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Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Self-care is a broad concept that refers to the actions taken to preserve or improve health, which can vary depending on the academic literature. A useful framework to understand self-care is the Self-Care Matrix, which consists of four dimensions: activities, behaviours, context, and environment. Self-care activities are the specific practices that promote health, such as physical activity, healthy eating, hygiene, and rational use of health products. Self-care behaviours are the principles and actions that guide positive health behaviours and lifestyle choices. Self-care context is the degree of dependence or independence from external healthcare resources. Self-care environment is the external factor that influences self-care practices within the community. Self-care is closely related to Lifestyle Medicine, which supports individuals in adopting sustainable health practices and prioritises preventive strategies over reactive measures. Lifestyle Medicine and self-care play a crucial role in both primary and secondary prevention of diseases. The future of self-care envisions a healthcare landscape where technology and personalised approaches enhance self-care and Lifestyle Medicine. However, there are also challenges to address, such as potential inequalities and misconceptions that may arise as health systems pivot towards self-care.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Traditional clinical training has often lacked the leadership and management skills necessary for practitioners to effectively drive change. Despite facing systemic pressures and resource limitations, clinicians can be agents of change by innovating within their work environments. Practising self-care and understanding the benefits of Lifestyle Medicine are essential for healthcare practitioners to sustain their wellbeing and energy for these changes. The transformation of healthcare environments to encourage healthier choices can profoundly affect the wellbeing of both staff and patients. Large-scale change can be fostered by engaging with the community and connecting patients to local groups and activities. The UK has seen examples of successful Lifestyle Medicine projects and we explore some examples of success in this chapter. To innovate in healthcare, one must be clear about their motivation, be prepared to initiate projects without initial funding, plan for their evaluation, and ensure that the projects are enjoyable for all participants involved.
This chapter explores the relationship between primary health care (PHC), health literacy and health education with empowering individuals, groups and communities to improve and maintain optimum health. PHC philosophy encompasses principles of accessibility, affordability, sustainability, social justice and equity, self-determination, community participation and intersectoral collaboration, which drive health care service delivery and health care reform. Empowerment is a fundamental component of social justice, which seeks to redistribute power so those who are disadvantaged can have more control of the factors that influence their lives. Lack of empowerment is linked to poorer health outcomes due to limited control or agency, associated with poorer social determinants of health. This influences personal resources, agency and participation, as well as limited capacity to access services and opportunities. Health care professionals and systems need to work in ways to promote the empowerment of individuals, groups and communities to achieve better health outcomes.
Individuals’ COVID-19 protection and awareness could be related to their health literacy levels. This study aims to determine individuals’ COVID-19 awareness and health literacy levels in eastern Turkey and the relationship between them.
Methods
This study utilized a descriptive and correlational design. The target population was individuals aged 18-65 years who sought treatment in the emergency department of a state hospital in Turkey. The sample consisted of 762 individuals who visited the health institution where data were collected between July 15, 2021-December 15, 2021 and agreed to participate in the study. Data were collected through the Personal Information Form, the COVID-19 Awareness Scale, and the Health Literacy Scale. Ethics committee approval and institutional permissions were obtained to conduct the study. Data analysis used arithmetic means, standard deviations, skewness and kurtosis coefficients, t test, ANOVA, Welch ANOVA, Bonferroni tests, and correlation analysis.
Results
The participants’ COVID-19 Awareness Scale total mean score was 50.71 ± 14.93, and the Health Literacy Scale total mean score was 45.03 ± 10.57. A moderate positive correlation was detected between the participants’ health literacy levels and the COVID-19 awareness scale sub-scales and total scores (r = 0.350).
Conclusions
The participants’ health literacy level increased with their COVID-19 awareness level. It is recommended that health literacy levels be increased to help individuals increase their awareness of COVID-19 and to protect and improve their health.
The 2018 Common Rule revision intended to improve informed consent by recommending a concise key information (KI) section, yet provided little guidance about how to describe KI. We developed innovative, visual KI templates with attention to health literacy and visual design principles. We explored end users’ attitudes, beliefs, and institutional policies that could affect implementing visual KI pages.
Materials and methods:
From October 2023 to April 2024, we conducted semi-structured interviews with principal investigators, research staff, and Institutional Review Board (IRB) personnel, including those in oversight/management, and community partners. Forty participants from three academic institutions (in the Midwest, Southeast, and Mountain West) viewed example KI pages and completed interviews. We coded written transcripts inductively and deductively based on the capability, opportunity, and motivation to change behavior (COM-B) framework. Data were analyzed using content analysis and organized thematically.
Results:
Participants responded positively to the visual KI examples. They discussed potential benefits, including improving information processing and understanding of study procedures, diversity in research, trust in research, and study workflow. They also described potential challenges to consider before widespread implementation: IRBs’ interpretations of federal guidelines, possible impacts on IRB submission processes, the effort/skill required to develop visuals, and difficulty succinctly communicating study risks. There was no consensus about when to use visual KI during consent, and some wondered if they were feasible for all study types.
Discussion:
Visual KI offers a promising solution to long-standing informed consent challenges. Future work can explore resources and training to address challenges and promote widespread use.
Clinical research trials rely on informed consent forms (ICFs) to explain all aspects of the study to potential participants. Despite efforts to ensure the readability of ICFs, concerns about their complexity and participant understanding persist. There is a noted gap between Institutional Review Board (IRB) standards and the actual readability levels of ICFs, which often exceed the recommended 8th-grade reading level. This study evaluates the readability of over five thousand ICFs from ClinicalTrials.gov in the USA to assess their literacy levels.
Methods:
We analyzed 5,239 US-based ICFs from ClinicalTrials.gov using readability metrics such as the Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning Fog Index, and the percentage of difficult words. We examined trends in readability levels across studies initiated from 2005 to 2024.
Results:
Most ICFs exceeded the recommended 8th-grade reading level, with an average Flesch-Kincaid Grade Level of 10.99. While 91% of the ICFs were written above the 8th-grade level, there was an observable improvement in readability, with fewer studies exceeding a 10th-grade reading level in recent years.
Conclusions:
The study reveals a discrepancy between the recommended readability levels and actual ICFs, highlighting a need for simplification. Despite a trend toward improvement in more recent years, ongoing efforts are necessary to ensure ICFs are comprehensible to participants of varied educational backgrounds, reinforcing the ethical integrity of the consent process.
Limited research is available on how motivations to adopt plant-based diets and nutrition literacy influence diet quality. This study assessed diet quality, diet motives and nutrition literacy in vegans, vegetarians and semi-vegetarians and investigated predictors of dietary quality.
Design:
Cross-sectional study, participants completed an online survey about diet-related motives and nutrition literacy. Dietary intake was assessed with the Diet History Questionnaire III, and diet quality was calculated with the Healthy Eating Index (HEI)-2015. A one-way ANCOVA was used to compare diet quality, nutrition literacy and diet motives among diets. Hierarchical regression analysis was performed to identify significant predictors of diet quality.
Setting:
Online survey, participants were recruited through paid targeted social media (Facebook/Instagram) advertising.
Participants:
Adults following a plant-based diet, including 117 (52·5 %) vegans, 51 (22·9 %) vegetarians and 55 (24·6 %) semi-vegetarians.
Results:
Vegans had higher HEI-2015 scores (80·8 (sd 6·5), P < 0·001) compared to vegetarians (75·1 (sd 9·1)) and semi-vegetarians (76·8 (sd 7·5)). Most participants (74 %) had good nutrition literacy scores. Total nutrition literacy did not differ between groups, but vegans had higher vegetarian nutrition literacy than vegetarians and semi-vegetarians (P < 0·001). Ecological welfare, health and sensory appeal were highly important to all participants. Motives accounted for 12·8 % of the variance in diet quality scores. HEI-2015 scores were positively associated with motives of health and natural content, but negatively associated with weight control motivation (all P < 0·05).
Conclusions:
Individuals following plant-based dietary patterns have high diet quality and nutrition literacy. Messages valuing intrinsic over extrinsic factors may facilitate healthier dietary adherence in this population.
This Element considers health misinformation and the problems it presents. The evolving communication context—changing doctor-patient relationships and developments in information technology—presents patients with a vastly enriched information landscape and new challenges to patients navigating it. These challenges are magnified as growing patient empowerment and autonomy have increased expectations for patient involvement in medical decisions. In this context, the ways people approach presented information, learn from it, understand it, and use it, exacerbate the risk that they become misinformed—believing things that are inimical to improved health. Moreover, these same processes make it difficult to correct such beliefs. Approaches building on trust between patient and professional exemplify improved communication to increase accurate patient knowledge and understanding in the service of better health. This title is also available as Open Access on Cambridge Core.
Georgia lies to the northeast of Türkiye, having a western border on the Black Sea. With a population of some 3·73 million, Georgia has a tradition of gastronomic excellence dating back millennia. However, changing lifestyles and external influences have, as elsewhere, led to problems of suboptimal nutrition, and lifestyle-related diseases and disorders prevail. There is considerable scope for improving the focus on public health (PH) and nutrition in Georgia. With this in mind, the Georgian Nutrition Society teamed up with The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a PH charity based in Istanbul, Türkiye, to host a conference and workshops in Tbilisi, Georgia. The primary purpose was to review the current status of PH and nutrition in Georgia with reference to the situation elsewhere, to share examples of best practice and to identify opportunities for improvement. A particular highlight was the presentation of a programme of nutrition education for family physicians recently implemented in Türkiye. This summary of the proceedings is intended as a blueprint for action in Georgia and also to inspire others to consider how PH might be improved via a focus on balanced nutrition.
This study examined the effectiveness of an intervention program to enhance the self-confidence of kindergarten teachers who address radiation-related health concerns among parents following the Fukushima Daiichi Nuclear Power Plant accident in March 2011, wherein radiation anxiety among mothers with young children was high. Kindergarten teachers are expected to address the concerns of these parents
Methods:
Participants from 2 private kindergartens in Fukushima City were assigned to either the intervention group (n = 10), which received an intervention program comprising lectures, group discussions, and presentations, or the control group (n = 16), which received only written materials used in the intervention program. Changes in the measured scores post-intervention were calculated, and the mean values were compared between both groups using the Student’s t-test.
Results:
The primary outcome was self-confidence, and the difference-in-differences approach was used to assess the effectiveness of the intervention program. The study found a more significant difference between pre- and post-intervention self-confidence in the intervention group compared to the control group (P < 0.01).
Conclusions:
The intervention program effectively enhanced the self-confidence of kindergarten teachers in dealing with radiation-related health concerns of parents with young children.
Edited by
Scott L. Greer, University of Michigan,Michelle Falkenbach, European Observatory on Health Systems and Policies,Josep Figueras, European Observatory on Health Systems and Policies,Matthias Wismar, European Observatory on Health Systems and Policies
Education has become the principal pathway to good health, financial security, stable employment, and social success. Due to the fact that education is strongly associated with life expectancy, morbidity and health behaviours it is widely recognized that health and education are mutually influential. While the focus has primarily been on the impact of education on health, advancing health and wellbeing remains a critical pathway to achieve education and life-long learning. As such, a re-orientation of systemic thinking and practice that builds on health and wellbeing as central elements of achieving quality education during the life course is key to achieving SDG 4 quality education.
Complications of parotidectomy can have a massive impact on patients’ quality of life. This study aimed to evaluate the readability and quality of online health information on parotidectomy.
Method
The search terms ‘parotidectomy’, ‘parotid surgery’, ‘parotidectomy patient information’ and ‘parotid surgery patient information’ were parsed through three popular search engines.
Results
The websites were analysed using readability scores of the Flesch Reading Ease test and the Gunning Fog Index. The DISCERN instrument was used to assess quality and reliability. The average Flesch Reading Ease score was 50.2 ± 9.0, indicating that the materials were fairly difficult to read, the Gunning Fog Index score showed that the patient health information was suitable for an individual above 12th grade level, and the DISCERN score indicated that the online patient health information had fair quality. The Kruskal–Wallis test showed a significant difference in Flesch Reading Ease and DISCERN tool scores according to website category (p < 0.05).
Conclusion
Current online patient health information on parotidectomy is too difficult for the public to understand, and it exceeds the reading levels recommended by Health Education England and the American Medical Association.
Optimum nutrition plays a major role in the achievement and maintenance of good health. The Nutrition Society of the UK and Ireland and the Sabri Ülker Foundation, a charity based in Türkiye and focused on improving public health, combined forces to highlight this important subject. A hybrid conference was held in Istanbul, with over 4000 delegates from sixty-two countries joining the proceedings live online in addition to those attending in person. The primary purpose was to inspire healthcare professionals and nutrition policy makers to better consider the role of nutrition in their interactions with patients and the public at large to reduce the prevalence of non-communicable diseases such as obesity and type 2 diabetes. The event provided an opportunity to share and learn from different approaches in the UK, Türkiye and Finland, highlighting initiatives to strengthen research in the nutritional sciences and translation of that research into nutrition policy. The presenters provided evidence of the links between nutrition and disease risk and emphasised the importance of minimising risk and implementing early treatment of diet-related disease. Suggestions were made including improving health literacy and strengthening policies to improve the quality of food production and dietary behaviour. A multidisciplinary approach is needed whereby Governments, the food industry, non-governmental groups and consumer groups collaborate to develop evidence-based recommendations and appropriate joined-up policies that do not widen inequalities. This summary of the proceedings will serve as a gateway for those seeking to access additional information on nutrition and health across the globe.
Informed consent forms (ICFs) and practices vary widely across institutions. This project expands on previous work at the University of Arkansas for Medical Sciences (UAMS) Center for Health Literacy to develop a plain language ICF template. Our interdisciplinary team of researchers, comprised of biomedical informaticists, health literacy experts, and stakeholders in the Institutional Review Board (IRB) process, has developed the ICF Navigator, a novel tool to facilitate the creation of plain language ICFs that comply with all relevant regulatory requirements.
Methods:
Our team first developed requirements for the ICF Navigator tool. The tool was then implemented by a technical team of informaticists and software developers, in consultation with an informed consent legal expert. We developed and formalized a detailed knowledge map modeling regulatory requirements for ICFs, which drives workflows within the tool.
Results:
The ICF Navigator is a web-based tool that guides researchers through creating an ICF as they answer questions about their project. The navigator uses those responses to produce a clear and compliant ICF, displaying a real-time preview of the final form as content is added. Versioning and edits can be tracked to facilitate collaborative revisions by the research team and communication with the IRB. The navigator helps guide the creation of study-specific language, ensures compliance with regulatory requirements, and ensures that the resulting ICF is easy to read and understand.
Conclusion:
The ICF Navigator is an innovative, customizable, open-source software tool that helps researchers produce custom readable and compliant ICFs for research studies involving human subjects.
Understanding the predictors of belief in covid-related conspiracy theories and willingness to get vaccinated against COVID-19 may aid the resolution of current and future pandemics.
Objectives
We aim to investigate how psychological and cognitive characteristics influence general conspiracy mentality and covid-related conspiracy theories.
Methods
A cross-sectional study was conducted based on data from an online survey of a sample of Czech university students (n=866) collected in January 2021, using multivariate linear regression and mediation analysis.
Results
Sixteen percent of respondents believed that COVID-19 is a hoax; 17% believed that COVID-19 was intentionally created by humans. Seven percent of the variance of the hoax theory and 10% of the variance of the creation theory was explained by (in descending order of relevance) low cognitive reflection, low digital health literacy, high experience with dissociation and, to some extent, high bullshit receptivity. Belief in covid-related conspiracy theories depended less on psychological and cognitive variables compared to conspiracy mentality (16% of the variance explained). The effect of digital health literacy on belief in covid-related theories was moderated by cognitive reflection.
Conclusions
Belief in conspiracy theories related to COVID-19 was influenced by experience with dissociation, cognitive reflection, digital health literacy and bullshit receptivity.
This chapter focuses on the dynamic Personal, Social and Community Health strand of the Australian Curriculum: Health and Physical Education and on health education and health promotion more generically. The chapter provides scaffolding for educators at all levels of education to provide health and wellbeing learning from a range of theoretical perspectives to individual and group (for instance, institutional and community) audiences. Health education is framed through a ‘social view of health’ lens while acknowledging personal and social responsibilities. A personalised inquiry approach focused on developing critical health literacies relevant to the students’ everyday lives and environments is recommended. Elements of teaching health education and promoting health, such as the educative purpose in constructing socially relevant health education programs that encompass student developmental needs and their interests, are discussed in depth.
This chapter focuses on resources, strategies, and interventions when working with older adults with low health literacy. Integrating practical ways of engaging this population can enhance and improve older adults’ health status, and enhance the interaction and relationships with health-care providers. As patients are asked to take a more active role in the management of their health, enabling participation and better communication, the patients’ involvement can have a dramatic effect in improving health outcomes and patient satisfaction. Health professionals can encourage clear health communication to promote the overall health and well-being of older adults.
Engaging and working with older adults with low health literacy is critical to improving health outcomes. For those with low health literacy, it's important to ensure health messages, both verbal and written, are communicated clearly so that patients can understand what they need to do, in order to achieve better health and make informed decisions about their care. Older adults may be more hesitant to ask questions of their health providers, or lack the skills to find, evaluate, and utilize health information online. Other factors, such as physical, cognitive, and social age-related changes, can also impact older adults’ ability to understand and process health information.
Unhealthy diets are a major threat to population health and are especially prevalent among those with a low socioeconomic status (SES). Health promotion initiatives often rely on nutrition information interventions (NIIs), but are usually less effective among adults with a low SES than in their high-SES counterparts. Explanations for this lower effectiveness are set out in extant studies. These have been conducted across a wide range of disciplines and subject fields and using a variety of methodological approaches. We have therefore conducted a scoping review to identify and synthesise the following: (1) explanations suggested in studies carried out in high-income countries for why NIIs are (in)effective among adults with a low SES and (2) whether these suggested explanations were studied empirically. Eight databases were searched for relevant studies published since 2009 across various disciplines. This identified 4951 papers, 27 of which were included in our review after screening. Only fifteen of these proposed an explanation for the (in)effectiveness of NIIs among adults with a low SES. The following four main themes were uncovered: health literacy, economic resources, social resources and convenience. Ten studies tested their explanations empirically, but the results were inconsistent. The reasons why NIIs are (in)effective among low-SES adults are therefore still largely unclear. Also, current literature predominantly relies on individualistic explanations, most notably focusing on psychological and economic attributes. Consequently, if the effectiveness of NIIs among low-SES populations is to be improved, future studies should examine a wider range of explanations and test them systematically and empirically.
Clinical research is complex, and research-related terms can be challenging to understand. Clear, supportive communication with patients, potential study participants, and their caregivers must be prioritized by healthcare providers as well as investigators and their research teams. In clinical research, health literacy best practices support the ethical tenets of respect, justice, and beneficence. Plain language advances the understanding of informed consent documents, as well as comprehension of educational information, recruitment materials, study instructions, and study results summaries, among others. Further, a more collaborative research partnership is fostered when study participants are given understandable materials, while a lack of understanding can delay accrual and decrease adherence. We launched a pilot initiative to develop a consensus-driven, plain language clinical research glossary to promote clarity, consistency, and transparency across clinical research stakeholder groups. The resulting resource, described herein, is intended to be used widely to support a greater understanding of clinical research and empower study participants. Considerations for expansion are also discussed.