 1.82; t1=-2.551; P=.01).

Conclusions: The gamified inhaled medication education program based on the Fogg Behavior Model can improve inhaled medication adherence, inhaler technique accuracy, health literacy, lung function, and health-related quality of life; help reduce the severity of dyspnea and COPD physical symptoms; and reduce the risk of acute exacerbations in patients with COPD. This study can provide a reference for inhaled medication education in patients with COPD.

Trial registration: China Clinical Trials Registry (ChiCTR) ChiCTR2300070213; https://www.chictr.org.cn/showprojEN.html?proj=194829.

Keywords: COPD; Fogg Behavior Model; chronic obstructive pulmonary disease; gamification; inhaled medication; medication adherence; randomized controlled trial.

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. 2025 May 14;317(1):758.
doi: 10.1007/s00403-025-04262-3.

Enhancing oncodermatology support: assessing patient utilization and satisfaction with educational resources for managing dermatologic toxicities of cancer treatment

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Enhancing oncodermatology support: assessing patient utilization and satisfaction with educational resources for managing dermatologic toxicities of cancer treatment

Sabrina Saeed et al. Arch Dermatol Res. .

Abstract

Dermatologic toxicities resulting from cancer treatments are common, debilitating, and can significantly impact a patient's quality of life. In some cases, these toxicities may require dose adjustments or even discontinuation of treatment. Timely management of dermatologic adverse events (DAEs) is crucial to improving patient outcomes, and educational resources are instrumental in empowering patients to recognize and manage these issues. This cross-sectional survey study aims to characterize patient utilization of and satisfaction with educational resources regarding dermatologic toxicities of cancer treatments. Findings indicate that while 77.5% (n = 110) of patients received information on managing dermatologic toxicities, a larger proportion (n = 123; 86.5%) experienced these side effects. Healthcare providers were the primary source of information (n = 102/110; 92.7%), followed by self-searching on the internet (n = 59/110; 53.6%), and social media (n = 43/110; 39.1%). Despite most patients receiving educational content, patients expressed low satisfaction with both the quality and quantity of information provided, with only 31.3% (n = 41) reporting satisfaction with the amount of information and 33.8% (n = 44) reporting satisfaction with its quality, highlighting a significant gap in resource effectiveness. Notably, patients reported the highest satisfaction with information provided by healthcare providers, suggesting that integrating comprehensive dermatologic education into oncologic care could improve patient satisfaction and outcomes.

Keywords: Dermatologic toxicity; Oncodermatology; Oncology; Patient education; Skin toxicity; Social media.

Conflict of interest statement

Declarations. Competing interests: Jonathan Leventhal received honoraria from Sanofi Regeneron and La Roche Posay for advisory boards; clinical trial research funding from OnQuality and Azitra, Inc; and royalties from UpToDate and Elsevier. Patient consent: Not applicable. IRB approval status: Study determined to be IRB exempt. Reprint requests: Jonathan Leventhal, jonathan.leventhal@yale.edu.

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. 2025 Apr 29;17(9):1515.
doi: 10.3390/nu17091515.

Food Literacy as an Instrument for Health Promotion Among Hospital Workers: The "ABCibi Project"

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Food Literacy as an Instrument for Health Promotion Among Hospital Workers: The "ABCibi Project"

Samar El Sherbiny et al. Nutrients. .

Abstract

Background: Health literacy (HL) promotes the achievement of skills and information useful to endorse health. Food Literacy (FL) is a subtype of HL related to the knowledge necessary to achieve a healthy diet. Methods: This pilot study aimed to assess and improve FL of hospital workers through a survey before and after an educational intervention consisting of nutrition courses, infographics, and updates to the canteen service. FL was evaluated with a questionnaire, and Kruskal-Wallis, Friedman and Wilcoxon test was performed to assess group differences. Results: Of 897 participants, 375 (T1) completed both surveys, while 522 completed only T0. A pairwise comparison stratified by role, age and education revealed a significant improvement in FL scores in the T1 group. Improvements were observed in the T1 group, with overall scores rising from 6.2 ± 2.7 to 6.9 ± 2.1 (p-value < 0.001). An upgrade was noted in healthcare workers (T0 = 6.5 ± 2.2 vs. T1 = 7 ± 2, p-value < 0.001), administrative workers (T0 = 5.5 ± 2.5 vs. T1 = 6.2 ± 2.4, p-value = 0.008), all age groups (T0 = 6.3 ± 2.4 vs. T1 = 6.8 ± 2, p-value = 0.03, T0 = 6.2 ± 2.3 vs. T1 = 6.7 ± 2.2, p-value = 0.02, T0 = 6.2 ± 2.3 vs. T1 = 7 ± 2, p-value = 0.003), low and high education (T0 = 5.7 ± 2.3 vs. T1 = 6.6 ± 2.1, p-value < 0.001, T0 = 6.6 ± 2.3 vs. T1 = 7.1 ± 2 p-value = 0.03). Conclusions: Our survey highlights the efficacy of a multifactorial intervention in enhancing FL and proves the importance of food health promotion within workplaces.

Keywords: food literacy; health literacy; health promotion; occupational health; public health.

Conflict of interest statement

The authors declare no conflicts of interest.

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. 2025 Apr 25;17(9):1438.
doi: 10.3390/nu17091438.

Protein Counting as an Educational Strategy to Optimize Low-Protein-Diet Adherence and Satisfaction in Stage 4 and 5 Chronic Kidney Disease Patients: A Pilot Study

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Protein Counting as an Educational Strategy to Optimize Low-Protein-Diet Adherence and Satisfaction in Stage 4 and 5 Chronic Kidney Disease Patients: A Pilot Study

Francesca K Martino et al. Nutrients. .

Abstract

Background/objectives: Educational support is a well-established strategy in diet management for chronic diseases. No study has reported the impact of protein counting in a low-protein diet for chronic kidney disease (CKD). We aimed to assess how a protein-counting educational program could enhance adherence and satisfaction in managing a low-protein diet in CKD patients with an eGFR below 20 mL/min/1.73 m2.

Methods: We conducted a prospective pilot study comparing adherence and satisfaction before and after an educational program, which included four group meetings and two individual meetings over six months. Diet adherence was assessed by estimating protein intake using 24 h urine urea excretion, while diet satisfaction was evaluated with the MDRD questionnaire.

Results: Twenty-four patients with a mean age of 63.9 years experienced improved diet adherence, with a significant reduction in protein intake (from 59.82 ± 15.57 g/day to 47.18 ± 13.7 g/day, p < 0.001) and a significant increase in overall diet satisfaction (from a median of 3.57 (3.1-4) to 4 (3.6-4.1), p = 0.001).

Conclusions: An educational program that includes protein counting assists CKD stage 4-5 patients in improving their diet adherence and increasing overall dietary satisfaction.

Keywords: adherence; chronic kidney disease; low-protein diet; protein counting; satisfaction.

Conflict of interest statement

The authors declare no conflicts of interest.

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. 2025 May 13.
doi: 10.1111/jop.13642. Online ahead of print.

Patient Education and Levels of Disease-Specific Information Needs Among Individuals With Oral Epithelial Dysplasia

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Patient Education and Levels of Disease-Specific Information Needs Among Individuals With Oral Epithelial Dysplasia

Waleed Alamoudi et al. J Oral Pathol Med. .

Abstract

Background: Oral epithelial dysplasia (OED) is a histological diagnosis that carries an increased risk of the individual developing oral squamous cell carcinoma. We assessed the information needs (IN) and explored the sources of education used by individuals with OED using a validated OED-specific measurement.

Methods: A total of 102 adults with OED from the oral medicine clinic of a dental hospital in Central London were selected using convenience sampling. A cross-sectional survey was conducted in which participants completed the 33-item Oral Epithelial Dysplasia Informational Needs Questionnaire (ODIN-Q), which assessed IN and gathered perspectives on patient education.

Results: Approximately two-thirds of the participants (n = 66, 64%) reported meeting the IN, whereas the remaining participants (n = 36, 35%) did not. The mean and median total scores from the questionnaire were 2.43 (± 0.38) and 2.6, respectively, indicating a low sufficient level of IN. Most participants (n = 80, 78%) preferred one-on-one meetings as the primary mode of obtaining information, followed by written materials (n = 64, 62%), audiovisual resources (n = 24, 23%), and group discussions (n = 8, 0.7%).

Conclusions: Some topics were insufficiently met, necessitating additional educational efforts, such as risk factors and lifestyle modifications, physical and psychological impacts, awareness of potential complications, and seeking medical and psychological support. Sex and degree of dysplasia were associated with the levels of IN. These findings may guide future longitudinal research on OED IN assessment, support the creation of tailored educational tools, and facilitate further evaluation of the psychometric properties of the ODIN-Q.

Keywords: information needs; mouth precancer; oral dysplasia; patient education; quantitative study.

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. 2025 May 13:27:e63030.
doi: 10.2196/63030.

Analyzing Usage of the Metaverse by Associations of Patients With Prostate Cancer During the 2023 Blue Ribbon Campaign: Cross-Sectional Survey Study

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Free article

Analyzing Usage of the Metaverse by Associations of Patients With Prostate Cancer During the 2023 Blue Ribbon Campaign: Cross-Sectional Survey Study

Jung Ki Jo et al. J Med Internet Res. .
Free article

Abstract

Background: It is important to explain early diagnosis and treatment plans to patients of prostate cancer due to the different stages that diagnosis is made at and the corresponding stage-specific treatment options, as well as the varying prognoses depending on the choices made. Although various studies have implemented metaverse-based interventions across diverse clinical settings for medical education, there is a lack of publications addressing the implementation and validation of patient education using this technology.

Objective: This study explored the potential of the metaverse as an educational and informational tool for prostate cancer. We measured and analyzed participants' satisfaction and perceptions following a metaverse-based prostate cancer awareness campaign. We also evaluated the feasibility and potential effectiveness of the metaverse as a platform for hosting a virtual patient association and delivering health education.

Methods: The study was conducted via a questionnaire administered from September 15 to October 20, 2023, during the Blue Ribbon Campaign organized by the Korean Urological Association and the Korean Society of Urological Oncology. The postevent questionnaire was designed to assess the effectiveness of using the metaverse to increase awareness of prostate cancer. A total of 119 participants, including patients, caregivers, and members of the general population, completed the survey within the metaverse space and assessed their satisfaction and perceived awareness using a 5-point Likert scale.

Results: The mean educational satisfaction score was 4.17 (SD 0.65), the mean psychological satisfaction score was 4.06 (SD 0.70), the mean overall satisfaction score was 4.12 (SD 0.72), and the mean awareness score was 4.09 (SD 0.72) out of a possible 5 points. Among responses rated 4 or higher ("agree" or "strongly agree"), 82.8% (394/476) were in the educational aspect, 76.6% (365/476) in psychological satisfaction, 81% (289/357) in overall satisfaction, and 80.4% (287/357) in awareness. Statistical analysis revealed significant differences in psychological (median 4.0, IQR 3.50-4.63, vs median 4.50, IQR 4.0-4.56) and overall (median 4.0, IQR 3.67-4.83, vs median 4.33, IQR 4.0-4.67) aspects between the general population group and patients and caregivers (median 4.0, IQR 3.33-4.33, vs median 4.67, IQR 4.0-4.67).

Conclusions: The findings suggest that the metaverse holds promise as a platform for health care education and patient support, offering accessible and engaging experiences for patients, caregivers, and members of the general population. Our approach demonstrated a positive influence on participants' satisfaction and perceived awareness, highlighting its potential to enhance health communication and patient engagement. Despite these encouraging results, limitations, such as the sample being skewed toward younger participants and reliance on self-reported data, underscore the need for more rigorous and multidimensional assessment strategies. Future studies should incorporate objective knowledge assessments, behavioral follow-ups, and qualitative methods to better evaluate the intervention's effectiveness. This study provides early evidence that metaverse-based interventions can support disease awareness and promote preventive health behaviors, contributing to the ongoing evolution of digital health education.

Keywords: Korean; awareness; cancer; cross-sectional study; digital health; effectiveness; healthcare; medical education; metaverse; morbidity; oncology; patient education; patient engagement; patient satisfaction; prostate cancer; prostatic neoplasm; questionnaire; self-help group; survey; technology; urologic malignancy; urology; virtual reality.

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. 2025 May 8:19:1337-1350.
doi: 10.2147/PPA.S513375. eCollection 2025.

Mediating Effects of Health Literacy, Self-Efficacy, and Social Support on the Relationship Between Disease Knowledge and Patient Participation Behavior Among Chronic Ill Patients: A Cross-Sectional Study Based on the Capability-Opportunity-Motivation and Behavior (COM-B) Model

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Mediating Effects of Health Literacy, Self-Efficacy, and Social Support on the Relationship Between Disease Knowledge and Patient Participation Behavior Among Chronic Ill Patients: A Cross-Sectional Study Based on the Capability-Opportunity-Motivation and Behavior (COM-B) Model

Minjuan Wu et al. Patient Prefer Adherence. .

Abstract

Purpose: Patient participation is essential for improving patient safety and quality of care. It mainly refers to patients participating in their own healthcare through various ways, such as searching information on treatment options, engaging in decision-making, and communicating with healthcare professionals. This study aimed to investigate the relationships between disease knowledge, health literacy, self-efficacy, social support, and patient participation behavior in chronic ill patients based on the Capability-Opportunity-Motivation and Behavior (COM-B) model.

Methods: This cross-sectional survey, conducted from October 2023 to January 2024, involved 389 chronic ill patients from five clinical departments (cardiology, endocrinology, respiratory medicine, neurology, and geriatrics) at a tertiary hospital in Hangzhou, Zhejiang Province. Patients completed the health literacy management scale, general self-efficacy scale, core knowledge of chronic diseases questionnaire, social support rating scale, and patient participation scale. We used t-tests / ANOVA, Pearson's correlation coefficient, Fisher's z-test, linear regression, and mediation model to analyze data.

Results: The total effect of disease knowledge on patient participation behavior was significant (β = 0.496, p < 0.001), and the direct effect was also significant (β = 0.144, p < 0.001). Meanwhile, the relationship between disease knowledge and patient participation behavior was mediated by self-efficacy (β = 0.043, p < 0.001), health literacy (β = 0.027, p < 0.001), and social support (β = 0.193, p < 0.001), respectively.

Conclusion: This study proposed a conceptual model that includes the mediating effects of health literacy, self-efficacy, and social support, which helps clarify the underlying mechanisms between disease knowledge and patient participation behavior. Targeted interventions to increase disease knowledge, health literacy, self-efficacy, and social support can help chronic ill patients engage more actively in their own healthcare.

Keywords: chronic diseases; health literacy; patient participation; self-efficacy; social support.

Conflict of interest statement

The authors report no conflicts of interest in this work.

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. 2025 May 12;24(1):509.
doi: 10.1186/s12912-025-03118-5.

Bridging the gap: summative content analysis of understanding barriers in elderly patient education from nurses' perspectives

Affiliations

Bridging the gap: summative content analysis of understanding barriers in elderly patient education from nurses' perspectives

Afshin Khazaei et al. BMC Nurs. .

Abstract

Background: One of the main tasks of nurses in providing health therapeutic services is patient education, an essential component of nursing care. This educative process is necessary for elderly patients with multiple and personalized needs. Hence, this study identified and prioritized the factors that hinder nurses from educating elderly patients admitted to teaching hospitals.

Methods: Data were collected through an electronic survey (Porsline) via summative content analysis. This study was conducted with nurses in teaching hospitals in Hamadan, western Iran, from December 2024 to January 2025. Seven hundred twenty-four nurses were recruited through convenience sampling to answer the following open-ended question: "In your opinion, what are the causes and factors that you when educating elderly patients in the hospital ward?"

Results: The analysis was organized into 12 main categories and 26 subcategories, which were ultimately reduced to six main themes, and their frequencies were calculated. The most frequent category was "staff training," which appeared 1,387 times, whereas the least frequent category was "lack of motivation," with 91 repetitions. Other categories were identified through data analysis on the basis of frequency and significance, including "hospital setting," "memory issues," "attention deficits," language and communication difficulties," sensory impairments," family involvement," peer support," mobility issues," pain and discomfort," anxiety and depression."

Conclusions: This study identified the main barriers preventing nurses from educating elderly patients in Iranian hospitals. Nurses can address these barriers by being more thorough in training, improving human resources, and upgrading relevant capacities and methods, leading to enhanced health literacy, self-care management, and improved quality of care overall for this population group. Organized community in-process support for multimorbidity patients is the key to strengthening self-care management. Implications of all the available evidence The results of this study have implications for practice. These findings may serve as a foundation for developing interventions and policies to address these barriers and enhance care for geriatric patients.

Clinical trial number: Not applicable.

Keywords: Elderly; Nursing; Patient education; Qualitative study.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Hamadan University of Medical Sciences (IR.UMSHA.REC.1403.601) and was conducted in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments [41]. Before participating in the survey, the participants were informed about the study’s objectives and methods, the confidentiality of their data, and their right to withdraw at any time without consequence. Each participant provided written informed consent. All study procedures adhered to the applicable guidelines and regulations. Consent for publication: The participants provided consent for their data to be published. Competing interests: The authors declare no competing interests.

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. 2025;31(1):1-8.
doi: 10.5114/pedm.2025.148400.

Cross-sectional evaluation of people with type 1 diabetes participating in the GoPump Structured Diabetes Education Program during "Insulin Pump Weeks"

Affiliations

Cross-sectional evaluation of people with type 1 diabetes participating in the GoPump Structured Diabetes Education Program during "Insulin Pump Weeks"

Marta Najmanowicz et al. Pediatr Endocrinol Diabetes Metab. 2025.

Abstract

Introduction: Despite advances in therapy, most persons with type 1 diabetes (PwT1Ds) do not achieve treatment goals. Education is fundamental to the care of PwT1Ds treated with continuous subcutaneous insulin infusion (CSII).

Aim of the study: To evaluate PwT1Ds treated with CSII and receiving in-hospital education and to identify factors associated with treatment effectiveness.

Material and methods: This cross-sectional study included adults with type 1 diabetes (T1D), who received diabetes education using the proprietary Structured Diabetes Education Program, GoPump, during "Insulin Pump Weeks" in 2022-2023. Metabolic control of diabetes was evaluated. Reports from personal insulin pumps, blood glucose meters, and continuous glucose monitoring (CGM) systems were assessed.

Results: Data from 107 individuals with a median age of 26.7 years (Q1-Q3: 19.0-30.8) were analysed, including 65 women (60.7%). The median duration of T1D was 13 years (Q1-Q3: 10.0-18.0), and the median duration of personal insulin pump use was 8 years (Q1-Q3: 5.0-12.0). The median body mass index was 23.9 kg/m². CGM was used by 52.3% of individuals. The median time in range (TIR) was 57.0% (Q1-Q3: 45.0-69.5%), and the median glycated haemoglobin (HbA1c) level was 7.9% (Q1-Q3: 6.8-8.5%). A positive correlation was found between age and TIR (rs = 0.42, p = 0.001). The use of temporary basal rate and dual-wave and square bolus features was positively correlated with TIR (rs = 0.34, p = 0.012 and rs = 0.31, p = 0.021, respectively) and inversely with time above range > 250 mg/dl (rs = -0.37, p = 0.007 and rs = -0.27, p = 0.045, respectively). Lower HbA1c levels were observed in individuals with a higher number of daily boluses (rs = -0.33, p = 0.001).

Conclusions: In the study cohort, older age, more frequent use of advanced insulin pump features, and a higher number of daily boluses were associated with better glycaemic control in adults with T1D.

Wstęp: Mimo postępów w leczeniu większość osób z cukrzycą typu 1 (PwT1Ds) nie osiąga celów terapeutycznych. Edukacja stanowi podstawę opieki nad PwT1Ds, leczonymi za pomocą ciągłego podskórnego wlewu insuliny (continuous subcutaneous insulin infusion – CSII).

Cel: Ocena PwT1Ds stosujących CSII, edukowanych w trakcie hospitalizacji, a także identyfikacja czynników powiązanych z efektywnością leczenia.

Materiał i metody: Do badania przekrojowego włączono dorosłe osoby z cukrzycą typu 1 (T1D) edukowane z wykorzystaniem autorskiego programu Strukturalnych Programów Edukacji Diabetologicznej GoPump w trakcie „Tygodni pompowych” w latach 2022–2023. Oceniano wyrównanie metaboliczne cukrzycy. Analizie poddano raporty z osobistych pomp insulinowych, glukometrów i systemów ciągłego monitorowania glikemii (continuous glucose monitoring – CGM).

Wyniki: Analizowano dane 107 pacjentów z medianą wieku 26,7 roku (Q1–Q3: 19,0–30,8), w tym 65 kobiet (60,7%). Mediana czasu trwania T1D wynosiła 13 lat (Q1–Q3: 10,0–18,0), a mediana czasu stosowania osobistych pomp insulinowych wynosiła 8 lat (Q1–Q3: 5,0–12,0). Mediana wskaźnika masy ciała wynosiła 23,9 kg/m2. CGM stosowano u 52,3% osób. Mediana czasu w zakresie docelowym (time in range [TIR]) wynosiła 57,0% (Q1–Q3: 45,0–69,5%), a mediana wartości hemoglobiny glikowanej (HbA1c) wynosiła 7,9% (Q1–Q3: 6,8–8,5%). Stwierdzono dodatnią korelację między wiekiem a TIR (rs = 0,42, p = 0,001). Korzystanie z funkcji bazy tymczasowej oraz bolusa złożonego i przedłużonego istotnie korelowało pozytywnie z TIR (odpowiednio rs = 0,34, p = 0,012 i rs = 0,31, p = 0,021) oraz negatywnie z czasem powyżej zakresu docelowego >250 mg/dl (odpowiednio rs = –0,37, p = 0,007 i rs = –0,27, p = 0,045). Wartości HbA1c były mniejsze u osób z większą liczbą bolusów na dzień (rs = –0,33, p = 0,001).

Wnioski: W badanej grupie starszy wiek, częstsze korzystanie z zaawansowanych funkcji pompy insulinowej oraz większa liczba bolusów wiążą się z lepszą kontrolą glikemii u dorosłych osób z T1D.

Keywords: continuous glucose monitoring; continuous subcutaneous insulin infusion; type 1 diabetes mellitus.; diabetes education.

Conflict of interest statement

non declared

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. 2025 May 9:S0363-5023(25)00163-7.
doi: 10.1016/j.jhsa.2025.03.022. Online ahead of print.

Evaluating the Association Between Health Literacy and Patient-Reported Outcome Measures After Distal Radius Fracture

Collaborators, Affiliations

Evaluating the Association Between Health Literacy and Patient-Reported Outcome Measures After Distal Radius Fracture

Katherine R Miclau et al. J Hand Surg Am. .

Abstract

Purpose: Patient-reported outcome measures (PROMs) are used to assess patients' outcomes during the treatment of distal radius fractures (DRFs). Limited health literacy is linked to poorer health outcomes. We asked whether limited health literacy is associated with PROM scores in patients with a DRF.

Methods: This cross-sectional study enrolled adults ≥18 years of age with an isolated DRF from two urban hospitals within 6 weeks of injury or surgery. Participants completed a demographics survey, brief health literacy screen, and three PROMs: Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity v2.0 Short Form-7a (PROMIS-UE); and Numeric Rating Scale (NRS). Associations between social determinants of health (SDOH) factors (health literacy, income, education, and preferred language) and PROMs were assessed using multivariable linear regressions. Propensity score analyses to control for confounding and postmatching regressions were conducted.

Results: Sixty-five patients participated in this study. In this sample, the mean age was 54 years, 65% were women, 26% had limited health literacy, 46% had public insurance, 18% completed at most a high school education, and 23% preferred a language other than English (PLOE). In multivariable analyses, limited health literacy and PLOE were associated with worse PROMIS-UE, and low income was associated with worse QuickDASH and NRS; associations between health literacy and QuickDASH and NRS were not statistically significant. Propensity score analyses indicated that all SDOH variables had confounding effects on associations between health literacy and PROMs. The postmatching regression analysis demonstrated that PLOE was associated with worse PROMIS-UE, and low income and PLOE with worse QuickDASH and NRS scores; limited health literacy was not significantly associated with any PROMs.

Conclusions: Low income and PLOE were significant predictors of worse PROM scores. After adjusting for other SDOH variables, limited health literacy was not significantly associated with PROM scores. These findings underscore the importance of recognizing and addressing the multiple interconnected SDOH aspects associated with PROM scores.

Type of study/level of evidence: Prognosis IV.

Keywords: Distal radius fracture; health literacy; income; language; patient-reported outcomes.

Conflict of interest statement

Conflicts of Interest No benefits in any form have been received or will be received related directly to this article.

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. 2025 May 9;26(1):232.
doi: 10.1186/s12882-025-04153-9.

Clinical and financial impacts of nursing education programs on recurrent urinary tract infections after kidney transplant: a cohort study

Affiliations

Clinical and financial impacts of nursing education programs on recurrent urinary tract infections after kidney transplant: a cohort study

Hany M El Hennawy et al. BMC Nephrol. .

Abstract

Background: Urinary tract infections (UTIs) are the most prevalent infections among kidney transplant recipients, with recurrent cases imposing a significant financial burden due to increased hospitalizations and treatment costs.

Objective: This study aims to investigate the incidence of recurrent UTIs and evaluate the financial impact of a comprehensive nursing education initiative.

Methods: A retrospective cohort study was conducted with kidney transplant patients, divided into two groups: a control group prior to the intervention and a study group following the implementation of the education program. The intervention consisted of weekly training sessions focusing on infection prevention, catheter care, and hygiene. Patient outcomes were monitored for one year post-transplant, with a focus on UTI rates, patient adherence, knowledge, and healthcare costs.

Results: The nursing education program resulted in a 26% reduction in UTI incidence and decreased average hospital stays from 8 days to 4 days. Healthcare costs per admission fell from $10,000 to $6,000, leading to total savings of $700,000 based on 175 admissions. The program resulted in a net saving of $650,000. Additionally, significant improvements were observed in patient knowledge, satisfaction, and compliance.

Conclusions: Nursing education on UTI prevention for kidney transplant patients effectively enhances clinical outcomes and reduces healthcare costs. These findings underscore the importance of integrating structured education programs into transplant care protocols to achieve sustainable health and economic benefits.

Clinical trial number: Not Applicable.

Keywords: Kidney transplant; Nursing; Patient education; Recurrent utis.

Conflict of interest statement

Declarations. Ethical approval and consent to participate: The local ethical committee approved the study (Armed Forces Hospitals Southern Region: AFHSRMREC/SURGERY, SECTION OF TRANSPLANTATION/746), and all participants gave informed consent to participate. This study was conducted according to the principles of the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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. 2025 May 9:14:e71849.
doi: 10.2196/71849.

Telenursing Health Education and Lifestyle Modification Among Patients With Diabetes in Bangladesh: Protocol for a Pilot Study With a Quasi-experimental Pre- and Postintervention Design

Affiliations
Free article

Telenursing Health Education and Lifestyle Modification Among Patients With Diabetes in Bangladesh: Protocol for a Pilot Study With a Quasi-experimental Pre- and Postintervention Design

Michiko Moriyama et al. JMIR Res Protoc. .
Free article

Abstract

Background: The global burden of chronic diseases is increasing and becoming a public health issue throughout the world. The use of telenursing is increasing significantly during and after the COVID-19 pandemic to treat and prevent chronic diseases. Telenursing is growing in many countries to reduce health care costs, increase the number of aging and chronically ill populations, and increase health care coverage to distant, rural, small, or sporadically populated regions. Among its many benefits, telenursing may help to solve increasing shortages of nurses, reduce distances, save travel time, and keep patients out of the hospital.

Objective: The objective of this study is to apply the self-management telenursing program and telenursing system developed by the researchers to Bangladesh and to evaluate its feasibility and efficacy (improved diabetes control in participants).

Methods: This is a pilot, quasi-experimental pre- and post-intervention study. Diabetes patients who will attend the Grameen Primary Health Centers (PHCs) in Bangladesh will be enrolled between September 2024 and August 2025. We include patients who have been diagnosed with type 2 diabetes, both sexes, ages 18-75 years old, all types of treatment, willing to participate and give us consent. We exclude patients who have been diagnosed with gestational diabetes, diabetes as a secondary cause, complication of chronic kidney disease (CKD) stage 5, Hemoglobin A1c (HbA1c) is less than 7% for the past 1 year with CKD stage 1 or 2, no complications or complications with good control, having enough knowledge (had education before) and implemented good practice regarding diabetes management assessed by the research nurses, and disabled persons who need other person's support for daily living. The sample size was calculated and found 70. Written informed consent will be obtained from all the participants. The study protocol got approval from the National Research Ethics Committee of the Bangladesh Medical Research Council (BMRC/NREC/2022-2025/336) on September 08, 2024. The outcome of this study is to evaluate the effects of telenursing intervention by controlling HbA1c.

Results: The project was funded in 2024. The enrollment of the participants started on October 26, 2024, and the required sample (n=70) enrollment was completed in February 2025. Data analysis will be started after completion of data collection and results will be expected to be submitted for publication in 2026.

Conclusions: Diabetic patients will acquire disease-specific management skills. Setting and monitoring goals ensures the continuation of the desired behavior and gives the patients control over their lifestyle. After developing self-management skills, patients assess their lab data and lifestyles including diet, and understand their condition so that they can work with their physiological data by acquiring knowledge of both the disease and self-care. By making self-supported decisions, the patients will be able to manage their diet, exercise, and medication.

Trial registration: ClinicalTrials.gov NCT06632652; https://clinicaltrials.gov/study/NCT06632652.

International registered report identifier (irrid): DERR1-10.2196/71849.

Keywords: Bangladesh; diabetic patients; health education; lifestyle modification; telenursing.

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Randomized Controlled Trial
. 2025 May 8;15(1):15982.
doi: 10.1038/s41598-025-01152-6.

Effects of health education based on self-determination theory on hemodialysis knowledge and self-management in maintenance hemodialysis patients

Affiliations
Randomized Controlled Trial

Effects of health education based on self-determination theory on hemodialysis knowledge and self-management in maintenance hemodialysis patients

Jiquan Zhang et al. Sci Rep. .

Abstract

The purpose of this study was to examine the impact of health education based on self-determination theory on hemodialysis knowledge, self-management, interdialytic weight gain and anxiety and depression in maintenance hemodialysis patients. The study is a quasi-randomized control trial, a total of 86 maintenance hemodialysis patients who met the inclusion criteria were included equally in the intervention and control groups. The control group received routine care, and the intervention group received health education based on self-determination theory. Three months after the intervention, the intervention effects were evaluated using the Hemodialysis Related Knowledge Scale, Self-Management Behavior Scale, Interdialytic Weight Gain, and Hospital Anxiety and Depression Scale. Three months after the intervention, the hemodialysis knowledge scores of the intervention group was higher than that of the control group and baseline; the scores of the intervention group in problem solving, partnership, emotional processing, executive self-care dimensions and the total self-management scores were higher than that of the control group and baseline; the interdialytic weight gain of the intervention group was lower than that of the control group and baseline; the anxiety and depression scores of the intervention group were lower than that of the control group and baseline. All these differences were statistically significant (P < 0.05). Health education based on self-determination theory can improve the hemodialysis knowledge level and self-management ability of maintenance hemodialysis patients, and reduce the interdialytic weight gain and anxiety and depression level.

Keywords: Maintenance hemodialysis; Quasi-randomized control trial; Self-determination theory; Self-management.

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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Randomized Controlled Trial
. 2025 May 8:27:e58024.
doi: 10.2196/58024.

Efficacy of a Self-Guided Internet Intervention With Optional On-Demand Feedback Versus Digital Psychoeducation on Sleep Hygiene for University Students With Insomnia: Randomized Controlled Trial

Affiliations
Free article
Randomized Controlled Trial

Efficacy of a Self-Guided Internet Intervention With Optional On-Demand Feedback Versus Digital Psychoeducation on Sleep Hygiene for University Students With Insomnia: Randomized Controlled Trial

Anna-Carlotta Zarski et al. J Med Internet Res. .
Free article

Abstract

Background: Internet-based cognitive behavioral therapy for insomnia (iCBT-I) provides flexibility but requires significant time and includes potentially challenging components such as sleep restriction therapy. This raises questions about its incremental effectiveness compared to less demanding minimal interventions such as sleep hygiene psychoeducation.

Objective: This study aimed to assess the incremental efficacy of self-guided iCBT-I with optional on-demand feedback for university students with insomnia compared to a single session of digital psychoeducation on sleep hygiene.

Methods: In a randomized controlled trial, 90 students with insomnia (Insomnia Severity Index ≥10) were randomly allocated to self-help-based iCBT-I (45/90, 50%) or one session of digital sleep hygiene psychoeducation with stimulus control instructions (active control group [aCG]: 45/90, 50%). The self-help-based iCBT-I consisted of 6 sessions on psychoeducation, sleep restriction, and stimulus control, including written feedback on demand from an eCoach. Assessments occurred at baseline (T1), 8 weeks after treatment (T2), and at a 6-month follow-up (T3) via web-based self-assessment and diagnostic telephone interviews. The primary outcome was insomnia severity at T2. Analyses of covariance were conducted in an intention-to-treat sample. Secondary outcomes included diagnoses of insomnia and major depression, sleep quality, sleep efficiency, worrying, recovery experiences, recovery activities, presenteeism, procrastination, cognitive irritation, and recuperation in sleep.

Results: There was no difference in insomnia severity at T2 between the iCBT-I group (mean 11.27, SD 5.21) and aCG group (mean 12.36, SD 4.16; F1,989.03=1.12; P=.29; d=-0.26; 95% CI 0.68 to 0.17). A significant difference emerged at T3 (iCBT-I: mean 9.43, SD 5.36; aCG: mean 12.44, SD 5.39; F1,426.15=4.72; P=.03), favoring iCBT-I with a medium effect (d=-0.57; 95% CI 1.07 to -0.06). Most secondary outcomes revealed no significant differences between the groups. In total, 51% (23/45) of participants in the iCBT-I group completed all 6 sessions, and 69% (31/45) completed the 4 core sessions.

Conclusions: In the short term, students might benefit from low-intensity, easily accessible digital sleep hygiene psychoeducation or iCBT-I. However, it appears that iCBT-I offers superiority over sleep hygiene psychoeducation in the long term.

Trial registration: German Clinical Trials Register DRKS00017737; https://drks.de/search/de/trial/DRKS00017737.

Keywords: CBT-I; active control group; cognitive behavioral therapy for insomnia; insomnia; internet intervention; randomized controlled trial; university students.

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Multicenter Study
. 2025 May 8;25(1):657.
doi: 10.1186/s12913-025-12695-9.

The relationship between diabetes distress and eHealth literacy among patients under 60 years of age with diabetes: a multicenter cross-sectional survey

Affiliations
Multicenter Study

The relationship between diabetes distress and eHealth literacy among patients under 60 years of age with diabetes: a multicenter cross-sectional survey

Haoyang Chen et al. BMC Health Serv Res. .

Abstract

Background: Given the increasing prevalence of digital health management, eHealth literacy plays a crucial role in the self-management of diabetes. eHealth literacy refers to an individual's ability to use electronic devices and online resources to manage health issues. In diabetes self-care, the way patients effectively access and apply health information directly impacts disease management outcomes. However, limited research has examined eHealth literacy among diabetes patients, and there is insufficient evidence to show its specific impact on diabetes distress. Therefore, this study aims to assess the eHealth literacy of diabetes patients and explore its relationship with diabetes distress.

Methods: This cross-sectional study was conducted from November 2022 to July 2023 and involved 260 diabetes patients from three tertiary hospitals in Nantong, China. The participants were selected using convenience sampling, and all participants were adults aged 60 years or younger who were capable of communicating in Chinese. Individuals with severe mental illness, hearing or visual impairments, or physical conditions that hindered their participation were excluded. The eHealth Literacy Scale (eHEALS) was used to assess the participants' eHealth literacy. Additionally, data were collected on social support, anxiety, depression, and diabetes distress (DDS). Structural equation modeling (SEM) was used to analyze the data and explore the pathways through which eHealth literacy influences diabetes distress.

Results: eHealth literacy was significantly negatively correlated with anxiety, depression, and diabetes distress (r = - 0.408, p < 0.01; r = - 0.294, p < 0.01; and r = - 0.398, p < 0.01, respectively). Additionally, eHealth literacy was significantly positively correlated with social support (r = 0.346, p < 0.01). The results of the mediation analysis revealed that social support and psychological factors (anxiety and depression) played mediating roles in the relationship between eHealth literacy and diabetes distress.

Conclusions: This study shows that eHealth literacy significantly influences the perception of distress among patients with diabetes, with social support and psychological status playing important mediating roles. Enhancing eHealth literacy, especially patients' ability to access and apply health information, may help reduce diabetes distress. Future research should explore more representative samples and long-term study designs to validate these findings and evaluate the effectiveness of various interventions.

Keywords: Anxiety; Depression; Diabetes; Distress; Social support; eHealth.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study involved research on human participants and was conducted in accordance with the Declaration of Helsinki and with the approval of the Ethics Committee of the Nantong Second People’s Hospital (Ethics Approval Number: 2022-039). The authors confirm that all research methods were carried out in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants and/or their legal guardians. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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. 2025 May 8:9:e69611.
doi: 10.2196/69611.

Boosting Digital Health Engagement Among Older Adults in Hong Kong: Pilot Pre-Post Study of the Generations Connect Project

Affiliations

Boosting Digital Health Engagement Among Older Adults in Hong Kong: Pilot Pre-Post Study of the Generations Connect Project

Aaron Wan Jia He et al. JMIR Form Res. .

Abstract

Background: Older adults' utilization of digital health care remains low despite a high demand for regular health services. Easily accessible eHealth interventions designed for older adults are needed.

Objective: This study aimed to examine the feasibility and effectiveness of an intergenerational, home-based eHealth literacy intervention package on older adults in Hong Kong.

Methods: In this study, 101 older adults (n=64, 63.4% female) with a median age of 80 (IQR 77-85) years received an intergenerational, home-based eHealth literacy intervention package, delivered by trained university student interventionists. The intervention (median 60, IQR 40.8-70 minutes) included personalized guidance on using mobile health apps, QR code scanners and instant messaging, and access to online health information, along with recommendations for physical and mental well-being. Following the intervention, a daily health-coaching message was sent to older adults via WhatsApp for 14 days. eHealth literacy, health, and lifestyle were assessed at baseline and at a 2-week follow-up using paired t tests.

Results: Retention rate for the 2-week follow-up was 70.3% (71/101). Compared to baseline, eHealth literacy scores increased by 2.39 points (P=.11; Cohen d=0.20), and daily smartphone use rose by 0.45 hours (P=.07; Cohen d=0.05). Participants self-reported increased physical activity (50/71, 70%), more frequent viewing of health videos (43/70, 61%), and improved handwashing practices (39/71, 55%). The intervention achieved a high satisfaction rating of 4.32 out of 5.

Conclusions: The intergenerational, home-based eHealth literacy intervention package was feasible and acceptable, showing promise for increasing older adults' engagement with digital health care resources and promoting healthy behaviors. Future studies should explore longer-term effects and ways to further improve the intervention.

Keywords: eHealth literacy; health promotion; home-based intervention; intergenerational learning; older adults.

Conflict of interest statement

None declared.

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. 2025 May 8;22(5):e1004577.
doi: 10.1371/journal.pmed.1004577. eCollection 2025 May.

Change in willingness for surgery and risk of joint replacement after an education and exercise program for hip/knee osteoarthritis: A longitudinal cohort study of 55,059 people

Affiliations

Change in willingness for surgery and risk of joint replacement after an education and exercise program for hip/knee osteoarthritis: A longitudinal cohort study of 55,059 people

Belinda J Lawford et al. PLoS Med. .

Abstract

Background: Numerous studies report that education and exercise interventions can shift people's willingness to undergo joint replacement surgery for osteoarthritis. We aimed to investigate whether becoming unwilling to undergo surgery following an education and exercise intervention for hip and knee osteoarthritis is associated with lower probability of receiving actual surgery.

Methods and findings: This was a register-based cohort study including people from the Swedish Osteoarthritis Register who underwent a 3-month education and exercise intervention for knee or hip osteoarthritis. Participants self-reported their willingness to have joint replacement surgery ('yes' or 'no') and were grouped based on their response pre- and post-intervention (always willing for surgery; became unwilling for surgery; never willing for surgery; became willing for surgery). Data on joint replacement surgery was obtained through the Swedish Arthroplasty Register. The probability and hazard of surgery occurring, as well as the mean time without surgery was calculated up to 5-years (primary outcome) and 9-years (secondary outcome) post-intervention. We adjusted for age, sex, body mass index (BMI), education, joint pain, quality of life, walking difficulties, number of prior visits with an orthopedic surgeon, prior joint surgeries in the knee or hip (other than joint replacement), and comorbidities. 55,059 people were included, 69% were female (N = 37,739), with a mean age 66years (standard deviation [SD] = 9.3), and a BMI of 27.5 (SD = 4.9). In total, 70% (N = 38,386) were never willing for surgery, 14% (N = 7,736) were always willing for surgery, 10% (N = 5,649) became unwilling for surgery, and 6% (N = 3,288) became willing for surgery. Compared to those who were always willing for surgery, participants who became unwilling had a 20% (95% confidence interval [CI]: 18, 22%) lower probability of having surgery by 5-years post-intervention. This corresponded to delaying surgery by 1.1 (95% CI: 1.0, 1.1) years. Compared to those who were always willing for surgery, the hazard of surgery occurring at 1-year post-intervention was lower in those who became unwilling (hazard ratio (HR) 0.5 [95% CI: 0.4, 0.5]), though was then higher at 5-years (HR 1.4 [95% CI: 1.2, 1.7]). Estimates remained stable from 5 to 9 years. Limitations of our study include the inability to account for all potential confounders, and to infer the contribution of the intervention to change in willingness for surgery due to the absence of a control group. Data were collected in Sweden, generalisability to other countries may be limited.

Conclusions: Becoming unwilling for joint replacement surgery following an education and exercise program for hip and knee osteoarthritis could reduce the number of joint replacement surgeries by 20% at 5 years post-intervention, with the possibility of maintaining most of this reduction up to 9 years post-intervention. Interventions that can shift willingness to undergo surgery may thus result in relevant delays and reductions in future joint replacements.

Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: ME is a consultant for Grunenthal Sweden AB and Key2Compliance.

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. 2025 May 6:63:567-573.
doi: 10.1016/j.gerinurse.2025.04.004. Online ahead of print.

Relationship between stigma and negative emotions among patients with Parkinson's disease: The mediating role of health literacy and family function

Affiliations

Relationship between stigma and negative emotions among patients with Parkinson's disease: The mediating role of health literacy and family function

Aoxue Zhu et al. Geriatr Nurs. .

Abstract

Background: Parkinson's disease is a neurodegenerative disorder causing physical and psychological challenges. Stigma exacerbates negative emotions, resulting in anxiety and depression, as well as undermining self-perception and social participation. Health literacy aids in disease management, and family function plays a crucial supportive role. However, the interplay between these variables remains underexplored.

Objective: To examine the chain mediating effects of health literacy and family function between stigma and negative emotions in patients with Parkinson's disease.

Methods: This study adopted a cross-sectional design, recruiting eligible patients from a tertiary hospital in Guangzhou, China. A total of 245 participants completed questionnaires on stigma, health literacy, family function and negative emotions. Statistical analyses were performed using Spearman's correlation and mediation effect analysis.

Results: Negative emotions were positively correlated with stigma (β = 0.584) and inversely associated with health literacy (β = -0.258) and family function (β = -0.144). Mediation effect analysis showed that the mediating effects of health literacy, family function, and their combined effects on the relationship between stigma and negative emotions were 0.033, 0.020, and 0.008, respectively, accounting for 8.89%, 5.39%, and 2.16% of the total effect.

Conclusions: Stigma in patients with Parkinson's disease not only directly affects negative emotions but also indirectly influences them through health literacy and family function.

Keywords: Family function; Health literacy; Mediation analysis; Negative emotions; Parkinson’s disease; Stigma.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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. 2025 May 6:kqaf014.
doi: 10.1093/occmed/kqaf014. Online ahead of print.

Occupational health literacy and affecting factors on healthcare workers

Affiliations

Occupational health literacy and affecting factors on healthcare workers

E Karasu et al. Occup Med (Lond). .

Abstract

Background: In the realm of occupational accidents, the healthcare sector holds a significant position as it is classified as a highly hazardous workplace, thus bearing a heightened probability of accidents. Consequently, it becomes imperative to assess the occupational Health Literacy (OHL) of healthcare workers and identify the influencing factors.

Aims: The aim is to determine the OHL levels of healthcare workers and examine their relationship with demographic, socio-cultural characteristics, and variables related to the work environment.

Methods: This cross-sectional survey was conducted among 200 healthcare workers employed in healthcare services, administrative services, and support services at an education and research hospital in Niğde, Turkey, from November-December 2023. Data collection involved the utilization of a personal information form encompassing participants' socio-demographic characteristics and occupational health practices, along with the OHL Scale. Descriptive statistics, intergroup difference analyses, and multiple regression analysis were employed for data analysis.

Results: The participants demonstrated an average OHL score of 94.07 ± 11.33. They scored highest in Understanding occupational health and safety (OHS) Information (40.93) and lowest in Evaluating OHS Information (9.57). OHL among healthcare workers varied based on demographics, socio-cultural factors, and work-related variables. Age, education, tenure, vaccination, regular health screenings, workplace accidents and personal protective equipment (PPE) usage positively impacted OHL.

Conclusions: Findings revealed participants possess a certain level of OHL. Age, education, tenure, vaccination, regular health screenings, workplace accidents and PPE usage accounted for 53% of OHL variance. Enhancing workplace safety measures and improving healthcare workers' OHL are recommended.

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. 2025 Apr 17;15(4):135.
doi: 10.3390/nursrep15040135.

Nursing Complexity and Health Literacy as Determinants of Patient Outcomes: A Prospective One-Year Multicenter Cohort Study

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Nursing Complexity and Health Literacy as Determinants of Patient Outcomes: A Prospective One-Year Multicenter Cohort Study

Antonello Cocchieri et al. Nurs Rep. .

Abstract

Background/Objectives: Although nursing complexity and health literacy (HL) are critical determinants of patient outcomes, their combined impact on mortality, hospital re-admissions, and emergency department (ED) visits remains poorly understood. This study aims to measure nursing complexity and HL in hospitalized patients, examine their interaction, and analyze their impacts on mortality, hospital re-admissions, and ED visits over a one-year follow-up period. Methods: Adult patients from two hospital centers were enrolled, excluding those with stays under two days or cognitive impairments. Data were collected at baseline to assess nursing complexity (measured according to the number of nursing diagnoses assigned to patients within 24 h from hospital admission) and HL (assessed using the Single-Item Literacy Screener, SILS). Patients were followed during a 12-month follow-up period to track mortality, hospital re-admissions, and ED visits. Latent class analysis classified patients into distinct nursing complexity and HL profiles. Survival analyses and Cox proportional hazard models were used to evaluate the relationships between variables. Results: At baseline, among the 2667 enrolled patients, 55.9% were classified as having high nursing complexity, and 32% had inadequate HL. High nursing complexity was associated with lower HL (r = 0.384; p < 0.001). During follow-up, 387 patients (14.5%) were lost. Of the remaining sample, mortality occurred in 8.3% of the patients, hospital re-admissions in 27.2%, and ED visits in 16.8%. Nursing complexity was significantly associated with higher mortality (HR: 1.84, adjusted HR: 1.81), but not with hospital re-admissions or ED visits. The patients with inadequate HL (32%) had increased risks of mortality (HR: 11.21, adjusted HR: 7.75), hospital re-admissions (HR: 3.61, adjusted HR: 3.58), and ED visits (HR: 20.78, adjusted HR: 14.45). The patients with both high nursing complexity and inadequate HL had the highest mortality risk and the lowest 12-month survival rate (75%; 95% CI: 71.1-79.1%; p < 0.001). Conclusions: This study demonstrates that both high nursing complexity and inadequate HL independently and jointly contribute to adverse patient outcomes. Interventions targeting HL and supporting patients with high nursing complexity could reduce risks, enhance care, and improve patient survival. While these findings underscore the critical role of both factors in patient outcomes, the limitations include this study's single-country setting and reliance on a single-item HL measure. Future research should validate these findings in broader healthcare contexts and integrate multidimensional HL assessments for a more comprehensive evaluation.

Keywords: emergency room visits; health literacy; nursing complexity; nursing diagnosis; patient outcome assessment; patient re-admission; survival.

Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of this study; in the collection, analyses, or interpretation of data; in the writing of this manuscript; or in the decision to publish the results.

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. 2025 May 2;71(3):e20240935.
doi: 10.1590/1806-9282.20240935. eCollection 2025.

Approach to external cephalic version through social media: experience from a tertiary center in Brazil

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Approach to external cephalic version through social media: experience from a tertiary center in Brazil

Suellyn de Pinho Alves et al. Rev Assoc Med Bras (1992). .

Abstract

Objective: The aim of this study was to develop a communication and health education page on external cephalic version through the social media Instagram and, second, to assess the degree of patients' prior understanding of the external cephalic version procedure.

Methods: We conducted a prospective cohort study on 133 singleton pregnancies (until 41 weeks of gestation), for which an online questionnaire (Google Forms) was applied on the social media Instagram, with four sections. The questionnaire was applied between January 2022 and December 2023. Before the intervention (reading the content displayed on Instagram), sections 1, 2, and 3 were applied, and after reading, section 4. Pregnant women of any gestational age who received prenatal care at our service were included. Patients<14 years of age and those who could not read were excluded.

Results: A statistically significant difference was found after reading the content made available on Instagram, with a positive evolution after reading (p<0.001). Of this sample, 100% felt that knowledge about the external cephalic version should reach the major population of pregnant women, 131 (98.50%) opined that they would talk to other pregnant women about it, and 113 (84.96%) said that they would perform the procedure if they had indications for it.

Conclusion: This study provided a comprehensive overview of pregnant women's knowledge about external cephalic version. Through the results obtained, it is possible to observe the evolution of pregnant women's knowledge about external cephalic version after reading the content available on Instagram. In addition, the pregnant women expressed a strong desire to share information about the external cephalic version with other pregnant women.

Conflict of interest statement

Conflicts of interest: the authors declare there is no conflicts of interest.

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. 2025 May 2:33:e4494.
doi: 10.1590/1518-8345.7395.4494. eCollection 2025.

Sociodemographic and clinical characteristics associated with health literacy in people hospitalized for chronic diseases

[Article in English, Portuguese, Spanish]
Affiliations

Sociodemographic and clinical characteristics associated with health literacy in people hospitalized for chronic diseases

[Article in English, Portuguese, Spanish]
Francini de Oliveira Rodrigues et al. Rev Lat Am Enfermagem. .

Abstract

to identify the association between health literacy and sociodemographic and clinical variables of hospitalized patients in people hospitalized with chronic diseases.

this was a cross-sectional study of patients with chronic illnesses admitted to a general hospital. A sociodemographic/clinical questionnaire and the Health Literacy Questionnaire comprising nine scales measured by scores, were used, with descriptive and inferential data analysis.

Social Support for Health was associated with the level of primary education (p=0.009). Understanding and Support from Health Professionals were related to the length of chronic illness (p=0.044). Evaluation of Health Information was associated with age (p=0.001), being able to read (p=0.010) and write (p=0.032). Navigating the Health System was also associated with age (p=0.018), as was the Ability to Find Good Health Information (p=0.002) and being able to read (p=0.010), and Understanding Health Information Well Enough to Know What to Do was associated with age (p=0.001) and being able to write (p=0.010).

schooling, age group, length of time with a chronic illness, and being able to read and write interfere with health literacy. This highlights the need for personalized strategies that take these variables into account in order to improve health literacy in hospitalized populations.

identificar a associação do letramento em saúde com as variáveis sociodemográficas e clínicas de pacientes hospitalizados com doenças crônicas.

estudo transversal, realizado com pacientes com doenças crônicas, internadas em um hospital geral. Utilizaram-se um questionário sociodemográfico/clínico e o Health Literacy Questionnaire, composto por nove escalas, mensuradas por escores, com a análise dos dados descritiva e inferencial.

o Suporte Social Para a Saúde foi associado ao nível de escolaridade fundamental (p=0,009). Compreensão e Apoio dos Profissionais de Saúde foram relacionados ao tempo de doença crônica (p=0,044). A Avaliação das Informações de Saúde mostrou-se associada à faixa etária (p=0,001), saber ler (p=0,010) e escrever (p=0,032). Navegar no Sistema de Saúde também esteve relacionado à faixa etária (p=0,018), assim como a Capacidade de Encontrar Boas Informações de Saúde (p=0,002), e saber ler (p=0,010), e Compreender as Informações de Saúde bem o Suficiente para Saber o que Fazer esteve associada à faixa etária (p=0,001) e saber escrever (p=0,010).

escolaridade, faixa etária, tempo de doença crônica, saber ler e escrever, interferem no letramento em saúde. Isso destaca a necessidade de estratégias personalizadas que levem em consideração essas variáveis para melhorar o letramento em saúde em populações com doenças crônicas hospitalizadas.

Destaques:: (1) Primeiro estudo brasileiro que avaliou o letramento em saúde de pessoas com DCNT. (2) Potencialidades: capacidade de interação, navegar no sistema e suporte social. (3) Fragilidades: avaliação das informações de saúde e capacidade de encontrá-las. (4) Idade, escolaridade, saber ler e escrever interferem no letramento em saúde.

identificar la asociación entre alfabetización en salud y las variables sociodemográficas y clínicas de pacientes hospitalizados con enfermedades crónicas.

estudio transversal, realizado con pacientes con enfermedades crónicas ingresadas en un hospital general. Se utilizó un cuestionario sociodemográfico/clínico y el Health Literacy Questionnaire, compuesto por nueve escalas, medidas por puntajes. Análisis descriptivo e inferencial de los datos.

el apoyo social a la salud se asoció con el nivel de educación primaria (p=0,009). La comprensión y el apoyo de los profesionales de la salud se relacionaron con la duración de la enfermedad crónica (p=0,044). La evaluación de la información de salud se asoció con la franja etaria (p=0,001), saber leer (p=0,010) y escribir (p=0,032). Navegar por el sistema de salud también estuvo relacionado con la franja etaria (p=0,018), al igual que la capacidad para encontrar buena información de salud (p=0,002), saber leer (p=0,010) y comprender la información de salud lo suficientemente bien como para saber qué hacer se asoció con la franja etaria (p=0,001) y saber escribir (p=0,010).

la educación, la franja etaria, la duración de la enfermedad crónica y el saber leer y escribir interfieren en la alfabetización en salud. Esto destaca que es necesario desarrollar estrategias personalizadas que consideren esas variables para mejorar la alfabetización en salud de la población hospitalizada.

Destacados:: (1) Primer estudio brasileño que evaluó la alfabetización en salud de personas con ECNT. (2) Potencialidades: Capacidad para interactuar, navegar en el sistema y apoyo social. (3) Debilidades: Evaluación de la información de salud y capacidad para encontrarla.(4) La edad, la educación y el saber leer y escribir interfieren en la alfabetización en salud.

Conflict of interest statement

Conflict of interest: the authors have declared that there is no conflict of interest.

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. 2025 May 6;15(1):15818.
doi: 10.1038/s41598-025-00745-5.

The effects of sexuality education program on sexual quality of life among patients following coronary artery bypass graft

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The effects of sexuality education program on sexual quality of life among patients following coronary artery bypass graft

Arthit Oeychanai et al. Sci Rep. .

Abstract

Patients who undergo coronary artery bypass grafting surgery rarely receive information or have discussions regarding sexual quality of life with their healthcare providers. This quasi-experimental study aimed to assess the effectiveness of sexuality education programs on sexual quality of life following coronary artery bypass grafting surgery in Thailand. The experimental group, consisting of 30 participants, received sexual education, while a control group of 30 participants received routine care. The primary outcome measured was sexual quality of life, evaluated both before and after the intervention. An independent samples t-test was utilized to compare outcomes between the two groups, and a paired t-test was employed to assess changes within the intervention group. The results demonstrated a statistically significant difference in sexual quality of life between the groups (t = 3.47, p = 0.001). Moreover, the sexual quality of life score increased significantly in the intervention group (t = 4.52, p < 0.001), while no significant changes were observed in the control group (t = 0.41, p = 0.688). These findings underscore the positive impact of sexuality education programs on improving sexual quality of life following coronary artery bypass grafting. It is essential for healthcare providers to incorporate health education for patients prior to hospital discharge and to monitor sexual quality of life during follow-up visits.

Keywords: Coronary artery bypass; Health education; Quality of life; Sexual behavior.

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval: The study protocol was in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all patients before data collection, and this study received approval to certify full compliance by the Siriraj Institutional Review Board (COA No. Si 153/2021).

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. 2025 Mar-Apr;21(2):163-169.
doi: 10.5055/jom.0918.

Examining the effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at preventing opioid-induced constipation

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Examining the effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) at preventing opioid-induced constipation

Taylor Hammack et al. J Opioid Manag. 2025 Mar-Apr.

Abstract

Objective: The prevention of opioid-induced constipation (OIC) in patients treated for chronic pain is important for an improved quality of life and prevention of complications. This study aims to determine whether the implementation of the Primary Care Pain Education and Opioid Monitoring Program (PC-POP) improved the management of OIC in patients receiving opioids for chronic noncancer pain. Design/measure: Pharmacy records regarding the presence of an appropriate laxative prescription, prescription fills, and laxative types were obtained. The primary outcome was the proportion of patients with an appropriate laxative prescription on file for the management of OIC.

Setting: This study was conducted in the Salt Lake City Veterans Affairs (VA) Medical Center's primary care setting.

Subjects: Patients aged 18 and older being treated with opioids for chronic noncancer pain >3 months who were enrolled in PC-POP and had attended at least two classes were compared to patients receiving standard primary care at a VA Medical Center.

Results: Of the 698 patients included, 39.2 percent of patients enrolled in PC-POP had a laxative prescription on file compared to 20.9 percent for patients receiving standard primary care from a VA provider. Presence of appropriate laxative prescription was significantly higher for the PC-POP group (p = <0.001).

Conclusion: PC-POP enrollment was associated with a significantly higher number of appropriate laxative prescription for the management of OIC. This study indicates that there is potential for improvement in prescribing practices to ensure patients receive appropriate laxatives to mitigate the impact of OIC. It also indicates that implementation of a similar program at other VA Medical Centers could improve OIC management in veterans receiving opioids for chronic noncancer pain.

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. 2025 Jun;23(2):e70107.
doi: 10.1002/msc.70107.

Consensus-Building on Patient Education for Chronic Non-Specific Low Back Pain: A Qualitative Study on Patient Physiotherapist Perspectives

Affiliations

Consensus-Building on Patient Education for Chronic Non-Specific Low Back Pain: A Qualitative Study on Patient Physiotherapist Perspectives

Mayuresh Jamkar et al. Musculoskeletal Care. 2025 Jun.

Abstract

Background: The scientific literature provides limited insights into patient education. A successful patient-therapist relationship requires active patient participation in back care and conditioning programs, which enhances exercise adherence. As an integral component of rehabilitation, patient education should be incorporated within a patient-centric, therapist-driven approach.

Objective: This study explores the perspectives of patients and physiotherapists on patient education in the management of chronic non-specific low back pain in Indian settings.

Methods: Semi-structured interviews were conducted with thirty-three outpatients referred to physiotherapy and online forms were obtained from twenty clinical physiotherapists. The questions investigated the expectations of the patient and the education provided by the physiotherapist. Data saturation was obtained based upon the ceiling effect achieved during data synthesis which was tailed with thematic analysis to identify categories and themes.

Results: Themes including "barriers to adherence," "perceived benefits of intervention," "emotional responses to treatment," "clinical challenges in implementation," "recommended modifications to intervention," and "patient-physiotherapist communication dynamics emerged and patients with low back pain considered high expectations from their physiotherapist in terms of education, whereas physiotherapists were providing explanation of condition and prognosis lacking in education. This study emphasised the perspectives of patients to those of physiotherapists. Physiotherapists are advantageously positioned to address the expectations of patients and provide a patient-centric education.

Conclusion: For a better outcome on exercise adherence, patient education as an integral part of a rehabilitation programme should be designed considering the expectations of patients, encouraging education of causes, providing materials for retention of exercises and improving the patient-doctor relationship in terms of better prognosis.

Keywords: exercise adherence; patient centredness; patient education; patient preferences.

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. 2025 May 5:27:e70822.
doi: 10.2196/70822.

Physical, Mental, and Health Empowerment Disparities Across Chronic Obstructive Pulmonary Disease, Asthma, and Combined Groups and the Moderating Role of eHealth Literacy: Cross-Sectional Study

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Physical, Mental, and Health Empowerment Disparities Across Chronic Obstructive Pulmonary Disease, Asthma, and Combined Groups and the Moderating Role of eHealth Literacy: Cross-Sectional Study

Jiaying Li et al. J Med Internet Res. .

Abstract

Background: Nonpharmacological management plays a key role in enhancing the quality of life for individuals with chronic obstructive pulmonary disease (COPD), asthma, or both. However, disparities in their physical, mental, and health empowerment outcomes have not been fully explored, particularly in relation to the moderating effect of eHealth literacy.

Objective: This study aims to assess these disparities and examine how eHealth literacy moderates them to guide the development of tailored nonpharmacological strategies.

Methods: We analyzed data from 2 waves of the nationally representative "Psychology and Behavior Investigation of Chinese Residents" surveys to identify participants who self-reported asthma, COPD, or both. We assessed 5 physical outcomes (quality of life, physical activity, sleep quality, appetite, nicotine dependence), 4 mental outcomes (anxiety, depression, perceived stress, resilience), and 3 health empowerment measures (social support, self-efficacy, eHealth literacy). Multiple regression with Holm-Bonferroni corrections revealed health disparities and the moderation effect of eHealth literacy.

Results: This unfunded study enrolled 1044 participants between June 2022 and August 2023, with data analysis completed within 7 months following data collection. The sample included 254 (24.3%) participants with asthma, 696 (66.7%) participants with COPD, and 95 (9.1%) participants with both conditions. The mean age of the participants was 48.61 (SD 19.70) years, and 536 (51.3%) participants were male. Linear regression showed that individuals with both COPD and asthma had lower health-related quality of life and higher anxiety and depression compared with those with either condition alone (b ranges from -0.15 to 3.35). This group also showed higher nicotine dependence than asthma-only (b=0.88) and lower resilience than COPD-only groups (b=-0.76) (all adjusted P<.05). eHealth literacy significantly moderated the effect of the disease group on all outcomes except physical activity (all adjusted P for interaction <.05). Nine disease pairs showed disparities in both eHealth literacy groups, 4 only in high literacy, and 8 only in low literacy (all P<.05).

Conclusions: Individuals with both COPD and asthma had poorer quality of life, greater anxiety and depression, higher nicotine dependence, and lower resilience, underscoring the need for integrated psychosocial and behavioral interventions. Although higher eHealth literacy was associated with improved quality of life, sleep quality, and resilience, it also widened disparities in anxiety and depression. Therefore, while enhancing eHealth literacy may help reduce overall health inequities among patients with chronic respiratory diseases, its potential adverse effects on mental well-being warrant careful attention. Moreover, lower eHealth literacy was linked to more pronounced disparities, indicating that outreach efforts and digital resources should be specifically designed to reach and empower vulnerable populations. Overall, our findings advocate for condition-specific, eHealth-enhanced care pathways that not only foster digital literacy but also integrate comprehensive mental health services, thereby mitigating health disparities among individuals with chronic respiratory diseases.

Keywords: asthma; chronic obstructive pulmonary disease; chronic respiratory diseases; eHealth literacy; health outcome.

Conflict of interest statement

Conflicts of Interest: None declared.

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. 2025 May 5;20(5):e0323102.
doi: 10.1371/journal.pone.0323102. eCollection 2025.

To develop online platform and determine its effectiveness in ENHANCING DIABetes knowledge among diabetes patients in primary CARE clinic (Enhancing-Diab-Care Study): Study protocol

Affiliations

To develop online platform and determine its effectiveness in ENHANCING DIABetes knowledge among diabetes patients in primary CARE clinic (Enhancing-Diab-Care Study): Study protocol

Hui Zhu Thew et al. PLoS One. .

Abstract

Diabetes Mellitus (DM)- Type 2 is increasingly prevalent in today's population. DM remains poorly controlled due to insufficient knowledge and understanding of this disease. Maintaining good diabetic self-care requires knowledge and empowerment. The COVID-19 pandemic had caused a shift of some public attention from non-communicable to communicable diseases, leading to patients becoming ignorant of their diabetic status. Therefore, we aim to develop an online education video platform that enables patients to enhance their knowledge about Diabetes Mellitus Type 2. In this blocked randomised control trial, a minimum number of 232 participants with type 2 diabetes mellitus will be needed. Patients will consent and voluntarily participate during their follow-up at public primary health care clinic (Klinik Keshihatan Cheras Baru). Patients undergoing diabetic follow-up will be divided into two groups where only patients within the intervention group will receive diabetic care video. Patients' clinical profiles such as date of birth, gender, education status, Diabetes Knowledge Test (DKT) and Diabetic Empowerment Scale (DES-28) were collected to assess diabetes self-care knowledge and empowerment using self-administered questionnaires. Patients will be reminded to complete the educational video at the 3-month and 6-month follow-ups, and the aforementioned parameters will be reassessed. The data will be assessed using an independent t-test for the difference between intervention and control groups. A Paired t-test will assess the difference between the patient pre and post-intervention after 6 months. A generalised Estimating Equation will be used to investigate the effectiveness of diabetes knowledge and clinical outcome, adjusted with covariates. P < 0.05 will be considered statistically significant. Ethical principles outlined in the Declaration of Helsinki and Malaysian Good Clinical Practice Guideline will be followed. Ethical approval will be obtained from MREC and NMRR before starting any study-related activities.

Conflict of interest statement

The authors have declared that no competing interests exist.

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. 2025 Jun:250:109322.
doi: 10.1016/j.thromres.2025.109322. Epub 2025 Apr 28.

EKITE phase 2: A valuable readily available resource for patient education on thrombosis and warfarin anticoagulation therapy

Affiliations

EKITE phase 2: A valuable readily available resource for patient education on thrombosis and warfarin anticoagulation therapy

Mary Bauman et al. Thromb Res. 2025 Jun.

Abstract

Long-term anticoagulation (LTA) is a chronic therapy. Like many chronic therapies, the foundation of effective LTA management lies in developing and maintaining patient knowledge about the treatment. Children and their families often struggle to understand and stay motivated to ensure safe and effective therapy, which includes routine monitoring. This study aims to evaluate the effectiveness of the electronic KidClot interactive Thrombophilia Education (eKITE) Warfarin web-based training modules in reinforcing and enhancing anticoagulation knowledge for children on long-term warfarin and their families as part of routine clinical follow-up by KidClot/Stollery Children's Hospital.

Methods: This prospective study utilized the eKITE Warfarin series (thrombosis, safety of anticoagulation, lab INR, and home INR testing) as an annual requirement for patients on warfarin as part of their ongoing clinical care. This approach aimed to refresh and build knowledge about warfarin and educate those transitioning to warfarin self-management. Patients conducted INR testing at home using a coagulometer or visited the laboratory for venipuncture INR testing. Children and their families accessed online warfarin education from home. Participants completed eKITE modules, quizzes, and surveys to assess and reinforce their warfarin knowledge. The validated Patient Preference Survey assessed patient preferences for learning styles. The State Anxiety Score was used to evaluate patient stress and anxiety related to learning warfarin management, while the KidClot PAC QL assessed warfarin's impact on quality of life. INRs were collected, and time in therapeutic range was calculated.

Results: A total of 136 children on warfarin participated; twenty-nine (21 %) underwent laboratory INR testing, while 107 (79 %) performed INR tests at home using the CoaguChek XS INR meter. The primary indication for long-term warfarin therapy was an underlying cardiac disorder with varied INR target ranges. Yearly mean follow-up knowledge scores were 84(IQR 70-100) and 90(IQR 80-100) at 6 and 18 months post-enrollment, respectively. The time in therapeutic range was 70.1(IQR 63-76) and 70.5 (IQR 57-74 for self-testing and self-management at 18 months post-enrollment. Stress-related to learning decreased, and health-related quality of life (HrQOL) improved over the study period.

Conclusion: eKITE is a practical, cost-effective, readily available, diverse online education series that teaches and provides always-available resources to children and families about thrombosis and anticoagulation, supporting knowledge and improving HrQOL.

Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mary Bauman reports financial support was provided by F Hoffmann-La Roche Ltd. Mary Bauman reports financial support was provided by Roche Diagnostics. Mary Bauman reports a relationship with F Hoffmann-La Roche Ltd. that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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. 2025 Apr 10:76:102892.
doi: 10.1016/j.ejon.2025.102892. Online ahead of print.

The mediating role of psychological well-being in the relationship between mindfulness and patient education implementation among oncology nurses: A cross-sectional study

Affiliations

The mediating role of psychological well-being in the relationship between mindfulness and patient education implementation among oncology nurses: A cross-sectional study

Bugse Yüceer et al. Eur J Oncol Nurs. .

Abstract

Purpose: This research investigates the relationships between mindfulness, psychological well-being, patient education implementation among oncology nurses. Additionally, it examines the determinants influencing patient education implementation and investigated the mediating function of psychological well-being in the association between mindfulness and patient education implementation.

Methods: A cross-sectional study was conducted with oncology nurses between 2023 and 2024 at an oncology hospital. The study utilized validated instruments, including the Nurse Information Form, Mindful Attention Awareness Scale, Psychological Well-Being Scale, Patient Education Implementation Scale. The data were analysed using descriptive and correlational statistics and structural equation modelling. Independent variables were mindfulness and psychological well-being; the dependent variable was patient education implementation in this hypothesized model.

Results: A total of 218 nurses participated in the study. Patient education implementation scores varied significantly by professional roles and were higher among charge nurses (F = 4.076, p = .008). The structural equation modeling analysis demonstrated that mindfulness exerted a significant direct influence on patient education implementation (β = 0.180, p < .001), while also having an indirect effect (β = 0.117, p < .001) mediated by psychological well-being. These results indicate that psychological well-being serves as a partial mediator in the mindfulness and patient education implementation relationship.

Conclusion: This study highlights that higher mindfulness are associated with improved patient education implementation, both directly and indirectly through enhanced psychological well-being. Nursing managers should recognize the impact of mindfulness and psychological well-being on nurses' ability to provide high-quality patient education and consider strategies to enhance these attributes.

Keywords: Cancer; Mediation effect; Mindfulness; Oncology nurses; Patient education; Psychological well-being.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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. 2025 May 2;25(1):524.
doi: 10.1186/s12884-025-07654-5.

Determinants of well-being in pregnancy: the impact of sociodemographic and obstetric variables and maternal health literacy, cross sectional study

Affiliations

Determinants of well-being in pregnancy: the impact of sociodemographic and obstetric variables and maternal health literacy, cross sectional study

Pınar Kara. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal well-being is paramount in elevating maternal, fetal, and societal health. This study aimed to examine the impact of pregnant women's sociodemographic and obstetric variables, as well as maternal health literacy, on well-being during pregnancy.

Methods: A cross-sectional study was conducted between April and October 2024 at a public hospital in a southeastern province of Türkiye. The study was completed with the participation of 456 pregnant women who met the inclusion criteria. Data were collected utilizing the "WHO-5 Well-Being Index", the "Maternal Information Form," and the "Maternal Health Literacy Inventory in Pregnancy (MHELIP)". The statistical significance level was defined as p<0.05 for all analyses.

Results: The study identified maternal health literacy as the most significant predictor of well-being during pregnancy (β=0.320). Additionally, perceiving income as insufficient (B=-1.872), residing in urban centers (B=-1.708), and the presence of pregnancy-related risks (B=-2.145) were found to contribute substantially to diminished well-being during pregnancy (p<0.05).

Conclusion: This study found that maternal health literacy along with various maternal socio-demographic and obstetric variables are important determinants of well-being in pregnancy. These findings may provide essential insights to better comprehend the necessities for improving well-being during pregnancy, guiding policymakers and healthcare providers in developing targeted solutions. This understanding could also inform the adaptation of existing health and community services to create a health literacy-sensitive environment more likely to address the diverse health needs of pregnant women and mothers.

Keywords: Maternal health literacy; Obstetric determinants; Pregnancy; Pregnant women; Social determinants; Well-being.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The principles of the Declaration of Helsinki were adhered to throughout the study process. The study commenced after obtaining ethical committee approval from Kahramanmaraş İstiklal University (number: 2024/04-04, date: February 23, 2024) and permission from the Provincial Health Directorate for the institution where the study was to be conducted. Pregnant women were informed of their right to withdraw from the study at any time. Verbal and written informed consent was obtained from each participant. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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. 2025 May 2;25(1):525.
doi: 10.1186/s12884-025-07651-8.

The effect of prenatal education on exclusive breastfeeding among women in Quito: prospective cohort study

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The effect of prenatal education on exclusive breastfeeding among women in Quito: prospective cohort study

Betzabé Tello et al. BMC Pregnancy Childbirth. .

Abstract

Background: Breast milk is the optimal food for humans, however, many mothers face challenges in sustaining exclusive breastfeeding (EBF). Prenatal education (PE) has been suggested as a strategy to promote EBF, but there is evidence that its impact on EBF duration remains inconclusive. This study aimed to evaluate the effect of PE on EBF continuation among mothers who gave birth in private and public hospitals in Quito, Ecuador, and to identify modifiable risk factors associated with EBF discontinuation.

Methods: A prospective cohort study was conducted, recruiting 278 mothers, of whom 152 received PE and 126 did not. Participants were followed from birth to six months postpartum. Data collection included a structured survey, with baseline clinical information obtained through face-to-face interviews before hospital discharge and follow-up telephone interviews at one, four, and six months postpartum.

Results: Comparisons between the PE and non-PE groups revealed significant differences in education level, health insurance, antenatal care visits, rooming-in rates, parity, and maternal breastfeeding (BF) intentions. Participants who received PE had a significantly longer mean EBF duration (89.4 ± 77.2 days vs. 66.1 ± 70.2 days, p = 0.004). The incidence rate of EBF abandonment was 11.81 per 100 person-months in the PE group and 14.91 per 100 person-months in the non-PE group. Cox survival analysis indicated a lower risk of EBF cessation among mothers who received PE (adjusted hazard ratio [aHR] = 0.58, 95% CI = 0.40-0.84, p = 0.004). Other factors associated with EBF discontinuation included delivery at a public health facility, postpartum depression, insufficient milk supply, return to work, healthcare provider recommendations, family advice, and negative BF experiences.

Conclusion: Standardized PE programs have a significant and independent positive impact on EBF duration among mothers in Quito, Ecuador. Integrating PE into routine prenatal care and providing comprehensive postpartum support is essential to promoting BF continuation. Targeted interventions should address modifiable risk factors, such as postpartum mental health, return-to-work policies, and healthcare provider recommendations regarding BF.

Keywords: Exclusive breastfeeding; Maternal health; Postpartum depression; Prenatal education; Public health practice.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The research protocol was approved by the Institutional Research Ethics Committee (CIEI-Human) of the Universidad Peruana Cayetano Heredia (Certificate 093-05-17 dated February 17, 2017) and by the Ethics Committee for Research in Human Subjects of the Pontifical Catholic University of Ecuador (Letter CEISH-736-2019 dated April 30, 2019). Informed consent was obtained from all participants before enrollment under the Declaration of Helsinki. Measures were taken to ensure participant confidentiality and privacy throughout the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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. 2025 May 2:1-12.
doi: 10.1080/00365521.2025.2497952. Online ahead of print.

Mapping conditional health literacy and digital health literacy in patients with inflammatory bowel disease to optimise availability of digital health information: a cross-sectional study

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Free article

Mapping conditional health literacy and digital health literacy in patients with inflammatory bowel disease to optimise availability of digital health information: a cross-sectional study

Sigurd Maurud et al. Scand J Gastroenterol. .
Free article

Abstract

Background and aims: Health literacy and digital health literacy are crucial for spreading information that enhances self-management and health outcomes. IBD patients have called for relevant and reliable information to enable self-management. However, mapping conditional capacities for adapting IBD health information remains unaddressed. This study examines IBD patients' health literacy and digital health literacy covariance with clinical, demographic and patient-reported outcomes.

Methods: This cross-sectional study recruited patients between April 2023 to February 2024 from a Norwegian university hospital. Canonical correlations identified maximum covariance between health literacy and digital health literacy dimensions against clinical, demographic and patient-reported characteristics. Hierarchical clustering of covariance patterns were compared on external variables using bivariate analyses and logistic regression.

Results: Of 432 consents, 380 (87.96%) IBD patients ≥ 18 years were included. Mean age was 43.6 (14.9) years, 173 (45.5%) had UC, 207 (54.5%) had CD, and 108 (53%) were male. Self-efficacy, illness perception, health status and age correlated with several health literacy and digital health literacy dimensions. Of two identified patient clusters, cluster 1 embodied patients with lowest levels of health literacy, digital health literacy, self-efficacy, health status, illness perception and longest disease duration. Cluster 1 demonstrated significantly lower medication adherence and QoL, higher rates of unemployment, elevated disease activity and fewer receiving biological treatment. Disease activity and biological treatment were the strongest predictors of cluster membership.

Conclusions: The findings emphasize the necessity of addressing clinical characteristics alongside health literacy and digital health literacy in the dissemination of IBD health information.

Keywords: Health literacy; crohn’s disease; digital health literacy; inflammatory bowel disease; ulcerative colitis.

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. 2025 Apr 30:15:26335565251333877.
doi: 10.1177/26335565251333877. eCollection 2025 Jan-Dec.

Outpatients' perceptions of collaboration across clinics and health literacy among patients with diabetes and at least one comorbidity: A hospital-level cross-sectional study

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Outpatients' perceptions of collaboration across clinics and health literacy among patients with diabetes and at least one comorbidity: A hospital-level cross-sectional study

Ida-Marie Dons Graversen et al. J Multimorb Comorb. .

Abstract

Background: Patients with multiple chronic conditions often face fragmented care and inconsistent information, increasing their risk of serious health issues. Their perceived collaboration across clinics may be shaped by difficulties in accessing and using information for informed decision-making. This study explored the association between patient-perceived collaboration across clinics and health literacy among outpatients with diabetes and at least one comorbidity at the hospital level. Methods: This cross-sectional study at the outpatient clinic at Steno Diabetes Center Aarhus included all patients with diabetes and at least one comorbidity who were simultaneously receiving treatment at another outpatient clinic within the hospital. The association between patient-perceived extensive collaboration across clinics (exposure) and patient health literacy (outcome) was assessed using four selected scales and regression models. Results were presented as both unadjusted and adjusted, accounting for potential confounders. Results: A total of 3,435 outpatients received a survey, with 1,655 responses. Of these, 686 reported receiving cross-clinic treatment. Among the 552 respondents who answered the exposure-related question, 44.7% perceived extensive collaboration across clinics, while 55.3% perceived limited collaboration. Statistically significant differences were found in three out of four health literacy scales, with those who perceived limited collaboration scoring lower in areas related to managing their health and engaging with healthcare providers. Conclusion: The findings suggest that outpatients with comorbidities and perceived poor clinic collaboration may have low health literacy, highlighting the need to address this in their treatment and communication with healthcare providers. Future research is needed to determine whether limited perception arises from personal challenges, elements of the treatment process, or relational and organizational issues across clinics, in order to improve the perception of collaboration and clinical outcomes.

Keywords: collaboration; diabetes; health literacy; multimorbidity; patient-reported outcomes.

Conflict of interest statement

The author(s) declare no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

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Observational Study
. 2025 May 1;14(1):26.
doi: 10.1186/s13584-025-00686-4.

Enhancing medication literacy through a telepharmacy call center in Israel: consultation overview and patient satisfaction

Affiliations
Observational Study

Enhancing medication literacy through a telepharmacy call center in Israel: consultation overview and patient satisfaction

Ran Nissan et al. Isr J Health Policy Res. .

Abstract

Background: Telepharmacy, the use of telecommunications technology to facilitate pharmacy services, has emerged as an integral component of telehealth, particularly during the COVID-19 pandemic. In Israel, the shortage of pharmacists nationwide has led to longer wait times and reduced consultation opportunities at community pharmacies. In response, the Pharmaceutical Society of Israel (PSI) established a telepharmacy call center to provide free pharmaceutical consultations to the public. This study aimed to describe the framework of this center, the types of pharmaceutical consultations and patient satisfaction with the service.

Methods: This cross-sectional observational study analyzed unidentified data from 1,542 ambulatory patient inquiries to the PSI telepharmacy call center between October 2022 and June 2023. The consultations were categorized into clinical, logistical, and patient rights-related inquiries. A satisfaction survey was conducted among a representative sample of callers.

Results: The majority of inquiries (93.3%) were received via telephone, with the 65-85 age group accounting for 38.4% of callers. A small proportion of inquiries were submitted via email, either exclusively or in combination with a telephone communication. Clinical inquiries comprised 89% of the total, with the most common topics being drug interactions (26.7%), general drug usage guidance (17.8%), and inquiries about drug side effects (16.4%). The patient satisfaction survey revealed that 87% of respondents strongly agreed that the pharmacists demonstrated empathy and attentiveness, and 93.5% were satisfied with the responses provided. The overall service rating was 8.9 out of 10, and 94.1% of respondents were willing to recommend the call center to others.

Conclusion: This study highlights the value and feasibility of operating a national telepharmacy call center in Israel, addressing the diverse pharmaceutical needs of the public, particularly the elderly population. The high satisfaction levels among callers underscore the potential for such initiatives to enhance access to comprehensive pharmaceutical consultation and improve medication management.

Keywords: Healthcare access; Patient satisfaction; Pharmaceutical counseling; Telehealth; Telepharmacy.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Since no identifying information was available to the researchers, there was no need in receiving any type of informed consent. In addition, this study received approval from the Hillel Yaffe Medical Center Institutional Review Board (#HYMC-0122-23). All methods were performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Funding: This research was not supported by funding. All authors approve that they do not have any financial and personal relationships with other people, or organizations, that could inappropriately influence (bias) this research and this manuscript.

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Randomized Controlled Trial
. 2025 May 1:13:e67151.
doi: 10.2196/67151.

Clinical Impact of Personalized Physician's Education and Remote Feedback Via a Digital Platform on Glycemic Control: Pilot Randomized Controlled Trial

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Randomized Controlled Trial

Clinical Impact of Personalized Physician's Education and Remote Feedback Via a Digital Platform on Glycemic Control: Pilot Randomized Controlled Trial

Jin Yu et al. JMIR Mhealth Uhealth. .

Abstract

Background: The digital education platform Doctorvice (iKooB Inc.) offers face-to-face physician-patient education during outpatient clinic visits, remote glucose monitoring, and the delivery of educational messages, and is expected to be effective for personalized diabetes care.

Objective: This study aims to evaluate the effectiveness of the digital education platform for diabetes care by comparing cases that included both face-to-face education and remote monitoring with those that included only face-to-face education.

Methods: This was a randomized clinical study conducted at the Diabetes Center of Seoul St. Mary's Hospital. Participants were aged ≥19 years and had glycated hemoglobin (HbA1c) levels between 7.5% and 9.5%. In the intervention group, physicians used the digital education platform to provide face-to-face education at enrollment and at the 3- and 6-month visits, along with remote monitoring during the first 3 months of the 6-month study period. The control group received conventional outpatient education. Both groups completed questionnaires-assessing satisfaction with diabetes treatment, diabetes-related stress, and adherence to diabetes medication-at the beginning and end of the study. The primary endpoint was the change in HbA1c levels.

Results: A total of 66 participants were enrolled between August 1, 2022, and August 31, 2023. Of these, 26 in the intervention group and 30 in the control group were analyzed, excluding 10 participants who dropped out of the study. The mean baseline HbA1c levels were 8.3% (SD 0.6%) in the intervention group and 8.0% (SD 0.5%) in the control group. At the 3-month follow-up, mean HbA1c decreased by 0.5%-7.8% (SD 0.9%; P=.01) in the intervention group and by 0.2%-7.8% (SD 0.7%) in the control group. HbA1c levels substantially improved during the first 3 months with both face-to-face education and remote glucose monitoring. However, HbA1c tended to increase during the 3- to 6-month follow-up in the intervention group without the remote monitoring service. Satisfaction with diabetes treatment significantly improved at the end of the study compared with baseline in the intervention group (mean change +3.6 points; P=.006). Medication adherence improved in both groups, with no significant difference at 6 months (P=.59), although the intervention group showed a greater increase from baseline. Subgroup analysis indicated that the reduction in HbA1c was greater for patients with baseline HbA1c levels ≥8.0%, those aged ≥65 years, smokers, drinkers, and those with obesity in the intervention group.

Conclusions: The digital education platform for personalized diabetes management may be beneficial for glycemic control in type 2 diabetes mellitus. Its effectiveness appears to be enhanced when physicians provide personalized face-to-face education combined with remote feedback.

Trial registration: Clinical Research Information Service (CRiS) of Republic of Korea KCT0007953; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23507&search_page=L.

Keywords: digital health; distance counseling; education, distance; remote patient monitoring; type 2 diabetes mellitus.

Conflict of interest statement

Conflicts of Interest: JHC is the CEO of iKoob Inc. The other authors have nothing to declare.

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. 2025 Apr 19;15(4):102672.
doi: 10.5498/wjp.v15.i4.102672.

Investigation of the relationship between nurses' levels of mental health literacy, holistic nursing competencies, and professional self-efficacy

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Investigation of the relationship between nurses' levels of mental health literacy, holistic nursing competencies, and professional self-efficacy

Kubra Durmus et al. World J Psychiatry. .

Abstract

Background: Given their responsibility for the well-being of individuals, nurses with advanced mental health literacy, along with strong holistic nursing competencies and professional self-efficacy, are better equipped to assess both the mental and physical health of their patients, leading to the provision of holistic nursing care.

Aim: To investigate the relationship between nurses' mental health literacy levels and their holistic nursing competencies, as well as their nursing professional self-efficacy.

Methods: This study is cross-sectional, correlational research. The study sample consisted of a total of 261 volunteer nurses working in a training and research hospital and a state hospital between March 11, 2024 and April 8, 2024. Data were collected face to face with the "Descriptive Data Form", "Mental Health Literacy Scale (MHLS)", "Holistic Nursing Competence Scale (HNCS)", and the "Nursing Profession Self-Efficacy Scale (NPSES)".

Results: The mean scale scores for the nurses were as follows: MHLS: 95.88 ± 11.67; HNCS: 179.46 ± 33.82; NPSES: 64.79 ± 11.24. A low-level positive correlation was found between the total scores of the MHLS, HNCS, and NPSES, and a moderate-level positive correlation was observed between the total scores of the HNCS and NPSES. These correlations were statistically significant (P < 0.05).

Conclusion: It is recommended that initiatives be undertaken to enhance the mental health literacy and holistic nursing competencies of nurses and that similar studies be conducted with nurses in different institutions and with a larger number of nurses.

Keywords: Competence; Holistic; Literacy; Mental health; Nursing; Self-efficacy.

Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

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Randomized Controlled Trial
. 2025 Apr 30;20(1):223.
doi: 10.1186/s13019-025-03461-3.

Impact of psycho-educational interventions on patients undergoing Coronary Artery Bypass Grafting Surgery

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Randomized Controlled Trial

Impact of psycho-educational interventions on patients undergoing Coronary Artery Bypass Grafting Surgery

Shahpar Bagheri et al. J Cardiothorac Surg. .

Abstract

Background: Postoperative period of Coronary Artery Bypass Grafting can be challenging, with physical and psychological problems and symptoms. We conducted this study to explore the effect of a psycho-educational intervention on anxiety, pain and physiological parameters among Coronary Artery Bypass Grafting surgery patients.

Methods: A randomized clinical trial design included one experimental and control group. Data were collected from 56 candidates for coronary artery bypass surgery (n = 28) in the intervention and (n = 28) in the usual care groups. Settings were the cardiac centers of the three teaching, specialty, and subspecialty Nemazee, Faghihi, and Al-Zahra hospitals affiliated with Shiraz University of Medical Sciences (SUMS). The data were collected using a demographic information form, the Short-Form McGill Pain Questionnaire, the Spielberger State-Trait Anxiety Inventory, and the physiological parameters form (systolic and diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation). Psycho-educational interventions were performed individually through face-to-face sessions. All tests were two-tailed, and the statistical level was considered 0.05.

Results: The mean scores of state anxiety and pain decreased significantly after the intervention (p < 0.05). Also, psycho-educational interventions affected peripheral oxygen saturation percentage, and breathing rate mean scores (P < 0.05). But, they did not affect the blood pressure and pulse rate (P > 0.05). At the same time, there was no significant difference in the control group.

Conclusion: This study indicated that the pre-operative psycho-educational interventions facilitated intrapersonal caring, reduce state anxiety, relieve pain and stabilize physiological parameters such as peripheral oxygen saturation percentage and breathing rate after surgery among Coronary Artery Bypass Grafting surgery patients. Hence, this intervention is recommended for developing care programs in same population.

Trial registration: https://www.irct.ir/trial/55652 : IRCT20090908002432N8 (2021-09-17).

Keywords: Anxiety; Coronary artery bypass grafting; Pain; Physiological parameters; Psycho-Educational intervention.

Conflict of interest statement

Declarations. Ethical approval: The Institutional Human Ethics Committee of Shiraz University of Medical Sciences approved this study (IR.SUMS.REC.1400.175). Then, the researchers started the sampling after trial confirmation at the Iranian Registry of Clinical Trials (IRCT) with the code IRCT20090908002432N8 (2021-09-17). Voluntary participation informed consent written forms were obtained from all the participants included in the study after providing complete information about the study objectives and procedures. Moreover, all the participants were assured about the confidentiality of their data and that they could withdraw from the study at any time without interfering with standard care. All procedures performed in this study complied with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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Case Reports
. 2025 Apr 29;18(4):e263910.
doi: 10.1136/bcr-2024-263910.

Multidisciplinary approach and the Self-Training Educative Pain Sensation (STEPS) model for managing orofacial complex regional pain syndrome

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Case Reports

Multidisciplinary approach and the Self-Training Educative Pain Sensation (STEPS) model for managing orofacial complex regional pain syndrome

Mai Aldera et al. BMJ Case Rep. .

Abstract

Orofacial complex regional pain syndrome (O-CRPS) presents a diagnostic challenge due to its overlap with other orofacial pain conditions. This case report highlights the value of a multidisciplinary approach in managing a patient with chronic and unexplained facial pain.This case report aims to illustrate: (1) the application of a multidisciplinary approach in diagnosing and managing O-CRPS within the Saudi healthcare system, and (2) the effectiveness of the Self-Training Educative Pain Sensation (STEPS) model in managing O-CRPS.

Case description: A woman in her early 20s presented with left-sided facial pain and motor/autonomic symptoms following a facial injury. Extensive evaluations by various specialists excluded underlying structural pathology. A diagnosis of O-CRPS was established based on Budapest criteria. The STEPS model was implemented for treatment.

Intervention: The STEPS model, a four-component intervention (pain education, graded motor imagery, sensory exposure, facial muscle exercises), aimed to reduce allodynia, normalise motor control and restore important functional activities.

Outcomes: Initial pain medications were ineffective. The STEPS model intervention significantly improved pain, function and overall quality of life.This case report emphasises the importance of a multidisciplinary approach to diagnosing O-CRPS and the potential benefits of the STEPS model in managing this complex condition.

Keywords: Dentistry and oral medicine; Pain; Physiotherapy (rehabilitation).

Conflict of interest statement

Competing interests: None declared.

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Randomized Controlled Trial
. 2025 Apr 30;29(5):278.
doi: 10.1007/s00784-025-06356-8.

Evaluation of the impact of AI-based chatbot on orthodontic patient education: a preliminary randomised controlled trial

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Randomized Controlled Trial

Evaluation of the impact of AI-based chatbot on orthodontic patient education: a preliminary randomised controlled trial

Simona Santonocito et al. Clin Oral Investig. .

Abstract

Objectives: To evaluate the impact of AI-based chatbots on orthodontic patient education in terms of compliance with oral hygiene procedures and level of knowledge and understanding of the treatment recommendations received. Furthermore, to assess the patient's satisfaction with the information received.

Materials and methods: 100 orthodontic patients were enrolled and randomly allocated to receive information leaflets (control group n = 50) or access to an AI-based chatbot created on the guidelines of the leading scientific societies in the field (n = 50). The plaque index (PI) and modified gingival index (MGI) were assessed at baseline (T0) and after 5 weeks of treatment (T1). A questionnaire with a Likert scale was used to evaluate patients' knowledge and satisfaction. Statistical investigations were conducted to perform intra- and inter-group evaluations and to compare the effects of orthodontic therapies on the independent variables analysed. The questionnaire' s reliability was assessed using Cronbach's α.

Results: At T1, a statistically significant increase in MGI and PI was observed in both analyzed groups (P < 0,001). However, the increase in MGI in the chatbot group was statistically lower than in the control group (P < 0.001). The increase in MGI was significantly higher in the chatbot-fixed orthodontic treatment subgroup than in the chatbot-aligners subgroup (P < 0,001).

Conclusions: The use of AI-based chatbots, whose reliability of the information provided can be validated, positively influences orthodontic oral hygiene in orthodontic patients. Further studies with greater follow-up should be conducted to understand the real impact of AI-based chatbot on patient education and satisfaction.

Keywords: AI-based chatbot; Artificial Intelligence; Dental monitoring; LLMs; Oral hygiene; Orthodontic treatment; Orthodontics.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Local Ethics Committee (registration number 60/2024/CL-PAR). All participants gave written informed consent prior to the use of their data and this study. Consent for publication: All study participants signed a consent form for the release of their data and participation in the study. Competing interests: The authors declare no competing interests.

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. 2025 Apr 29;26(1):421.
doi: 10.1186/s12891-025-08637-5.

Pre-operative education and prehabilitation provision for patients undergoing hip and knee replacement: a national survey of current NHS practice

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Pre-operative education and prehabilitation provision for patients undergoing hip and knee replacement: a national survey of current NHS practice

Ifrah Omar et al. BMC Musculoskelet Disord. .

Abstract

Background: Over 215,000 total hip replacements (THRs) and total knee replacements (TKRs) take place annually in the UK. Joint replacement has the longest waiting times of elective surgical treatments, with some patients waiting up to two years for surgery in the NHS. Pre-operative education and support interventions could improve both pre-operative health and optimise post-operative outcomes. However, current pre-operative NHS service provision is heterogenous and poorly described. This study aimed to describe the current services and care provided to patients on NHS waiting lists for THR and TKR.

Methods: A link to a national online survey about pre-operative education and prehabilitation was sent to relevant healthcare professionals involved in the pre-operative care of patients waiting for THR or TKR surgery at a sample of high-, mid- and low-volume NHS hospitals in the UK. Participants were asked questions about what pre-operative education and pre-habilitation services were offered at their hospital, and any barriers or facilitators to delivering care. Frequency statistics were used to describe categorical data and free-text data were coded into categories.

Results: Responses were received from 29 UK hospitals across seven regions. Pre-operative education was provided to patients at 28 hospitals, primarily at single session talks supplemented with booklets. Prehabilitation was provided to patients waiting for TKR at 17 hospitals and to patients waiting for THR at 14 hospitals. It comprised strengthening exercises and advice with written information. Three hospital respondents did not know if prehabilitation was provided before TKR and four hospitals before THR. Barriers to service provision include funding, staffing, facilities, and lack of awareness/evidence on how best to deliver services.

Conclusions: Prehabilitation services are not provided for all patients waiting for arthroplasty. Future work is needed to design and evaluate prehabilitation resources to optimise pre-operative health and improve patient outcomes after TKR and THR.

Conflict of interest statement

Declarations: For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising from this submission. Ethical approval and consent to participate: This study recruited NHS staff as research participants by virtue of their professional role and did not require ethical review as per the Health Research Authority guidance. This project was conducted as a Clinical Effectiveness Project, with approval from North Bristol NHS Trust (CE93612). The project was conducted in accordance with ICH E6 Good Clinical Practice (GCP) guidelines and the Declaration of Helsinki. Potential participants were provided with information and completion of the survey served as their implied consent to take part. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

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. 2025 Apr 29:5:e66845.
doi: 10.2196/66845.

#GenderAffirmingHormoneTherapy and Health Information on TikTok: Thematic Content Analysis

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#GenderAffirmingHormoneTherapy and Health Information on TikTok: Thematic Content Analysis

Julia Rose Beatini et al. JMIR Infodemiology. .

Abstract

Background: Transgender and gender diverse people often turn to online platforms for information and support regarding gender-affirming hormone therapy (GAHT); however, analysis of this social media content remains scarce.

Objective: We characterized GAHT-related videos on TikTok to highlight the implications relevant to GAHT prescribers.

Methods: We used a web scraper to identify TikTok videos posted under the hashtags #genderaffirminghormonetherapy and #genderaffirminghormones as of November 2023. We identified recurrent themes via qualitative content analysis and assessed health education videos with the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) scale and a modified Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test.

Results: Out of 69 videos extracted, 71% (49/69) were created by GAHT users, 24.6% (17/69) were created by health care workers, and 21.7% (15/69) were created to provide health education. Themes included physical changes on testosterone, GAHT access, and combating misinformation and stigma surrounding GAHT. Health education videos scored highly on PEMAT-A/V items assessing understandability (mean 88.3%, SD 11.3%) and lower on actionability (mean 60.0%, SD 45.8%). On the CRAAP test, videos scored highly on the relevance, authority, and purpose domains but lower on the currency and accuracy domains.

Conclusions: Discussions of GAHT on TikTok build community among transgender and gender diverse users, provide a platform for digital activism and resistance against legislation that limits GAHT access, and foster patient-provider dialogue. Educational videos are highly understandable and are created by reliable sources, but they vary in terms of currency and quality of supporting evidence, and they lack in actionability.

Keywords: CRAAP; Currency, Relevance, Authority, Accuracy, and Purpose; GAHT; PEMAT; TGD; TikTok; audiovisual materials; gender affirming; gender diverse; gender fluid; gender-affirming hormone therapy; hashtag; hormone therapy; media information; online platform; patient education materials assessment; qualitative; qualitative content analysis; social media; social media analysis; social media content; themes; transgender; transgender and gender diverse; web scraper.

Conflict of interest statement

ASK declares royalties as editor of a McGraw Hill textbook on transgender and gender diverse health care and of an American Psychiatric Association textbook on gender-affirming psychiatric care. The authors declare no competing financial interests.

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. 2025 Apr 29:9:e56855.
doi: 10.2196/56855.

Impact of the Kidney Score Platform on Communication About and Patients' Engagement With Chronic Kidney Disease Health: Pre-Post Intervention Study

Affiliations

Impact of the Kidney Score Platform on Communication About and Patients' Engagement With Chronic Kidney Disease Health: Pre-Post Intervention Study

Delphine Tuot et al. JMIR Form Res. .

Abstract

Background: Chronic kidney disease (CKD) affects 14% of the US adult population, yet patient knowledge about kidney disease and engagement in their kidney health is low despite many CKD education programs, awareness campaigns, and clinical practice guidelines.

Objective: We aimed to examine the impact of the Kidney Score Platform (a patient-facing, risk-based online tool that provides interactive health information tailored to an individual's CKD risk plus an accompanying clinician-facing Clinical Practice Toolkit) on individual engagement with CKD health and CKD communication between clinicians and patients.

Methods: We conducted a pre-post intervention study in which English-speaking veterans at risk for CKD in two primary care settings interacted with the Kidney Score platform's educational modules and their primary care clinicians were encouraged to review the Clinical Practice Toolkit. The impact of the Kidney Score on the Patient Activation Measure (the primary outcome), knowledge about CKD, and communication with their clinician about kidney health was determined with paired t tests. Multivariable linear and logistic models were used to determine whether changes in outcomes after versus before intervention were influenced by age, race or ethnicity, sex, and diabetes status, accounting for baseline values.

Results: The study population (n=76) had a mean (SD) age of 64.4 (8.2) years, 88% (67/76) was male, and 30.3% (23/76) self-identified as African-American. Approximately 93% (71/76) had hypertension, 36% (27/76) had diabetes, and 9.2% (7/76) had CKD according to the laboratory criteria but without an ICD-10 (International Classification of Diseases, 10th Edition) diagnosis. Patient interaction with the Kidney Score did not change the mean Patient Activation Measure (preintervention: 40.7%, postintervention: 40.2%, P=.23) but increased the mean CKD knowledge score (preintervention: 40.0%, postintervention 51.1%, P<.01), and changed the percentage of veterans who discussed CKD with their clinician (preintervention: 12.3%, postintervention: 31.5%, P<.01). Changes did not differ by age, sex, race, or diabetes status. Results were limited by the small sample size due to low recruitment and minimal clinician engagement with the Clinical Practice Toolkit during the COVID-19 pandemic.

Conclusions: One-time web-based tailored education for patients can increase CKD knowledge and encourage conversations about kidney health. Increasing patient activation for CKD management may require multilevel, longitudinal interventions that facilitate ongoing conversations about kidney health between patients and clinician teams.

Keywords: CKD communication; CKD; CKD knowledge; US; United States; adult; aging; awareness campaign; chronic kidney disease; clinical practice; clinician; health information; kidney; kidney health; kidney score platform; longitudinal intervention; mHealth; mobile health; patient activation; primary care; web-based.

Conflict of interest statement

None declared.

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. 2025 Apr 28:12:e60169.
doi: 10.2196/60169.

Education and Symptom Reporting in an mHealth App for Patients With Cancer: Mixed Methods Development and Validation Study

Affiliations

Education and Symptom Reporting in an mHealth App for Patients With Cancer: Mixed Methods Development and Validation Study

Carolina Muñoz Olivar et al. JMIR Hum Factors. .

Abstract

Background: The widespread prevalence of cancer across the globe demands cutting-edge solutions for its treatment. Current cancer therapies, notably chemotherapy, pose challenges due to their side effects. The early detection and management of the side effects are vital but complex. This study introduces a mobile health app designed to bridge the communication gaps between patients with cancer and health care providers. Hence, it allows patients to report symptoms immediately and also enables proactive symptom management by health care providers.

Objective: This study has 2 objectives: first, to design a cancer-focused mobile health app that integrates educational content and real-time symptom reporting for chemotherapy patients. Second, to validate and evaluate the app quality using the Mobile App Rating Scale (MARS). The app seeks to foster health care communication, reduce hospital readmissions, and optimize symptom management, contributing to a more impactful patient experience.

Methods: This mixed-methods study details the development and validation of mobile health applications. The app was designed by a multidisciplinary team, including nurses, medical professionals, pharmaceutical chemists, computer engineers, and software developers, using agile methodologies. For validation, the app was assessed by 13 evaluators, including clinical professionals (nurses and physicians) and engineers. The evaluation included technical performance analysis using Google tools and quality assessment using the MARS, which measures engagement, functionality, aesthetics, and information quality.

Results: Performance metrics highlighted areas for improvement, with loading times showing delays in displaying content. Meanwhile, the response time of the app was moderate, and visual stability remained excellent. The app achieved an overall MARS score of 3.75 (SD 0.42), indicating consistent quality, with functionality scoring the highest (4.35; SD 0.52) and engagement the lowest (3.31; SD 0.61). The reliability of the MARS was confirmed (interclass correlation coefficient: 0.84; 95% CI: 0.72-0.92). Evaluators unanimously praised the app's potential benefits for patients and clinical professionals while identifying areas for improvement such as customization, onboarding guidance, and navigation.

Conclusions: The CONTIGO app showed strengths in functionality, usability, and information quality, supported by robust security measures. However, areas such as user interactivity and engagement require improvement. Future refinements will integrate insights from patients with cancer to address user-specific needs and enhance the oncology care experience.

Keywords: application; cancer; chemotherapy; design; efficiency; evaluation; health care communication; mHealth; mixed methods; mobile health; patient-reported outcome measures; security; software design; surveys and questionnaires; toxicity; unpleasant symptom; validation.

Conflict of interest statement

None declared.

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Controlled Clinical Trial
. 2025 Apr 28:27:e60343.
doi: 10.2196/60343.

A Digital Outpatient Service With a Mobile App for Tailored Care and Health Literacy in Adults With Long-Term Health Service Needs: Multicenter Nonrandomized Controlled Trial

Affiliations
Controlled Clinical Trial

A Digital Outpatient Service With a Mobile App for Tailored Care and Health Literacy in Adults With Long-Term Health Service Needs: Multicenter Nonrandomized Controlled Trial

Heidi Holmen et al. J Med Internet Res. .

Abstract

Background: Patients with long-term health needs are often expected to actively participate in outpatient care, assuming that they have appropriate health literacy and digital health literacy. However, the association between participation in a digital outpatient service and health literacy remain unclear.

Objective: This study aims to evaluate whether digital outpatient care for 6 months improved health literacy, health-related quality of life (HRQoL), digital/eHealth literacy, and the use of health care services compared with usual care.

Methods: We conducted a multicenter nonrandomized trial with 1 intervention arm and 1 control arm. Patients aged ≥18 years receiving outpatient care in the pain, lung, neurology, or cancer departments at 2 Norwegian university hospitals were allocated in a 1:2 ratio, favoring the intervention arm. The intervention arm received digital outpatient care using tailored patient-reported outcome measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by health care workers via a dashboard with a traffic light system to draw attention to the most urgent reports. The control arm received usual care. The data were collected at baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire domain understanding health information well enough to know what to do from baseline to 6 months. The mean difference in change between the 2 treatment arms was the effect measure. The secondary outcomes were additional domains from the Health Literacy Questionnaire, digital/eHealth literacy, HRQoL, acceptability of the digital intervention, and health service use.

Results: Overall, 162 patients were recruited, 55 (34%) in the control arm and 107 (66%) in the intervention arm, with a 17.3% attrition rate after 6 months. There was no statistically significant difference in the primary outcome, "understanding health information well enough to know what to do," between the arms at 6 months (mean difference -0.05, 95% CI -0.20 to 0.10; P=.53). After 3 months, the health literacy domains actively managing my own health (-0.15, 95% CI -0.30 to -0.00; P=.048) and understanding health information well enough to know what to do (-0.17, 95% CI -0.34 to -0.00; P=.03), as well as both physical (-3.29, 95% CI -5.62 to -0.96; P=.006) and mental HRQoL (-3.08, 95% CI -5.64 to -0.52; P=.02), improved in the digital outpatient intervention arm compared with the control arm.

Conclusions: This study explored digital outpatient care. Although no statistical differences were observed in patients' health literacy after 6 months, our data indicate an improvement in health literacy domains and HRQoL at 3 months. The participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care.

Trial registration: ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869.

International registered report identifier (irrid): RR2-10.2196/46649.

Keywords: cancer; complex pain; digital solution; epilepsy; health literacy; interstitial lung disease; mHealth; mobile health; outpatient; patient-reported outcome measures; remote monitoring; self-monitoring.

Conflict of interest statement

Conflicts of Interest: None declared.

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. 2025 Apr 28;100(1):7.
doi: 10.1186/s42506-025-00184-0.

Mental health literacy: a comparative study on stigmatizing attitude and help-seeking behavior towards mental disorders between adolescents and adults

Affiliations

Mental health literacy: a comparative study on stigmatizing attitude and help-seeking behavior towards mental disorders between adolescents and adults

Amal M I Goda et al. J Egypt Public Health Assoc. .

Abstract

Background: Mental health awareness has the potential to contribute to the prompt identification and effective management of mental disorders. The negative perception connected to mental conditions presents a significant challenge for individuals seeking mental health services and the professionals providing them. This study aims to compare mental health literacy-encompassing knowledge, attitudes, and behaviors-between adults and adolescents attending Ain Shams University Hospitals' outpatient clinics and identify the socio-demographic factors that could predict these components.

Methods: The present survey was carried out during the years 2022-2023 on 369 individuals, who were 11 years or older. An Arabic questionnaire, validated and tested for reliability, was employed to evaluate knowledge, attitudes, and behaviors related to mental disorders. The tools consisted of three validated scales: the Mental Health Knowledge Schedule (MAKS), the Community Attitudes towards Mental Illness (CAMI), and the Reported and Intended Behavior Scale (RIBS).

Results: Adults demonstrated significantly higher knowledge scores (46.33 ± 4.69 vs. 43.16 ± 4.92, p ≤ 0.01) and behavior scores (16.66 ± 3.56 vs. 15.53 ± 3.71, p ≤ 0.01), while adolescents exhibited more favorable attitudes (99.03 ± 17.43 vs. 90.74 ± 11.78, p ≤ 0.01). Higher knowledge was associated with being female, having a university education, living in urban areas, and being employed. Favorable attitudes were linked to adolescents, males, rural residents, and lower educational levels. At the same time, positive behaviors were associated with being female, having a university education, living in urban areas, being employed, and knowing someone with a mental illness. Regression analysis highlighted education and urban residence as consistent predictors across all mental health literacy components, with employment and familiarity with mental illness further enhancing behavior scores.

Conclusion: This study highlights significant differences in mental health literacy between adults and adolescents, with adults exhibiting higher knowledge and behavior scores and adolescents demonstrating more favorable attitudes. Socio-demographic factors, particularly education, urban residence, and employment, emerged as consistent predictors influencing knowledge, attitudes, and behaviors. These findings underscore the need for targeted interventions, such as incorporating mental health education into curricula, launching stigma-reduction campaigns, and improving access to mental health services, particularly in rural areas.

Keywords: Mental health illnesses; Mental health literacy; Stigmatizing attitude.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The ASU Faculty of Medicine Institutional Review Board (IRB) granted ethical approval (approval number: FMASU R278/2022/2023). The approval date was October 1, 2023. The Executive Director of Ain Shams University Hospitals granted administrative approval. The study participants were asked to provide written informed consent, outlining the main objective of the research, and emphasizing that their participation was entirely voluntary and that they could withdraw at any moment. For participants below 18 years of age, written informed consent was obtained from their parents or legal guardians. The participants were informed that completing the survey would be contingent upon their consent to participate in the study. The anonymity provided by the questionnaire ensured the confidentiality of the information gathered; Participants’ privacy was assured. Consent for publication: Not applicable. Competing interests: The authors declare that we have no competing interests.

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. 2025 Apr 21:17:1103-1114.
doi: 10.2147/IJWH.S511322. eCollection 2025.

Factors Influencing Maternal Health Literacy in Postpartum Women

Affiliations

Factors Influencing Maternal Health Literacy in Postpartum Women

Alita Sangdang et al. Int J Womens Health. .

Abstract

Background and purpose: Maternal health literacy affects maternal and child health outcomes. The findings of previous studies have shown, that mothers with low maternal health literacy have inappropriate healthcare behaviors, especially among postpartum women. However, there is still a paucity of studies on the correlates of maternal health literacy in postpartum mothers. This study aimed to examine the predictive power of age, education level, family income, social support, and media use on maternal health literacy in postpartum women.

Patients and methods: A cross-sectional study was conducted among eligible postpartum women who delivered at full term and were admitted to the postpartum unit at two university hospitals. The purposive sampling method was employed. Data were initially collected at the postpartum unit. Then, after six weeks, data collection was performed online. The instruments used included the personal record form, the Social Support in Postpartum Questionnaire, the Media Use Questionnaire, and the Maternal Health Literacy Scale. After six weeks, nine women had not responded to the questionnaire at 6 weeks postpartum, and after identifying the outliers, 112 postpartum women were selected for analysis. Descriptive statistics and Multiple Linear Regression were used for data analysis in PASW Statistics version 18.

Results: Age, education level, family income, social support, and media use together statistically significantly predicted maternal health literacy among postpartum mothers, accounting for 32.90% (R2 = 0.329, F = 10.382, p < 0.001). Specifically, social support (β = 0.545, p < 0.001) and family income (β = 0.174, p < 0.05) were statistically significant predictors of maternal health literacy.

Conclusion: Postpartum mothers should be supported in their efforts to access maternal health information with the assistance of family members to promote maternal health literacy.

Keywords: maternal health literacy; postpartum period; social support.

Conflict of interest statement

The authors report no conflicts of interest in this work.

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Randomized Controlled Trial
. 2025 Mar 9;17(6):957.
doi: 10.3390/nu17060957.

Effects of 12-Week Anti-Inflammatory Dietary Education on Depressive Symptoms Among Depressed Patients with Breast Cancer Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial

Affiliations
Randomized Controlled Trial

Effects of 12-Week Anti-Inflammatory Dietary Education on Depressive Symptoms Among Depressed Patients with Breast Cancer Undergoing Adjuvant Chemotherapy: A Randomized Controlled Trial

Lan Cheng et al. Nutrients. .

Abstract

Background: Depressive symptoms (DepS) are prevalent among patients with breast cancer. Offering an anti-inflammatory diet is a promising strategy for DepS management, but it is costly and difficult to scale up. Instead, anti-inflammatory dietary education is cost-effective and may be more conducive to the promotion of an anti-inflammatory diet strategy. Methods: A prospective, assessor-blinded, two-arm randomized controlled trial was designed to determine the effects of 12-week anti-inflammatory dietary education on DepS in breast cancer patients with depression. Adult female patients with depression and receiving adjuvant chemotherapy were recruited. Participants in the intervention group received anti-inflammatory dietary education, while the control group received routine nursing care. Outcomes included the Center for Epidemiologic Studies Depression Scale (CES-D) score, energy-adjusted dietary inflammatory index (E-DII), plasma inflammatory biomarkers, and quality of life (QoL), which were all assessed at baseline and after a 12-week follow-up. The robustness of the estimates was investigated through sensitivity analyses. A post hoc power analysis was conducted to establish the observed effect sizes for the primary outcomes. Results: A total of 88.6% (62/70) of the participants completed the entire 12-week follow-up. No statistically significant between-group differences were found in the baseline characteristics, including sociodemographic factors, disease-related characteristics, and lifestyle factors. After the intervention, both the CES-D score (p = 0.040) and E-DII (p < 0.001) in the intervention group were significantly lower than in the control group, while the QoL was significantly increased (p < 0.001). Compared with the baseline, the tumor necrosis factor-α (TNF-α) (p = 0.002) and C-reactive protein (CRP) (p = 0.045) levels were significantly lower in the intervention group but not in the control group. Conclusions: Anti-inflammatory dietary education may improve DepS and QoL in breast cancer patients with depression and undergoing chemotherapy by regulating inflammation. Given its acceptability and practicality, this strategy may be incorporated into routine cancer care.

Keywords: anti-inflammatory diet; breast cancer; depressive symptoms; education; inflammation.

Conflict of interest statement

The authors declare no conflicts of interest.

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Randomized Controlled Trial
. 2025 Apr 27;25(1):118.
doi: 10.1186/s12902-024-01802-2.

Positive impact of mobile educational platforms on blood glucose control in patients with nephrotic syndrome and steroid-induced diabetes mellitus: a randomized controlled study

Affiliations
Randomized Controlled Trial

Positive impact of mobile educational platforms on blood glucose control in patients with nephrotic syndrome and steroid-induced diabetes mellitus: a randomized controlled study

Zhimin Yang et al. BMC Endocr Disord. .

Abstract

Objective: Steroid-induced diabetes mellitus (SDM) is a common complication in patients with nephrotic syndrome (NS) undergoing steroid therapy. Effective blood glucose control is critical for improving outcomes in these patients. This study evaluates the impact of mobile educational platforms on blood glucose control and patient adherence in patients with NS combined with SDM.

Methods: A randomised controlled study was conducted involving 56 patients with NS and SDM at Shanxi People's Hospital between April 2019 and December 2020. Participants were recruited using convenient sampling and were randomly assigned to either the intervention group (n = 28) or the control group (n = 28). The control group received routine health management, whereas the experimental group was provided with health management via a mobile educational platform. Blood glucose levels (fasting glucose and postprandial blood glucose), self-management efficacy and patient adherence to treatment were assessed over a 6-month period.

Results: The 56 participants included in the study had a mean age of 69.0 ± 10.5 years and an average diabetes duration of 7.2 ± 3.5 years. At the end of 6 months, the intervention group showed significant reductions in fasting blood glucose and postprandial blood glucose levels (P < 0.001). Self-management efficacy, assessed using the Diabetes Self-Efficacy Scale, improved significantly post-intervention (4.42 ± 0.53 vs. 4.15 ± 0.56, P = 0.020). Additionally, patient adherence to treatment improved by 25% in the intervention group compared with the control group.

Conclusion: The use of mobile educational platforms significantly resulted in better glycemic control and treatment adherence in the patients with NS and SDM compared to the control group. These findings suggest that integrating mobile health technologies into routine care can enhance disease management and optimise outcomes.

Trial registration: The study was retrospectively registered "ISRCTN23135945" on 05/11/2024.

Keywords: Blood glucose control; Mobile healthcare; Nephrotic syndrome; Self-management; Steroid-induced diabetes mellitus.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Shanxi Provincial People’s Hospital, [(2021) Provincial Medical Department Ethical Review No. (272)]. Informed consent was obtained from all participants prior to enrollment in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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. 2025 Jun:187:112124.
doi: 10.1016/j.ejrad.2025.112124. Epub 2025 Apr 17.

PRECISE framework: Enhanced radiology reporting with GPT for improved readability, reliability, and patient-centered care

Affiliations

PRECISE framework: Enhanced radiology reporting with GPT for improved readability, reliability, and patient-centered care

Satvik Tripathi et al. Eur J Radiol. 2025 Jun.

Abstract

Background: The PRECISE framework, defined as Patient-Focused Radiology Reports with Enhanced Clarity and Informative Summaries for Effective Communication, leverages GPT-4 to create patient-friendly summaries of radiology reports at a sixth-grade reading level.

Purpose: The purpose of the study was to evaluate the effectiveness of the PRECISE framework in improving the readability, reliability, and understandability of radiology reports. We hypothesized that the PRECISE framework improves the readability and patient understanding of radiology reports compared to the original versions.

Materials and methods: The PRECISE framework was assessed using 500 chest X-ray reports. Readability was evaluated using the Flesch Reading Ease, Gunning Fog Index, and Automated Readability Index. Reliability was gauged by clinical volunteers, while understandability was assessed by non-medical volunteers. Statistical analyses including t-tests, regression analyses, and Mann-Whitney U tests were conducted to determine the significance of the differences in readability scores between the original and PRECISE-generated reports.

Results: Readability scores significantly improved, with the mean Flesch Reading Ease score increasing from 38.28 to 80.82 (p-value < 0.001), the Gunning Fog Index decreasing from 13.04 to 6.99 (p-value < 0.001), and the ARI score improving from 13.33 to 5.86 (p-value < 0.001). Clinical volunteer assessments found 95 % of the summaries reliable, and non-medical volunteers rated 97 % of the PRECISE-generated summaries as fully understandable.

Conclusion: The application of the PRECISE approach demonstrates promise in enhancing patient understanding and communication without adding significant burden to radiologists. With improved reliability and patient-friendly summaries, this approach holds promise for fostering patient engagement and understanding in healthcare decision-making. The PRECISE framework represents a pivotal step towards more inclusive and patient-centric care delivery.

Keywords: Artificial Intelligence; Large Language Models; Patient Care; Radiology.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Randomized Controlled Trial
. 2025 Apr 26;53(1):81.
doi: 10.1007/s00240-025-01757-6.

The impact of video-animated information on anxiety, satisfaction, and pain perception in patients undergoing ESWL: a randomized controlled study

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Randomized Controlled Trial

The impact of video-animated information on anxiety, satisfaction, and pain perception in patients undergoing ESWL: a randomized controlled study

Recep Burak Degirmentepe et al. Urolithiasis. .

Abstract

Extracorporeal Shock Wave Lithotripsy (ESWL) is a widely used non-invasive treatment for kidney stones, but it can cause significant patient anxiety due to procedural unfamiliarity and discomfort. This study aimed to evaluate the effects of video-animated information on anxiety levels, procedural satisfaction, willingness to undergo ESWL again, and perceived pain during the procedure. A prospective randomized controlled trial was conducted with 80 patients scheduled for ESWL. Patients were randomized into two groups: the video group (n = 40) received video-animated information in addition to standard verbal and written information, while the non-video group (n = 40) received only standard information. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI), and pain perception, satisfaction, and willingness to repeat the procedure were evaluated using the Visual Analog Scale (VAS). The video group showed a significant reduction in situational anxiety (STAI-S scores: 40.1 ± 3.7 to 35.3 ± 2.7, p < 0.001) compared to the non-video group (39.7 ± 4.2 to 38.5 ± 4.5, p = 0.106). The video group also reported higher satisfaction scores (8.8 ± 1.3 vs. 7.2 ± 2.0, p < 0.01) and greater willingness to repeat the procedure (5.6 ± 2.0 vs. 3.6 ± 1.9, p < 0.01). No significant difference was observed in VAS pain scores between the groups (4.9 ± 1.3 vs. 5.4 ± 1.6, p = 0.298). Video-animated information significantly reduces situational anxiety and improves patient satisfaction and willingness to undergo ESWL again, without significantly affecting perceived pain levels. These findings support the use of multimedia tools in patient education to enhance the ESWL experience.

Keywords: Anxiety; ESWL; Video-animated information.

Conflict of interest statement

Declarations. Ethics approval: The study received approval from the Institutional Review Board of Sakarya University. Competing interests: The authors declare no competing interests.

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. 2025 Apr 9;13(8):861.
doi: 10.3390/healthcare13080861.

Enhancing Health Literacy and Self-Management in Glaucoma Patients: Evidence from a Nurse-Led Educational Intervention

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Enhancing Health Literacy and Self-Management in Glaucoma Patients: Evidence from a Nurse-Led Educational Intervention

Lοukia Tsichla et al. Healthcare (Basel). .

Abstract

Objective: This interventional cohort study evaluates the effectiveness of a nurse-led educational intervention designed to improve health literacy and self-management in glaucoma patients and examines correlations with demographic factors (sex, age, education level) and comorbidities. Material and Methods: A convenience sample of 312 glaucoma patients was recruited from the University General Hospital of Heraklion, Crete, between November 2022 and November 2023. The patients were randomly assigned to an intervention group (receiving nurse-led education) or a control group (receiving standard care). Health literacy was measured using the HLS-EU-16 questionnaire, while self-management levels were assessed with the Patient Activation Measure (PAM-13). Two-way repeated measures ANOVA analyzed intervention effects over time. Moreover, multiple linear regression analysis was used to test for potential correlations between variables. Results: Significant improvements were observed in both HLS-EU-16 and PAM-13 scores in the intervention group over time compared to the control group. In the post-test, the intervention group showed statistically higher health literacy scores (12.79 ± 2.64) than the control group (10.52 ± 3.60), with a mean difference in -2.27 (p < 0.001). Similarly, the PAM-13 scores were significantly higher in the intervention group (49.35 ± 10.36) compared to the control group (41.33 ± 24.12) post-test, with a mean difference of -8.01 (p < 0.001). The pre-intervention PAM-13 score was positively associated with both the HLS-EU16 score (B = 3.307, p < 0.001) and education level (B = 3.863, p = 0.037). Meanwhile, higher post-intervention PAM-13 was positively associated with greater post-intervention HLS-EU16 scores (B = 1.26, 95% CI [0.61, 1.91]). Furthermore, the participants of the intervention group exhibited significantly higher post-intervention PAM-13 scores than the control group (B = 5.36, 95% CI [1.03, 9.68]). Conclusions: The nurse-led educational intervention significantly enhanced health literacy and self-management in glaucoma patients, indicating its potential value in patient education strategies for chronic diseases.

Keywords: chronic disease; glaucoma; health literacy; nurse-led intervention; patient education; self-management.

Conflict of interest statement

The authors declare no conflicts of interest.

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. 2025 Apr 25;26(1):140.
doi: 10.1186/s13063-025-08842-6.

Respiratory biofeedback and psycho-education for patients with post COVID- 19 symptoms and bodily distress: study protocol of the randomized, controlled explorative intervention trial POSITIV

Affiliations

Respiratory biofeedback and psycho-education for patients with post COVID- 19 symptoms and bodily distress: study protocol of the randomized, controlled explorative intervention trial POSITIV

Hannah Dinse et al. Trials. .

Abstract

Background: A high number of individuals report suffering from physical and psychological sequelae symptoms after COVID-19-the so-called post COVID-19 condition. Commonly reported complaints include physical symptoms such as fatigue, headache, attention and concentration deficits or dyspnea and anxiety, symptoms of post-traumatic stress, or depression. Evidence-based treatment recommendations are still lacking up to this point. Associations between physical and psychological symptoms in chronic diseases are known for a long time. Support in coping with the disease and improvement of self-efficacy can have a positive effect on the course of diseases. For this reason, we designed a randomized, controlled explorative intervention trial as a treatment of bodily distress disorder in COVID-19 recovered persons.

Methods: Patients with a post COVID-19 condition meeting to the criteria of the WHO, along with a bodily distress disorder, are randomized in an intervention and control arm (TAU). Randomization takes place after a diagnostic interview, screening, and informed consent. In total, 60 patients will be included in the trial (30 per group). The intervention group receives a cognitive behavioral therapy as a video-conference-based group therapy (6 weeks) and mobile, respiratory biofeedback treatment (for 4 weeks). At several time points, both groups are assessed in terms of psychological and physical health status, treatment expectation, and satisfaction with the intervention. Furthermore, they will get biofeedback examination appointments. The primary outcome is the change in self-efficacy; secondary outcomes include assessed parameters of mental health, somatic symptoms, and satisfaction with the intervention. Data will be analyzed primarily using R and SPSS.

Discussion: The randomized, controlled, explorative intervention trial POSITIV is one of the very first interventions for patients with post COVID-19 condition and psychological burden due to their different symptoms. The aim of the study is to generate new evidence and help patients to cope with the disease and thus, increase their quality of life and reduce symptomatology. We expect with a high probability that the patients' self-efficacy and health status will improve as a result of the intervention.

Trial registration: German Clinical Trial Register (DRKS); DRKS-ID: DRKS00030565. Registered on December 22, 2022.

Keywords: Biofeedback; Bodily distress disorder; Cognitive behavioral therapy; Long COVID- 19; Psychosomatic; Psychotherapy; Randomized controlled trial; SARS-CoV- 2; Somatic symptom disorder.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study is conducted in accordance to the guidelines of the Declaration of Helsinki and approved by the local Ethics Committees of the University Hospital Essen (22–10844-BO). Written, informed consent to participate will be obtained from all participants. Consent for publication: Not applicable—no identifying images or other personal or clinical details of participants are presented here or will be presented in reports of the trial results. The participant information materials and informed consent form are available from the corresponding author on request. Competing interests: The authors declare that they have no competing interests. Collection and use of biological specimens. This trial does not involve collecting biological specimens for storage.

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. 2025 Apr 25;25(1):599.
doi: 10.1186/s12913-025-12775-w.

Defining, assessing, and implementing organizational health literacy: barriers, facilitators, and tools - a systematic review

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Defining, assessing, and implementing organizational health literacy: barriers, facilitators, and tools - a systematic review

Nicola Pelizzari et al. BMC Health Serv Res. .

Abstract

Background: Organizational health literacy (OHL) is increasingly recognized as a fundamental aspect of high-quality healthcare delivery, focusing on organizations' roles in enabling patients to access, understand, and use health information effectively. This systematic review synthesizes current research on OHL, focusing on its definitions, assessment tools, implemented practices, outcomes, and the factors influencing successful OHL integration within healthcare settings.

Methods: Guided by PRISMA and following a predefined registered protocol (PROSPERO 2024:CRD42024537425), this systematic review analyzed studies from six key databases, using targeted keywords associated with OHL. Eligibility criteria isolated research on OHL tools, practices, and outcomes in healthcare settings. Independent reviewers conducted study selection, data extraction, and bias risk analysis. Systematic quality assessment and data extraction were performed to thoroughly evaluate OHL's impact on healthcare.

Results: This systematic review identified 62 articles, published between 2010 and 2024, from 15 different countries. A notable share (30.6%) aimed to develop, validate, and pilot context-sensitive OHL assessment tools. Other studies included qualitative (24.1%), descriptive (14.6%), case studies (11.29%), cross-sectional (8.06%), mixed methods (8.06%), and quantitative (3.25%) approaches, investigating factors promoting and impeding OHL outcomes. The results highlight a 54.1% increase in studies during the COVID-19 pandemic compared to the pre-pandemic period.

Conclusion: OHL is instrumental in advancing healthcare systems towards greater accessibility and patient-centeredness. Nevertheless, overcoming the identified implementation barriers is crucial for realizing OHL's full potential in enhancing healthcare equity and efficiency. Strategic efforts are needed to foster organizational support, adapt structural practices, and allocate necessary resources for OHL initiatives to enhance healthcare.

Keywords: Health literacy; Health literate healthcare organization; Organizational health literacy.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This systematic review did not involve human participants, animals, or personal data requiring formal ethical approval. However, all included studies adhered to ethical guidelines and obtained relevant approvals where necessary. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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. 2025 Apr 24;20(4):e0322114.
doi: 10.1371/journal.pone.0322114. eCollection 2025.

Patient-centered perspectives: A qualitative evaluation of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER)

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Patient-centered perspectives: A qualitative evaluation of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER)

Aditya Dhariwal et al. PLoS One. .

Abstract

Over 55,000 total hip replacement (THR) surgeries were performed in Canada in 2021, with the number rising each year. Excluding rehabilitation, the cost of hip replacement procedures exceeded $675 million, a large burden on the Canadian healthcare system. Considering this large financial impact, prehabilitation delivered through electronic health (eHealth) can improve post-surgical outcomes and reduce overall healthcare expenditures by enhancing recovery and reducing hospital length of stay. This study utilized grounded theory to examine user experience of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER), an eHealth approach to prehabilitation education. Participants were purposively sampled and conventional content analysis was conducted on 18 transcribed semi-structured interviews with participants who completed the HIPPER program in preparation for THR surgery. We identified three categories and seven subcategories: 1) 'That wasn't so hard!', with the subcategories easy to use, learning information and appreciating HIPPER, which describe how participants were able to learn information and use the modules easily; 2) 'I'm ready', comprising of the subcategories being prepared for surgery and having a smooth and good experience which relates to how participants were prepared and confident going into surgery; 3) 'I'd like to have seen', including the subcategories having differing experiences and suggesting additions, which explore participants' constructive criticism and ideas for improvement. Our results show useful features to include in eHealth programs and demonstrate how educational prehabilitation in the form of eHealth is helpful and usable for older adults undergoing THR. We also discuss and inform the integration of feedback and development of eHealth programs for elective surgical procedures. This study was registered with ClinicalTrials.gov on November 21, 2016 with the registration number NCT02969512.

Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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. 2025 May 1;94(5):500-506.
doi: 10.1097/SAP.0000000000004238. Epub 2025 Feb 13.

Assessing the Readability, Quality, and Characteristics of Online Patient Educational Materials Pertaining to Gender-Affirming Surgery

Affiliations

Assessing the Readability, Quality, and Characteristics of Online Patient Educational Materials Pertaining to Gender-Affirming Surgery

Anitesh Bajaj et al. Ann Plast Surg. .

Abstract

Background: Patients access online resources for information about various treatment modalities, including gender-affirming surgery (GAS) patient populations. The present study provides a readability, content quality, technical quality, and qualitative characteristic assessment of online patient educational materials (OPEM) related to GAS.

Methods: An online search using search phrases related to GAS was performed. The first 20 unique search results for each search term were further assessed if identified as an OPEM. The readability, content quality, and technical quality were assessed. Characteristics including mention of World Professional Association for Transgender Health (WPATH) guidelines and discussion of insurance coverage were recorded. Statistical analyses included analysis of variance, chi-squared tests, and 2-sample t tests.

Results: Overall, 231 OPEM were identified (academic/hospital: 124, private practice: 47, online health reference: 43, other: 17). The average consensus grade level was 12.7, which was significantly higher than the National Institutes of Health/American Medical Association-recommended sixth-grade level (P < 0.001). With regard to content quality, academic/hospital websites had a significantly higher DISCERN score than private practice websites (P = 0.01). Notably, only 35% of OPEM mentioned WPATH guidelines. Academic/hospital websites mentioned WPATH guidelines at a significantly higher frequency than nonacademic/hospital websites (P < 0.001). Private practice websites had a significantly higher technical quality score than academic/hospital websites (P < 0.001).

Conclusions: A significant discrepancy in readability was identified between analyzed websites and the National Institutes of Health/American Medical Association recommendation of a sixth-grade level. Further efforts are necessary to ensure accessible and accurate information is available for patients seeking OPEM related to GAS.

Keywords: gender-affirming surgery; health literacy; patient resources; readability.

Conflict of interest statement

Conflicts of interest and sources of funding: none declared.

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. 2025 Apr 24:9:e64212.
doi: 10.2196/64212.

Mobile Health App for Adolescent Asthma Self-Management: Development and Usability Study of the Pulmonary Education and Knowledge Mobile Asthma Action Plan

Affiliations

Mobile Health App for Adolescent Asthma Self-Management: Development and Usability Study of the Pulmonary Education and Knowledge Mobile Asthma Action Plan

Xing He et al. JMIR Form Res. .

Abstract

Background: Adolescents with asthma are vulnerable to poor asthma outcomes due to inadequate self-management skills and nonadherence to medications. Mobile health (mHealth) apps have shown promise in improving asthma control, medication adherence, and self-efficacy. However, existing mHealth asthma apps lack personalization and real-time feedback and are not tailored for at-risk adolescents.

Objective: This study aimed to design, develop, and test a smartphone-based mHealth Asthma Action Plan for adolescents, called Pulmonary Education and Knowledge Mobile Asthma Action Plan (PEAK-mAAP), in preparation for a large-scale randomized controlled trial.

Methods: We employed user-centered design principles to develop our app, leveraging our previous work and following guidelines from the National Heart, Lung, and Blood Institute. The app consists of a patient-facing mobile app and a provider-facing portal. A convenience sample of 13 adolescents (aged 12-20 years) was recruited from the Arkansas Children's Research Institute database or direct health care provider referrals. Participants underwent a task-based usability assessment followed by the System Usability Scale assessment to measure user satisfaction, interface effectiveness, and overall system usability.

Results: PEAK-mAAP integrates 7 core modules supporting personalized asthma self-management, symptom monitoring, medication tracking, and real-time feedback. The mean System Usability Scale score was 83/100 (SD 5.54), indicating high user satisfaction and system usability. Notably, older adolescents (>17 years) reported higher usability scores (87.5) than younger users (77.5), suggesting potential age-related differences in app navigation and engagement.

Conclusions: The results demonstrate that PEAK-mAAP is a feasible and user-friendly mHealth intervention for adolescent asthma self-management. While the high usability score reflects a positive user experience, some participants encountered initial usability challenges, highlighting the need for minor refinements and user training materials. The integration of personalized self-management tools and real-time feedback distinguishes PEAK-mAAP from existing asthma apps, addressing key barriers to adherence and engagement. Moving forward, an ongoing randomized controlled trial will assess its clinical effectiveness, long-term engagement, and impact on asthma outcomes, providing further insights into its potential as a scalable solution for adolescent asthma care.

Keywords: adolescents; asthma self-management; mobile health; mobile phone; usability; user-centered design.

Conflict of interest statement

None declared.

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. 2025 Mar 28:14:128.
doi: 10.4103/jehp.jehp_1195_24. eCollection 2025.

Nurses' assessment of artificial ıntelligence chatbots for health literacy education

Affiliations

Nurses' assessment of artificial ıntelligence chatbots for health literacy education

Gulsum Asiksoy. J Educ Health Promot. .

Abstract

Background: Artificial intelligence (AI)-powered chatbots are emerging as a new tool in healthcare, offering the potential to provide patients with information and support. Despite their growing presence, there are concerns regarding the medical reliability of the information they provide and the potential risks to patient safety.

Material and methods: The aim of this study is to assess the medical reliability of responses to health-related questions provided by an AI-powered chatbot and to evaluate the risks to patient safety. The study is designed using a mixed-methods phenomenology approach. The participants are 44 nurses working at a private hospital in Cyprus. Data collection was conducted via survey forms and focus group discussions. Quantitative data were analyzed using descriptive statistics, while qualitative data were examined using content analysis.

Results: The results indicate that according to the nurses' evaluations, the medical reliability of the AI chatbot's responses is generally high. However, instances of incorrect or incomplete information were also noted. Specifically, the quantitative analysis showed that a majority of the nurses found the chatbot's responses to be accurate and useful. The qualitative analysis revealed concerns about the potential for the chatbot to misdirect patients or contribute to diagnostic errors. These risks highlight the importance of monitoring and improving the AI systems to minimize errors and enhance reliability.

Conclusion: AI chatbots can provide valuable information and support to patients, improving accessibility and engagement in healthcare. However, concerns about medical reliability and patient safety remain. Continuous evaluation and improvement of these systems are necessary, alongside efforts to enhance patients' health literacy to help them accurately assess information from AI chatbots.

Keywords: Artificial intelligence; chatbot; health literacy; healthcare; patient safety.

Conflict of interest statement

There are no conflicts of interest.

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. 2025 Apr 9:13:1561855.
doi: 10.3389/fpubh.2025.1561855. eCollection 2025.

The mediating role of self-efficacy in the relationship between eHealth literacy and childbirth readiness among pregnant women: a cross-sectional study

Affiliations

The mediating role of self-efficacy in the relationship between eHealth literacy and childbirth readiness among pregnant women: a cross-sectional study

Ningying Zhou et al. Front Public Health. .

Abstract

Background: Childbirth readiness is an important component of maternal and child health. Therefore, it is imperative to understand identify the factors influencing childbirth readiness to develop interventions for improving women's wellbeing. In the current digital age, it is crucial to explore the link between eHealth literacy and childbirth readiness. However, few studies have investigated this relationship. Here, we explored the effect of eHealth literacy on childbirth readiness and examined the mediating role of self-efficacy in this relationship.

Methods: A total of 350 third-trimester pregnant women were enrolled in this survey from April to June 2023 at the outpatient departments of the Affiliated Women's Hospital of Jiangnan University, China. Four questionnaires were used to collect data from participants: the General Information Questionnaire, eHealth Literacy Scale (eHEALS), General Self-Efficacy Scale (GSES), and Childbirth Readiness Scale (CRS). The associations among variables were determined through Pearson correlation analysis, and the Amos 26.0 software was employed to analyze the mediating role of self-efficacy.

Results: A total of 350 surveys were distributed to the participants, and 338 eligible questionnaires were finally collected, translating to a response rate of 96.57%. The average score of participants was 27.39 ± 6.40 on the GSES, 32.15 ± 6.16 on the eHEALS, and 74.26 ± 8.81 on the CRS. The eHEALS scores exhibited a strong positive association with self-efficacy (r = 0.509, P < 0.01), which in turn was positively correlated with childbirth readiness (r = 0.505, P < 0.01). Self-efficacy mediated the relationship between eHealth literacy and childbirth readiness, accounting for 33.02% of the total effect.

Conclusions: E-health literacy is a positive predictor of childbirth readiness among pregnant women, with self-efficacy mediating the association. These findings provide a basis for developing targeted interventions to improve childbirth readiness.

Keywords: childbirth readiness; eHealth literacy; mediating effect; pregnant women; self-efficacy.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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. 2025 Apr 23;25(1):1500.
doi: 10.1186/s12889-025-22799-w.

eHealth literacy level and its predictors among primary school teachers

Affiliations

eHealth literacy level and its predictors among primary school teachers

Mehdi Khancolabi et al. BMC Public Health. .

Abstract

Background and aim: The present study aims to investigate eHealth literacy and its related factors among primary school teachers in Sabzevar city.

Method: The current cross-sectional descriptive analytical study was conducted on 252 primary school teachers in Sabzevar city in 2021. The data collection tool included a three-part questionnaire. The first part included 21 demographic questions, the second part of the questionnaire included 8 questions regarding eHealth literacy, and the third part consisted of 10 questions created by the researcher to complete the standard questionnaire. Data analysis was performed using SPSS software and the statistical significance level was P ≤ 0.05.

Results: The mean scores of eHealth literacy of the teachers according to the standard and complete questionnaires were 25.44 ± 5.90 and 60.17 ± 10.17, respectively. There was a statistically significant difference in the eHealth literacy levels of the subjects according to the evaluation of the level of general health, regular physical activity, general knowledge in the field of health, the amount of using the Internet, the use of information related to health through social networks based on both questionnaires (standard/complete). For the standard and complete questionnaires, the multiple correlation coefficient values were 0.48 and 0.52, respectively. The adjustment coefficient value for both questionnaires (R2Adjusted = 0.20).

Conclusion: The eHealth literacy of the teachers in this study was not appropriate. The mastery of cyberspace, the level of education, having traditional health literacy were among the most important factors affecting the improvement of teachers' electronic health literacy.

Keywords: Primary schools; Teachers; eHealth literacy.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was carried out in accordance with relevant guidelines and regulations, and approved by the respective ethical committee of North Khorasan University of Medical Sciences that it conforms ministry of Health. All methods were carried out in accordance with relevant guidelines and regulations. All the subjects participated in this study voluntarily and by explaining the objectives and details of the study, written and informed consent was obtained from them. Competing interests: The authors declare no competing interests.

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. 2025 Apr 23.
doi: 10.1007/s11606-025-09510-w. Online ahead of print.

Enhancing Patient Understanding of Hospitalization and Post-Discharge Needs: The Impact of Physician-Led Verbal Communication and Teach-Back Method

Affiliations

Enhancing Patient Understanding of Hospitalization and Post-Discharge Needs: The Impact of Physician-Led Verbal Communication and Teach-Back Method

Payal Parikh et al. J Gen Intern Med. .

Abstract

Background: Safe transitions of care post inpatient hospitalization require robust communication practices during the discharge process to ensure patient understanding.

Objective: To determine if physician-led patient communication, inclusive of written and verbal instructions with the teach-back method, improves patient understanding of hospitalization and post-discharge needs.

Design: This pre-post study was piloted at an urban, 600-bed, academic tertiary care hospital over a 3-month period.

Participants: Study participants included adult patients admitted to the hospitalist medical teaching service (MTS).

Intervention: Study participants received both a written summary and verbal instruction reinforced with teach-back method. The instruction included the four core domains of patient education: reason for admission, inpatient management, medication changes, and follow-up plan.

Main measures: Changes in mean patient understandings scores from pre- to post-intervention were evaluated on a 3-point scale (no, partial, or full understanding) in addition to basic demographics, level of schooling, and primary language spoken to better ascertain the drivers of improved health literacy.

Key results: Among 120 study participants, mean survey scores in all four testing domains showed improvement in patient understanding of "admitting diagnosis" (21.5%, 95% CI, 0.21 to 0.40; P < 0.0001), "treatment undergone" (35.1%, 95% CI, 0.34 to 0.58; P < 0.0001), "medication changes" (45.8%, 95% CI, 0.40 to 0.67; P < 0.0001), and "discharge follow-up" (38.1%, 95% CI, 0.39 to 0.63; P < 0.0001). Mean scores improved more in patients with lower levels of schooling in all testing domains, except for "understanding of medication changes," showing more improvement in patients with high education achievement (95% CI, 0.08 to 1.09; P = 0.027).

Conclusions: While standard discharge practice involves only a printed discharge packet, the use of a written summary of instructions and verbal reinforcement using teach-back methods improves patient understanding and health literacy of post-discharge needs during transitions of care.

Keywords: discharge practices; teach-back technique; verbal instructions.

Conflict of interest statement

Declarations. Conflict of Interest: The authors declare that they do not have a conflict of interest.

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Case Reports
. 2025 Apr 23.
doi: 10.1111/phn.13565. Online ahead of print.

Analysis of the Impact of E-Health Literacy on Health Behavior Among the Elderly in Jiangsu: Structural Equation Model

Affiliations
Case Reports

Analysis of the Impact of E-Health Literacy on Health Behavior Among the Elderly in Jiangsu: Structural Equation Model

Aojie Chen et al. Public Health Nurs. .

Abstract

Objective: This study aims to determine the correlation between e-health literacy, physiology, and health behaviors of older adults in Jiangsu to assess the factors influencing digital health in older adults.

Methods: Data were collected through a 1:1 face-to-face survey conducted in hospitals and elderly communities from May 1 to June 14, 2024, using a structured questionnaire. In this study, the electronic health literacy questionnaire, the quality-of-life questionnaire, and the Anderson health behavior model were used. According to the collected data, the structural relationship between electronics and health literacy, physiological function, and health behavior of the elderly aged 60 years and above was confirmed, and the structural equation modeling (SEM) analysis was carried out.

Results: E-health literacy significantly positively impacted physiological function (β = 0.916, p < 0.001), while physiological function showed a positive but non-significant association with health behaviors (β = 0.343, p = 0.091). The mediating role of physiological function between e-health literacy and health behaviors was confirmed (*indirect effect = 0.005, 95% CI: -0.010 to 0.125*). Pearson correlations revealed significant relationships: e-health literacy with physiological function (γ = 0.331, p < 0.001) and physiological function with health behaviors (γ = 0.146, p < 0.01).

Conclusion: In the era of big data and the aging society, it is necessary to strengthen publicity and guidance to improve the e-health literacy of older adults, especially those with poor physiological function. Explain the potential threats of some health information and ensure healthy digital aging through multi-stakeholder societal participation.

Keywords: e‐health literacy; health behavior; older adults; physiology; public health.

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. 2025 Apr 2:16:1497074.
doi: 10.3389/fpsyt.2025.1497074. eCollection 2025.

Resilience and frailty among gynecological patients in oncological treatment: the chain mediating role of stigma and health literacy

Affiliations

Resilience and frailty among gynecological patients in oncological treatment: the chain mediating role of stigma and health literacy

Shuo Man et al. Front Psychiatry. .

Abstract

Background: Frailty poses a significant threat to the health status among gynecological patients in oncological treatment. Previous studies have shown that resilience, stigma, and health literacy are associated with frailty. However, their effects and potential relationship with frailty among gynecological patients in oncological treatment have not been fully studied.

Objective: The study aimed to explore the mediation role of stigma and health literacy between resilience and frailty among gynecological patients in oncological treatment.

Methods: A total of 202 gynecological patients in oncological treatment in three gynecological wards of a tertiary hospital in Wuxi from March 2024 to May 2024 were selected for the study using a cross-sectional research method. A convenience sampling method was used. Information was collected on demographic characteristics, resilience, stigma, health literacy, and frailty. The PROCESS macro program was used to explore the mediating role of stigma and health literacy in the relationship between resilience and frailty.

Results: The prevalence of frailty among gynecological patients in oncological treatment was 27.2%. The mediation effect results demonstrated that resilience was not a direct predictor of frailty (β = -0.010, 95%CI: -0.084 ~0.065) but indirectly predicted frailty through health literacy (β = -0.100, 95%CI: -0.155 ~ -0.053) and stigma-health literacy (β = -0.056, 95%CI: -0.091 ~ -0.029). However, no significant mediating effect of stigma alone was found (β = -0.038, 95%CI: -0.085 ~ 0.005).

Conclusions: The findings reveal the impact and potential relationship of resilience and frailty among gynecological patients in oncological treatment in patients with gynecologic oncology. Health literacy mediated the effect between resilience and frailty. Stigma and health literacy were chain mediators in the link between resilience and frailty. Healthcare professionals should pay timely attention to the psychological and mental status of gynecological patients in oncological treatment patients with gynecologic oncology and take measures to improve health literacy.

Keywords: frailty; gynecologic oncology; health literacy; mediation effect; resilience; stigma.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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. 2025 Apr 21;25(1):109.
doi: 10.1186/s12902-025-01917-0.

Recurrent education: A promising strategy for enhancing diabetes management and reducing hypoglycemia in children with type 1 diabetes

Affiliations

Recurrent education: A promising strategy for enhancing diabetes management and reducing hypoglycemia in children with type 1 diabetes

Didem Güneş Kaya et al. BMC Endocr Disord. .

Abstract

Background: This study aimed to assess the impact of recurrent individualized education on the management of hypoglycemia, hypoglycemia awareness, and metabolic control of diabetes in children and adolescents living with type 1 diabetes (T1D).

Methods: A prospective quantitative study involving participants aged 8 to 18 years with T1D was conducted. Three established hypoglycemia screening tools were employed: the Hypoglycemia Fear Survey (HFS), the Gold Hypoglycemia Awareness Questionnaire, and the Edinburgh Hypoglycemia Symptoms Scale. The participants used blinded continuous glucose monitoring (b-CGM) devices to document glucose values, meals, insulin doses, exercise periods, symptomatic hypoglycemia episodes, and glucose levels during hypoglycemia, experienced symptoms, and treatment approaches for hypoglycemia. Following this initial phase, the participants received education from healthcare professionals. The same procedures were repeated six weeks after the educational intervention.

Results: Prior to education, approximately half (n = 21) of the 47 participants were present with impaired hypoglycemia awareness (IHA), and half of the IHA group applied the appropriate hypoglycemia self-treatment. After education, almost all participants demonstrated an improved ability to manage hypoglycemia effectively. Following education, improvements in the frequency of fingerstick glucose measurement per day, time spent within the target glucose range (70-180 mg/dL), glycemic variability (GV), hypoglycemia perception, appropriate hypoglycemia self-treatment, and hypoglycemia fear were observed, both in participants with hypoglycemia awareness and those with IHA.

Conclusions: The results indicate that children and adolescents living with T1D benefit from recurrent self-management education. The benefits were observed in both participants with hypoglycemia awareness and those with IHA. Education positively impacts diabetes management and enhances hypoglycemia awareness.

Keywords: Diabetes self-management education; Fear of hypoglycemia.; Hypoglycemia unawareness; Type 1 diabetes.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with Declaration of Helsinki and approved by The İstanbul University-Cerrahpaşa Clinical Sciences Ethics Committee (29430533-604.01-1178050). Written informed consent was obtained from all participants and their parents. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

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. 2025 Apr 21;43(1):237.
doi: 10.1007/s00345-025-05588-3.

Appraisal of Spanish-language online patient education resources for kidney stones

Affiliations

Appraisal of Spanish-language online patient education resources for kidney stones

Juan Sebastian Arroyave et al. World J Urol. .

Abstract

Introduction: The internet is a primary source of health information, our study addresses the need to assess the credibility, readability, and reliability of Spanish-language medical websites concerning nephrolithiasis. With the Spanish-speaking population in the United States rapidly approaching 20% and growing, our research endeavors to fill a critical gap by evaluating the quality of online resources in Spanish for this common medical condition.

Methods: In our study, we evaluated the quality of Spanish-language online resources on nephrolithiasis for the growing Spanish-speaking population in the United States. Using Google searches with terms like "cálculos renales" and "nefrolitiasis," we analyzed 80 unique websites using Fernandez-Huerta readability software, HON-code certification, JAMA benchmark criteria, source classification, and brief DISCERN. The evaluation was performed by an expert urologist and a medical student, with discrepancies resolved by a third experienced reviewer.

Results: Interrater reliability was strong for JAMA (ICC: 0.98) and DISCERN (ICC: 0.85). Websites mainly originated from Physician/Community Hospitals (43.75%) and University/Academic institutions (23.75%). Only 32.5% had HON-code certification, and 17.5% met all JAMA criteria. Readability typically matched an 8th to 9th grade level, but 58.75% scored below the good quality threshold on DISCERN, with University/Academic sources performing significantly better than Physician/Community sources (p = 0.0078). No significant differences were noted in credibility or readability between these groups.

Conclusions: Our findings indicate that Spanish-language resources on nephrolithiasis often lack in quality, readability, and credibility, highlighting the need for enhanced online materials to support patient and provider management of kidney stones. University sources provide notably higher-quality information than other resource types.

Keywords: Healthcare Disparities; Patient-education; Urolithiasis.

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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. 2025 Apr 18.
doi: 10.1097/SCS.0000000000011274. Online ahead of print.

Disparities in the Readability and Quality of Online Patient Education Materials for Neurotoxin and Surgical Treatment of Chronic Migraine

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Disparities in the Readability and Quality of Online Patient Education Materials for Neurotoxin and Surgical Treatment of Chronic Migraine

Anitesh Bajaj et al. J Craniofac Surg. .

Abstract

The present study aims to evaluate the readability, content quality, and technical quality of online patient educational materials related to surgical intervention and neurotoxin treatment for chronic migraines. An online search using 10 search terms that corresponded to "surgical deactivation" or "neurotoxin treatment" was conducted. For each search term, the first 20 unique results were screened for online patient educational materials related to migraine treatment. Readability, content quality, and technical quality were assessed. Website-specific characteristics, including discussion of insurance coverage, photos, and videos were recorded. Analyses were performed across website types and between broad categories of search terms. Overall, 127 online patient educational materials were included (52% academic/hospital, 29.1% online health reference, 13.4% private practice, and 5.5% other). The average reading grade level was 10.8, which was found to be significantly higher than the AMA/NIH-recommended sixth-grade benchmark (P<0.001). Across website types, academic/hospital websites had a higher reading level than online health reference websites (11.5 vs. 9.7, P<0.001). Online health reference websites had significantly higher content quality scores than both academic/hospital and private practice websites (P<0.001). Notably, online patient educational materials within the "neurotoxin treatment" category were found to have a lower reading grade level (10.1 vs. 11.4) and an increased content quality score compared with those categorized within "surgical deactivation" (P<0.05). Online patient educational materials had a significantly higher reading level than the recommended sixth-grade level. Further efforts must be made to ensure online patient educational materials related to treatments for chronic migraines are accessible.

Keywords: Health literacy; migraine surgery; neurotoxin; online sources; readability.

Conflict of interest statement

The authors report no conflicts of interest.

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Randomized Controlled Trial
. 2025 May 1;33(9):e491-e501.
doi: 10.5435/JAAOS-D-24-00276. Epub 2024 Dec 27.

Information and Access for Safe Narcotic Disposal: A Cluster-Randomized Trial Among Pediatric Orthopaedic Surgical Patients in Los Angeles County

Affiliations
Randomized Controlled Trial

Information and Access for Safe Narcotic Disposal: A Cluster-Randomized Trial Among Pediatric Orthopaedic Surgical Patients in Los Angeles County

Rachel Wahhab et al. J Am Acad Orthop Surg. .

Abstract

Introduction: Greater than two-thirds of individuals report unused opioids following surgical procedures. The need for improved prescribing practices notwithstanding, efforts to improve safe narcotic disposal are requisite to decreasing aberrant narcotic availability and opioid-related hospitalizations. This study aimed to evaluate the additive efficacy of education and access to DEA-compliant narcotic return receptacles on narcotic disposal rates among pediatric orthopaedic surgical patients.

Methods: From July 2021 to July 2023, patients aged 5 to 17 years at two disparate sites were recruited for enrollment. Cluster randomization was done weekly to determine whether education was given on safe narcotic disposal versus standard discharge instructions. Halfway through the study, narcotic disposal receptacles were introduced as an additive intervention. Postoperatively, participants were asked to self-report opioid disposal rates and complete the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form to gauge pain control. Two sample z test of proportions and Fisher exact tests were used to compare disposal rates from both the isolated and combined interventions.

Results: Analysis was restricted to 131 of 576 total patients: 44 (33.6%) disposed of unused narcotic medications and 87 (66.4%) did not. No notable difference was observed in disposal rates between those who received education or not (28/70 [40.0%] vs. 16/61 [26.2%], P > 0.05) and those who had bin access or not (18/59 [30.5%] vs. 26/72 [36.1%], P > 0.05). Furthermore, no notable difference was found between the control group and combination intervention group receptacles (6/25 [24.0%] vs. 8/23 [34.8%], P > 0.05) or the education only and combination intervention group (20/47 [42.5%] vs. 8/23 [34.8%], P > 0.05).

Discussion: Neither preoperative education alone nor the addition of convenient disposal bins improved narcotic disposal rates following surgery.

Conclusion: Retention rates remained high despite either intervention. Therefore, efforts to decrease narcotic availability must be nuanced and multimodal. Further studies may investigate the role of longitudinal patient education to better influence risk perception and subsequent behavioral changes.

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. 2025 Apr 17;26(1):117.
doi: 10.1186/s12875-025-02819-9.

A cross-sectional study of the relationship between health literacy and health-promoting lifestyles in patients with hypertension in northwest Iran

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A cross-sectional study of the relationship between health literacy and health-promoting lifestyles in patients with hypertension in northwest Iran

Fatemeh Darabi et al. BMC Prim Care. .

Abstract

Background: Health literacy is a key factor in determining the use of health-related information, promoting health, and improving the quality of life. Therefore, the present study was conducted to investigate the relationship between health literacy and health-promoting lifestyle in patients with hypertension.

Methods: The present study was conducted using a descriptive-correlation method on 406 patients with hypertension who visited the emergency room of a northwestern Iranian hospital in 2022. The sampling method was convenient in type. The data collection instrument consisted of three parts, including the demographic information section, followed by the health literacy and health-promoting lifestyle sections. The inferential data analysis was done using Pearson's correlation coefficient, and multiple linear regression in SPSS 24 (Inc., Chicago, Ill., USA). The significance level was set at 5%.

Results: The mean and standard deviation of participants' age was 53.77 ± 13.79 years, within a range of 47 to 65 years. The results showed that a health-promoting lifestyle has a positive and significant relationship with health literacy (r = 0.927, p < 0.001). The health-promoting lifestyle had the highest correlation with the decision-making dimension (r = 0.913, p = < 0.001) and the lowest correlation with the reading dimension (r = 0.772, p = < 0.001). The results of linear regression showed that the dimensions of reading, understanding, appraisal, and decision-making were statistically significant in the regression model. The decision-making dimension with a coefficient of 0.592 had the greatest impact on the health-promoting lifestyle.

Conclusion: The moderate health literacy level among patients with hypertension is associated with lower adherence to healthy lifestyle practices. Therefore, it is essential for community health policymakers to organize the design of educational program interventions in the areas of health literacy and healthy lifestyle practices to help improve the overall health of patients.

Keywords: Cardiovascular diseases; Chronic diseases; Health behaviors; Health literacy; Health-Promoting lifestyle; Hypertension; Iran; Patient; Silent killer.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained and approved for the study from the Ethics Committee at the Kermanshah University of Medical Sciences. The ethics code allocated to this study is IR.KUMS.REC.1401.457. The required permission was gained to enter the Imam Ali Hospital in Kermanshah. Informed consent and written approval were obtained from all subjects. The principle of confidentiality was adhered to by not distorting the participants’ statements and using the same phrase in writing the research findings. To maintain the participants’ confidentiality about the information provided, an identification number was assigned to each interviewee. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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. 2025 Apr 17:14:e66846.
doi: 10.2196/66846.

Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) Education for Hospitalized African American Patients: Protocol for a Randomized Controlled Trial

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Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) Education for Hospitalized African American Patients: Protocol for a Randomized Controlled Trial

Akilah King et al. JMIR Res Protoc. .

Abstract

Background: End-stage kidney disease (ESKD) or kidney failure is a condition where the kidneys lose the ability to function. African American individuals are 4 times as likely to develop ESKD compared to White American individuals. In addition, African American patients are less likely to have an optimal dialysis start and to choose renal replacement therapy modalities that align with their goals and values. Our prior work shows that culturally tailored, in-person education improves patient outcomes. This is the foundation for our innovative intervention using an African American virtual patient educator as an option for hospitalized patients with chronic kidney disease (CKD).

Objective: The Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) study will determine whether the computerized adaptive education and usual hospital care impact the health literacy of African American patients with kidney disease. It will also assess how patients' lifestyle and commitment to health goals are impacted by the method of health literacy education.

Methods: We will screen, recruit, and enroll hospitalized patients who self-identify as African American and have advanced CKD based on their estimated glomerular filtration rate. Eligible patients who verbally consented will be randomly assigned into either the computerized adaptive education intervention group or the control group (usual hospital care). Patients in the intervention group will receive a culturally tailored, adaptive education module. To analyze pretest, posttest, and follow-up survey results on patient CKD knowledge, ESKD treatment options, and health goals, we will use a paired, 2-tailed t test with a Bonferroni adjustment for multiple comparisons.

Results: Recruitment for the I-C-CKD study began on May 2, 2023. We are currently recruiting and have enrolled 96 patients who completed both pretest and posttest surveys as of December 2024. This includes 50 patients in the control group and 46 patients in the intervention group. Data analysis has not occurred.

Conclusions: African American individuals often receive less patient education about self-care and treatment options for CKD. We hope this study provides a solution to increase hospitalized African American patients' knowledge of CKD and motivation for CKD self-care through computerized adaptive education, reduce disparities, and improve patient outcomes.

Trial registration: ClinicalTrials.gov NCT06364358; https://clinicaltrials.gov/study/NCT06364358.

International registered report identifier (irrid): DERR1-10.2196/66846.

Keywords: chronic kidney disease; computerized adaptive education; end-stage kidney disease; end-stage renal disease; glomerular filtration rate; inpatient; kidney failure; usual hospital care.

Conflict of interest statement

Conflicts of Interest: None declared.

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. 2025 Mar 17;17(3):e80717.
doi: 10.7759/cureus.80717. eCollection 2025 Mar.

Health Literacy and Patient-Reported Outcomes Measurement Information System Scores Among Patients Referred to Spine Surgeons

Affiliations

Health Literacy and Patient-Reported Outcomes Measurement Information System Scores Among Patients Referred to Spine Surgeons

Colin E Webster et al. Cureus. .

Abstract

Background Health literacy is "the degree to which individuals can obtain, process, and understand basic health information and services to make appropriate health decisions." Low health literacy is associated with adverse health outcomes, such as increased risk and length of hospitalization after abdominal surgery. However, the impact of health literacy on outcomes in the spine surgery patient population is understudied. This study seeks to evaluate the relationship between patients' health literacy scores and various outcomes, primarily a patient's Patient-Reported Outcomes Measurement Information System (PROMIS) score at their baseline visit with a spine surgeon. A greater understanding of the impact of health literacy on health outcomes may improve treatment for patients with lower health literacy. Methods This is a single-center retrospective study at New York University (NYU) Langone Orthopedic Center. A health literacy measurement survey (i.e., the Newest Vital Sign survey) was administered to English-speaking adult patients aged 18 years and older who presented to two attending spine surgeons between June 1, 2022, and August 15, 2022, as new or follow-up patients. The survey consists of six questions, and patients were categorized into two different health literacy levels based on the number of correct responses. A score of 0-3 suggests limited literacy, and a score of 4-6 indicates adequate literacy. Additional data collected include PROMIS at the patient's baseline appointment with the surgeon to create consistency between new and follow-up patients. Key demographic and clinical data were also collected. Univariate associations between health literacy and PROMIS scores were investigated using the Welch Two Sample t-test and Pearson's Chi-squared test. A multivariate analysis was carried out implementing a binary logistic regression model. Results This study included 57 patients with an average age of 57 years, 29 (51%) of whom identified as female. The racial breakdown of this cohort was 33 (58%) White, 11 (19%) Black, 5 (9%) Asian, and 5 (9%) Hispanic. The health literacy survey results demonstrated that 25 (44%) had limited health literacy, and 32 (56%) had adequate health literacy. Limited literacy patients were older (mean age of 62 years for Limited vs. 54 years for Adequate, P=0.024) and more likely to be patients of color (either Asian, Black, or Hispanic) (15 (60%) Limited vs. 6 (19%) Adequate, P = 0.002). Limited literacy patients also, on average, had a lower self-reported physical health score (36.6 for Limited vs. 41.2 for Adequate, P=0.050) and were more likely to have hypertension (20 (80%) Limited vs. 10 (31%) Adequate, P<0.001). A logistic regression model yielded an odds ratio of 1.16 between patient-reported physical health and health literacy, indicating that the odds of having adequate health literacy increase by about 16% for each unit increase in the Physical Health score. A Variance Inflation Factor (VIF) test was used and demonstrated minimal multicollinearity among the variables in the logistic regression. Conclusion This study shows that health literacy plays a significant role in health outcomes, especially in chronic health conditions like physical health for spine surgery patients and hypertension. These results align with the literature, showing how lower health literacy correlates with worse physical health scores and a greater incidence of hypertension.

Keywords: adi; area deprivation index; health literacy; mychart; orthopedic spine surgery; orthopedic surgery; promis; spine; spine surgery.

Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. NYU School of Medicine IRB issued approval i22-00725_MOD04. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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. 2025 Mar 14;22(3):434.
doi: 10.3390/ijerph22030434.

Heat Illness and Extreme Weather Health Literacy: Communication Preferences and Effectiveness for Patients Living in Climate-Change-Vulnerable Communities

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Heat Illness and Extreme Weather Health Literacy: Communication Preferences and Effectiveness for Patients Living in Climate-Change-Vulnerable Communities

Todd L Sack et al. Int J Environ Res Public Health. .

Abstract

Health professionals are trusted information sources and could be valuable for improving climate change health literacy. Few studies address teaching patients about health risks associated with climate change, and no studies have focused on the medical office waiting room as a teaching site for populations from heat-vulnerable neighborhoods. We gave adult patients in primary care office waiting rooms printed teaching materials about heat-related illnesses. We asked them to read these at home and then complete an online confidential survey concerning their preferences among teaching methods and their preferences for communication during health emergencies. Ninety-one surveys were received from patients residing in heat-vulnerable neighborhoods. Patients liked receiving information in waiting rooms. Printed brochures were favored statistically by patients, but other teaching methods that are feasible for waiting rooms also rated well, including single-page printed fliers, posters, and video screens. Digital options were far less favored. We conclude that printed teaching materials may improve decisions that impact human health. The medical office waiting room appears to be an accepted, time-efficient, and effective site to communicate knowledge on climate change and health. Additionally, medical offices could play a role supporting government agencies to communicate with patients during weather-related health emergencies.

Keywords: behavioral change; climate change; environmental justice; extreme heat; health education; health emergency; health literacy; health promotion; heat-related illness.

Conflict of interest statement

The authors have no financial conflicts of interest.

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. 2025 Mar 10;22(3):399.
doi: 10.3390/ijerph22030399.

Cross-Cultural Adaptation and Patient Evaluations of a Question Prompt List for Danish-Speaking Patients at the Orthopaedic Surgery Department, Odense University Hospital

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Cross-Cultural Adaptation and Patient Evaluations of a Question Prompt List for Danish-Speaking Patients at the Orthopaedic Surgery Department, Odense University Hospital

Nina Høy Chodkiewicz et al. Int J Environ Res Public Health. .

Abstract

Objectives: The Question Prompt List (QPL) enhances patients' consultation preparation by improving health literacy and communication with healthcare professionals. A validated tool for this context is not yet available. We adapted and translated an Australian QPL to ensure its validity. This study seeks to improve patient-centred communication and health literacy through the QPL. This study aims to conduct a translation and cross-cultural adaptation of the QPL.

Study design: Cross-cultural adaptation.

Methods: Beaton's five-step guide inspired the cross-cultural adaptation, which involved forward and back translations from the Australian to Danish versions. Patients at the orthopaedic department tested the final version, evaluating the QPL for clarity, usefulness, and context. Four semi-structured interviews supplemented this process. Feedback from patients led to the refinement and finalisation of the QPL.

Results: The translations revealed some contradictions, indicating a need for QPL adjustments to fit the Danish context. Most patients were satisfied with the QPL, finding it beneficial and comprehensive. They noted that the QPL would have been helpful in previous consultations. Minor criticisms of specific questions were also raised, leading to further discussion and refinement.

Conclusions: This cross-cultural adaptation has ensured the validity and quality of a Danish QPL, and implementation strategies are now ready for investigation.

Keywords: 5-point Likert scale; QPL; Question Prompt List; cross-cultural adaptation; health literacy; patient-centred communication; semi-structured interviews.

Conflict of interest statement

The authors declare no conflict of interest.

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. 2025 Apr 15;25(1):555.
doi: 10.1186/s12913-025-12679-9.

Process evaluation of a co-design and implementation study to improve professional health literacy in a regional care hospital (PIKoG): a mixed-methods study

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Process evaluation of a co-design and implementation study to improve professional health literacy in a regional care hospital (PIKoG): a mixed-methods study

Johanna Sophie Lubasch et al. BMC Health Serv Res. .

Abstract

Background: In connection with a hospital stay, patients have to make important health-related decisions. Adequately responding to the needs of patients requires good communication skills of healthcare professionals within healthcare organizations. The PIKoG project (As made for us - Improving professional health literacy in hospitals) aimed at improving professional health literacy by implementing participatory health literacy training and supporting measures in a hospital setting. This study aimed to analyze processes supporting and hindering the implementation of the complex intervention.

Methods: A mixed-methods study was conducted, including focus group interviews and a paper-pencil survey with healthcare professionals. Data was combined and analyzed using categories derived from the Medical Research Council's guidance on process evaluation: (1) Implementation, (2) Mechanisms of impact, and (3) Context. Interview data were analyzed using structured qualitative content analysis according to Kuckartz. Survey data were analyzed descriptively.

Results: One of three on-site, full-day health literacy training sessions was offered weekly. Supporting measures were implemented step by step over the course of a year. Both the training and the supporting measures were rated positively overall, but they could not be effectively integrated into daily routines. The COVID-19 pandemic as well as resource constraints adversely affected implementation by altering workflows, increasing stress levels and shifting priorities. The participatory approach and individual change agents fostered the implementation of the complex intervention. Nurses were reached the most, while physicians engaged least in the interventions. Adaptations during the implementation increased the use of the implemented measures and gave rise to ideas for future improvements.

Conclusion: The study highlights the challenges involved in implementing a complex intervention supporting professional health literacy in an organization and stresses the importance of considering available resources, recruiting opinion leaders, and being responsive to the needs of different groups. While the participatory co-design development approach was found to be valuable, it does not guarantee successful organizational change in times when hospitals face multiple challenges. Subsequent studies should therefore focus on investigating the capacities of healthcare organizations for organization-wide improvement processes and identify how healthcare organizations can be innovative and patient-centered even in the presence of extremely difficult contextual conditions.

Trial registration: DRKS00019830, since 16th of April 2020.

Keywords: Communication training; Complex intervention; MRC framework; Organizational development; Organizational health literacy.

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study is conducted in accordance with the Declaration of Helsinki in its current version (World Medical Association [WMA], 2013). Consultation by and ethics approval from the Ethics Committee of the Medical Faculty of Oldenburg (ethics vote of January 23, 2020, number 2019 − 148) as well as the responsible data protection officers of the University of Oldenburg and the participating hospital were obtained prior to the start of the study. Informed consent was obtained from all subjects involved in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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