Health Promotion Glossary 2021 Nutbeam, Don; Muscat, Danielle M
Health promotion international,
2021-Dec-23, Letnik:
36, Številka:
6
Journal Article
Recenzirano
Lay summary
The Health Promotion Glossary 2021 is designed to help clarify the meaning and relationship between terms commonly used in health promotion. This is the first full review and revision of ...the Glossary in over 20 years. It reflects the continued evolution and development of concepts since the 1998 Glossary, providing an updated overview of the many ideas which are central to contemporary health promotion.
The aim of the Glossary is to facilitate communication among the professions and sectors working in health promotion. The list of terms in the Glossary is not intended to be either exhaustive or exclusive, and draws upon the wide range of disciplines from which health promotion has its origins. The definitions should not be regarded as ‘the final word’ on the terms included. Definitions by their very nature are restrictive, often representing summaries of complex ideas and actions. The use of terms will often be context-specific, and influenced by different social, cultural and economic conditions in countries and communities. Despite these obvious restrictions, the glossary has been assembled to enable as wide an audience as possible to understand the basic ideas and concepts which are central to the development of health promotion.
Research into health literacy and shared decision-making has largely developed along parallel, but distinct lines over the past two decades. There is little evidence that the concepts and related ...practice have intersected except in the most functional way, for example, to simplify shared decision-making tools by improving readability scores of decision aids. This paper presents an integrated model to strengthen and sustain patient engagement in health care by drawing on the strengths of both concepts. This includes addressing patients’ skills and capacities, alongside modifications to written and verbal information. We propose an expanded model of shared decision-making which incorporates health literacy concepts and promotes two-tiered intervention methods to improve the targeting and personalization of communication
and
support the development of transferable health literacy skills among patients.
Background
Health literacy interventions and research outcomes are not routinely or systematically implemented within healthcare systems. Co‐creation with stakeholders is a potential vehicle through ...which to accelerate and scale up the implementation of innovation from research.
Methods
This narrative case study describes an example of the application of a co‐creation approach to improve health literacy in an Australian public health system that provides hospital and community health services to one million people from socioeconomically and culturally diverse backgrounds. We provide a detailed overview of the value co‐creation stages and strategies used to build a practical and sustainable working relationship between a University‐based academic research group and the local health district focussed on improving health literacy.
Results
Insights from our experience over a 5‐year period informed the development of a revised model of co‐creation. The model incorporates a practical focus on the structural enablers of co‐creation, including the development of a Community of Practice, co‐created strategic direction and shared management systems. The model also includes a spectrum of partnership modalities (spanning relationship‐building, partnering and co‐creating), acknowledging the evolving nature of research partnerships and reinforcing the flexibility and commitment required to achieve meaningful co‐creation in research. Four key facilitators of health literacy co‐creation are identified: (i) local champions, (ii) co‐generated resources, (iii) evolving capability and understanding and (iv) increasing trust and partnership synergy.
Conclusion
Our case study and co‐creation model provide insights into mechanisms to create effective and collaborative ways of working in health literacy which may be transferable to other health fields in Australia and beyond.
Patient and Public Contribution
Our co‐creation approach brought together a community of practice of consumers, healthcare professionals and researchers as equal partners.
•Perceived public health threat is associated with intentions to vaccinate.•Those believing the efficacy of vaccines is made up were less willing to get vaccinated.•To protect myself and others was ...the top reason for getting the vaccine.•Safety concerns was the top reason against getting the vaccine.
Vaccination rollout against COVID-19 is underway across multiple countries worldwide. Although the vaccine is free, rollout might still be compromised by hesitancy or concerns about COVID-19 vaccines.
We conducted two online surveys of Australian adults in April (during national lockdown; convenience cross-sectional sample) and November (very few cases of COVID-19; nationally representative sample) 2020, prior to vaccine rollout. We asked about intentions to have a potential COVID-19 vaccine (If a COVID-19 vaccine becomes available, I will get it) and free-text responses (November only).
After adjustment for differences in sample demographics, the estimated proportion agreeing to a COVID-19 vaccine if it became available in April (n = 1146) was 76.3%. In November (n = 1941) this was estimated at 71.5% of the sample; additional analyses identified that the variation was driven by differences in perceived public health threat between April and November. Across both surveys, female gender, being younger, having inadequate health literacy and lower education were associated with reluctance to be vaccinated against COVID-19. Lower perceived susceptibility to COVID-19, belief that data on the efficacy of vaccines is ‘largely made up’, having lower confidence in government, and lower perception of COVID-19 as a public health threat, were also associated with reluctance to be vaccinated against COVID-19. The top three reasons for agreeing to vaccinate (November only) were to protect myself and others, moral responsibility, and having no reason not to get it. For those who were indifferent or disagreeing to vaccinate, safety concerns were the top reason, followed by indecision and lack of trust in the vaccine respectively.
These findings highlight some factors related to willingness to accept a COVID-19 vaccine prior to one being available in Australia. Now that the vaccine is being offered, this study identifies key issues that can inform public health messaging to address vaccine hesitancy.
Background
There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development.
Purpose
An updated review as part of IPDAS 2.0 examined the ...extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations.
Data Sources
Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions).
Study Selection
RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s).
Data Extraction
Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability.
Data Synthesis
Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ2 = 14.11, P = 0.0002, I2 = 92.9%).
Limitations
We were unable to access 13 of 24 PtDAs. Conclusions. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.
•The multifaceted nature and wide variability of presentations present key challenges.•Women are dissatisfied with current options and have unmet information needs.•Personalised counselling according ...to PCOS subtype may reduce uncertainty.•Clarifying and addressing incongruent expectations will improve patient-centred care.
To explore clinicians’ and women’s views and experiences with managing polycystic ovary syndrome (PCOS).
Semi-structured interviews with 36 clinicians and 26 women with PCOS. Clinicians were recruited through advertising via relevant professional organisations, snowballing and contacting clinics across Australia. Women with PCOS were recruited through social media advertising. Transcribed audio-recordings were analysed thematically using Framework analysis.
Findings across women with PCOS and clinician interviews were organised into three themes. Both women and clinicians experienced 1) challenges with managing PCOS, often stemming from the disparate and wide spectrum of presentations, issues with current treatment options (including limited evidence) and the long-term nature of management. Both spoke about 2) online information about PCOS and alternative treatments, including lack of relevant information and widespread misinformation. 3) Follow-up and continuity of care, where we found notable differences between women’s and clinicians’ expectations.
This is the first study to explore both clinicians’ and women’s experiences with managing PCOS, illustrating several challenges in managing this heterogeneous condition.
Clarifying and addressing patient expectations, providing personalised counselling and information according to PCOS phenotype and a multidisciplinary approach may reduce uncertainty and improve patient-centred care.
Background
Previous research suggests that it would be useful to view health literacy as a set of ‘distributed competencies’, which can be found dispersed through the individual's social network, ...rather than an exclusively individual attribute. However, to date there is no focused exploration of how distributed health literacy has been defined, conceptualized or assessed in the peer‐reviewed literature.
Aims
This systematic review aimed to explore: (1) definitions and conceptual models of distributed health literacy that are available from the peer‐reviewed literature; and (2) how distributed health literacy has been measured in empirical research.
Methods
We searched MEDLINE, Embase, CINAHL, PsycInfo, Scopus, ERIC and Web of Science using truncated versions of the keywords ‘literacy’ and ‘distributed’ (within five words' distance). We collated the definitions and conceptual models of distributed health literacy, and report on how health literacy has been measured in empirical research studies. Findings related to distributed health literacy from included manuscripts were synthesized using thematic synthesis.
Results
Of the 642 studies screened, 10 were included in this systematic review. The majority were empirical manuscripts reporting on qualitative research in one of five countries, with two reviews, one conceptual analysis and one quantitative study. Edwards' definition of distributed health literacy, which emphasizes the health literacy abilities, skills and practices of others that contribute to an individual's level of health literacy was widely applied in a variety of clinical and geographical settings. However, we did not identify any quantitative instruments which directly measured distributed health literacy. There was significant variability in questions used to explore the concept qualitatively, and discrepancies across studies in regard to (a) what constitutes distributed health literacy and what does not (e.g., general social support), and (b) the relationship between distributed health literacy and other constructs (e.g., public health literacy).
Conclusion
Although there is a widely applied definition of distributed health literacy, our review revealed that the research space would benefit from the development of the concept, both theoretically for example via conceptual distinctions between distributed health literacy and other types of social support, and empirically for example through the development of a quantitative measurement instrument.
Patient or Public Contribution
This paper is a systematic review and did not involve patients or the public.
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