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Health Literacy in the Mediterranean Countries

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 23355

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Dr. Vieri Lastrucci

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Guest Editor

1. Epidemiology Unit, Meyer Children's University Hospital, 50139 Firenze, Italy
2. Departament of Health Sciences, University of Florence, 50134 Firenze, Italy
Interests: public health; health promotion; health prevention; health literacy; digital health literacy; nutrition literacy; organizational health literacy; health inequalities; epidemiology; health behaviors

Special Issue Information

Dear Colleagues,

We invite you to contribute a manuscript to a Special Issue of the International Journal of Environmental Research and Public Health focusing on health literacy in Mediterranean countries. In recent years, health literacy has gained attention as a fundamental determinant of health and as an underlying factor of several health inequalities within and between countries. Indeed, limited HL competencies have been shown to be associated both with poor socio-economic status and adverse health behaviors and outcomes. Although research is quickly deepening our understanding of the vast potential that optimizing health literacy can have on health and on associated healthcare costs, most of this research is still based on results from the United States and northern European Countries. Mediterranean Countries are characterized by interrelated cultural, political and socio-economic contexts and present specific and common health challenges—such as population ageing, increasing prevalence of chronic diseases, nutrition transition, and refugee and migrant health—in which health literacy may play a central role for public health policies and interventions. This Special Issue aims to help fill the literature gap of health literacy research in the Mediterranean area, and papers from all Mediterranean countries are encouraged. In particular, the topics of interest for this Special Issue include, but are not limited to:

Health literacy distribution in the general population and in selected population subgroups;
Effective health literacy interventions to improve health care service use and/or health outcomes among different population subgroups;
Health literate healthcare organization;
Migrants and vulnerable populations: the role of health literacy as a social determinant of health;
Health literacy, health behaviors, and non-communicable disease prevention and management;
Health literacy and digital health literacy in the COVID-19 pandemic: the relationship between seeking and using information on COVID-19, the impact on prevention practices, and risk perception;
The relationship between health literacy and vaccine adherence/hesitancy.

Dr. Vieri Lastrucci
Guest Editor

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Keywords

health literacy
digital health literacy
nutrition literacy
Mediterranean Countries
Southern European Countries
non-communicable diseases
health inequalities
migrants
refugees, health behaviors
health outcomes
vaccine adherence
vaccine hesitancy
COVID-19
health promotion
health intervention
prevention
health literate healthcare organization

Published Papers (10 papers)

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Research

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16 pages, 833 KiB

Open AccessArticle

Health Literacy among Older Adults in Portugal and Associated Sociodemographic, Health and Healthcare-Related Factors

by Andreia Costa, Rodrigo Feteira-Santos, Violeta Alarcão, Adriana Henriques, Teresa Madeira, Ana Virgolino, Miguel Arriaga and Paulo J. Nogueira

Int. J. Environ. Res. Public Health 2023, 20(5), 4172; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20054172 - 25 Feb 2023

Viewed by 1602

Abstract

Although the health literacy level of the general population was described recently, little is known about its specific levels among older adults in Portugal. Therefore, this cross-sectional study aimed to investigate the levels of health literacy demonstrated by older adults in Portugal and explore associated factors. Using a randomly generated list of telephone numbers, adults aged 65 years or more living in mainland Portugal were contacted in September and October 2022. Sociodemographic, health and healthcare-related variables were collected, and the 12-item version of the European Health Literacy Survey Project 2019–2021 was used to measure health literacy. Then, binary logistic regression models were used to investigate factors associated with limited general health literacy. In total, 613 participants were surveyed. The mean level of general health literacy was (59.15 ± 13.05; n = 563), whereas health promotion (65.82 ± 13.19; n = 568) and appraising health information (65.16 ± 13.26; n = 517) were the highest scores in the health literacy domain and the dimension of health information processing, respectively. Overall, 80.6% of respondents revealed limited general health literacy, which was positively associated with living in a difficult household financial situation (4.17; 95% Confidence Interval (CI): 1.64–10.57), perceiving one’s own health status as poorer (7.12; 95% CI: 2.02–25.09), and having a fair opinion about a recent interaction with primary healthcare services (2.75; 95% CI: 1.46–5.19). The proportion of older adults with limited general health literacy in Portugal is significant. This result should be considered to inform health planning according to the health literacy gap of older adults in Portugal. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

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14 pages, 400 KiB

Open AccessArticle

Development and Validation of the Breastfeeding Literacy Assessment Instrument (BLAI) for Obstetric Women

by María Jesús Valero-Chillerón, Rafael Vila-Candel, Desirée Mena-Tudela, Francisco Javier Soriano-Vidal, Víctor M. González-Chordá, Laura Andreu-Pejo, Aloma Antolí-Forner, Lledó Durán-García, Miryam Vicent-Ferrandis, María Eugenia Andrés-Alegre and Águeda Cervera-Gasch

Int. J. Environ. Res. Public Health 2023, 20(5), 3808; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20053808 - 21 Feb 2023

Cited by 1 | Viewed by 2218

Abstract

Background: Despite international efforts to protect and promote exclusive breastfeeding (EBF) for infants up to six months of age, global rates of EBF continue to fall short of the targets proposed by the WHO for 2025. Previous studies have shown a relationship between the level of health literacy and the duration of EBF, although this relationship was not determinant, probably due to the use of a generic health literacy questionnaire. Therefore, this study aims to design and validate the first specific breastfeeding literacy instrument. Methods: A Breastfeeding Literacy instrument was developed. Content validation was carried out by a group of 10 experts in health literacy, breastfeeding or instrument validation, obtaining a Content Validity index in Scale (S-CVI/Ave) of 0.912. A multicentre cross-sectional study was carried out in three Spanish hospitals to determine the psychometric properties (construct validity and internal consistency). The questionnaire was administered to 204 women during the clinical puerperium. Results: The Kaiser-Meier-Oklin Test (KMO = 0.924) and Bartlett’s Test of Sphericity (X² = 3119.861; p ≤ 0.001) confirmed the feasibility of the Exploratory Factor Analysis, which explained 60.54% of the variance with four factors. Conclusions: The Breastfeeding Literacy Assessment Instrument (BLAI) consisting of 26 items was validated. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

18 pages, 700 KiB

Open AccessArticle

Health Literacy, Misinformation, Self-Perceived Risk and Fear, and Preventive Measures Related to COVID-19 in Spanish University Students

by Pilar Bas-Sarmiento, María José Lamas-Toranzo, Martina Fernández-Gutiérrez and Miriam Poza-Méndez

Int. J. Environ. Res. Public Health 2022, 19(22), 15370; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192215370 - 21 Nov 2022

Cited by 4 | Viewed by 2317

Abstract

The “infodemic” is one of the main obstacles in the fight against the COVID-19 pandemic. In order to face it, health literacy (HL) is essential since it allows for knowledge about COVID-19 and the practice of preventive measures to be fostered. This is especially relevant in university students due to their idiosyncrasy. This study aims to evaluate the level of HL related to COVID-19 (HLC), risk perception, misinformation, and the attitudes and behaviors adopted to prevent the spread of coronavirus in Spanish university students. An online questionnaire was administered to 499 Spanish university students. The HLC index presented a mean of 33.89 out of 50; a total of 63.8% had an inadequate level of HLC. They practiced a mean of 7.54 out of 9 preventive behaviors, and the mean knowledge score was 10.40 out of 13. The HLC showed significantly different scores for the degree, the practice of preventive measures, and some sources of information. The level of HL correlates with the adoption of preventive measures. The higher the severity and perceived susceptibility, the more preventive measures are taken by the students. Therefore, there is a need to strengthen the HL skills of university students and address the dissemination of misinformation. Although caution should be taken when generalizing these results due to the limitations inherent within a cross-sectional study and the convenience sampling, our results can guide the establishment of health education strategies and policies for the management of the infodemic in pandemic situations, according to this target population. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

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12 pages, 345 KiB

Open AccessArticle

Determinants of Actual COVID-19 Vaccine Uptake in a Cohort of Essential Workers: An Area-Based Longitudinal Study in the Province of Prato, Italy

by Vieri Lastrucci, Chiara Lorini, Lorenzo Stacchini, Enrica Stancanelli, Andrea Guida, Alessio Radi, Chiara Morittu, Salvatore Zimmitti, Giorgia Alderotti, Marco Del Riccio, Angela Bechini, Sara Boccalini, COVID-19 Population Research Group and Guglielmo Bonaccorsi

Int. J. Environ. Res. Public Health 2022, 19(20), 13216; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192013216 - 14 Oct 2022

Cited by 6 | Viewed by 1328

Abstract

Identifying determinants of COVID-19 vaccine uptake is essential for developing effective strategies for promoting vaccination. This longitudinal study aimed to explore predictors of actual COVID-19 vaccine uptake in workers involved in essential services during the first lockdown period in the Prato Province (Italy). All essential workers were invited and surveyed before COVID-19 vaccine approval (96.5% participation rate). Participants were followed up to evaluate their actual COVID-19 vaccination uptake using the vaccination register. Multinomial models were performed to assess predictors of delayed vaccination or non-vaccination. A total of 691 participants were included, of whom 21.7% had delayed the vaccination and 4.4% were unvaccinated. Participants with a sufficient level of health literacy were 50.2% in the vaccinated-on-time group and 32.3% in the unvaccinated group. The multinomial model predictors of delayed vaccination were work type (OR = 0.51), age between 50 and 59 years (OR = 1.82), and influenza vaccination uptake in the last season (OR = 2.51). Predictors of being unvaccinated were work type (OR = 0.33) and attitudes related to attributing less importance to COVID-19 preventive measures (OR = 0.47). Findings showed distinct predictors for COVID-19 vaccination delay and for being unvaccinated. Being unvaccinated seems to be associated with a general skepticism toward prevention measures. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

12 pages, 607 KiB

Open AccessArticle

Health Literacy, Socioeconomic Status and Vaccination Uptake: A Study on Influenza Vaccination in a Population-Based Sample

by Patrizio Zanobini, Chiara Lorini, Saverio Caini, Vieri Lastrucci, Maria Masocco, Valentina Minardi, Valentina Possenti, Giovanna Mereu, Rossella Cecconi and Guglielmo Bonaccorsi

Int. J. Environ. Res. Public Health 2022, 19(11), 6925; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116925 - 06 Jun 2022

Cited by 7 | Viewed by 2564

Abstract

Background: Health Literacy (HL) has been recently hypothesized to affect the relationship between socio-economic status (SES) and health conditions. However, to date no study has yet assessed the potential contribution of HL in the pathway through which SES affects influenza vaccination status. We aim to examine the relationships among HL, SES factors, and influenza vaccination uptake in Tuscan (Italy) residents belonging to different high-risk groups (HRGs) for influenza. Methods: The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Mediation analyses were conducted using SES variables as independent variables, influenza vaccination status as dependent variable and HL as mediator variable. Results: A total of 3278 people belonged to HRGs for influenza. In the whole sample, 19.4% of the participants were vaccinated against influenza. Participants who were not employed or had a poor financial status were more likely to be vaccinated against influenza (OR 1.56, 95%CI 1.26–1.94, p < 0.001, and OR 1.21, 95%CI 1.00–1.48, p = 0.047 respectively). HL did not mediate the relationship of any of the independent variables with influenza vaccination status. Conclusions: Some SES determinants resulted to influence influenza vaccination uptake, while HL did not affect the likelihood of influenza vaccination uptake among HRGs. Universal health care systems, as in the case of Italy, offering influenza vaccination free of charge to HRGs help in reducing inequalities and mitigating HL demands. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

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13 pages, 378 KiB

Open AccessArticle

Predictors of Influenza Vaccination Uptake and the Role of Health Literacy among Health and Social Care Volunteers in the Province of Prato (Italy)

by Chiara Lorini, Vieri Lastrucci, Beatrice Zanella, Eleonora Gori, Fabrizio Chiesi, Angela Bechini, Sara Boccalini, Marco Del Riccio, Andrea Moscadelli, Francesco Puggelli, Renzo Berti, Paolo Bonanni and Guglielmo Bonaccorsi

Int. J. Environ. Res. Public Health 2022, 19(11), 6688; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19116688 - 30 May 2022

Cited by 3 | Viewed by 1703

Abstract

Annual influenza vaccination is recommended for volunteers involved in primary health and social services. Little is known about the volunteers’ adhesion to influenza vaccination recommendations. The aim of this study was to assess influenza vaccination determinants among a group of volunteers who provided essential activities during the first SARS-CoV-2 pandemic wave in the province of Prato, Tuscany (Italy) and to evaluate the role of health literacy in influencing vaccination determinants. Method: In this cross-sectional study, the predictors of influenza vaccination uptake were assessed through the administration of a questionnaire. Variables significantly associated with influenza vaccination uptake were included in five multivariate logistic regression models through a backward stepwise procedure. Results: Among the 502 enrolled volunteers, 24.3% reported being vaccinated in the 2019–2020 season. Vaccination uptake was 48.8% in participants aged 65 years or older and 15.7% in those aged 64 years or younger. Considering the whole sample in the final model of multivariate logistic regression analysis, the predictors of influenza vaccination uptake were age (OR = 1.05; 95% CI = 1.03–1.07), presence of heart diseases (OR = 2.98; 95% CI = 1.24–7.19), pulmonary diseases (OR = 6.18; 95% CI = 2.01–19.04) and having undergone surgery under general anesthesia in the prior year (OR = 3.14; 95% CI = 1.23–8.06). In the multivariate model considering only participants with a sufficient level of health literacy (HL), none of these predictors resulted in significant associations with vaccination uptake, except for age (OR= 1.04; 95% CI = 1.02–1.07). Conclusions: Our findings revealed a very low influenza vaccination uptake among volunteers, suggesting the need to increase awareness in this at-risk group by means of a better communication approach. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

17 pages, 889 KiB

Open AccessArticle

Validation of the COVID-19 Digital Health Literacy Instrument in the Italian Language: A Cross-Sectional Study of Italian University Students

by Chiara Lorini, Veronica Velasco, Guglielmo Bonaccorsi, Kevin Dadaczynski, Orkan Okan, Patrizio Zanobini and Luca P. Vecchio

Int. J. Environ. Res. Public Health 2022, 19(10), 6247; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19106247 - 20 May 2022

Cited by 11 | Viewed by 2248

Abstract

The Coronavirus Disease 19 (COVID-19) pandemic and the associated “infodemic” have shown the importance of surveillance and promotion of health literacy, especially for young adults such as university students who use digital media to a very high degree. This study aimed to assess the validity and reliability of the Italian version of the COVID-19 adapted version of the Digital Health Literacy Instrument (DHLI). This cross-sectional study is part of the COVID-19 University Students Survey involving 3985 students from two Italian universities. First, item analysis and internal consistency were assessed. Then, Principal Component Analysis (PCA) and Confirmatory Factor Analyses (CFA) were performed comparing different models. The Italian DHLI showed good psychometric characteristics. The protecting privacy subscale was excluded, given the criticalities presented in the validation process. CFA confirmed the four-factor structure, also including a high-order factor. This result allows using the scale to measure a global level of digital health literacy and consider its levels separately for each construct component: searching the web for information, evaluating reliability, determining personal relevance, and adding self-generated content. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

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13 pages, 351 KiB

Open AccessArticle

The Determinants of Vaccine Literacy in the Italian Population: Results from the Health Literacy Survey 2019

by Chiara Cadeddu, Luca Regazzi, Guglielmo Bonaccorsi, Aldo Rosano, Brigid Unim, Robert Griebler, Thomas Link, Paola De Castro, Roberto D’Elia, Valeria Mastrilli and Luigi Palmieri

Int. J. Environ. Res. Public Health 2022, 19(8), 4429; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19084429 - 07 Apr 2022

Cited by 14 | Viewed by 2705

Abstract

Vaccines are among the most important public health achievements of the last century; however, vaccine awareness and uptake still face significant challenges and the COVID-19 pandemic has only exacerbated this phenomenon. Vaccine Literacy (VL) is the ability to find, understand and judge immunisation-related information to make appropriate immunisation decisions. A cross-sectional study on a sample of 3500 participants, representative of the Italian adult population aged 18+ years, was conducted in Italy in 2021. A validated questionnaire, including sections on health literacy (HL), sociodemographic characteristics, risk factors, and lifestyles of respondents, was used. VL was measured by four items (item 19, 22, 26 and 29) of the HL section. While 67.6% of the respondents had a “good” (47.5%) or “sufficient” (20.1%) level of VL, 32.4% had “limited” VL levels. Although the overall VL level was quite high, many participants reported difficulties in dealing with vaccination information, particularly those with a lower educational level, those living in southern and insular regions of Italy, those with greater financial deprivation and those with a migration background. Improving VL in Italy should be a top priority in the political agenda, with special regard to socially and geographically disadvantaged communities. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

13 pages, 631 KiB

Open AccessArticle

by Aldo Rosano, Chiara Lorini, Brigid Unim, Robert Griebler, Chiara Cadeddu, Luca Regazzi, Daniela Galeone and Luigi Palmieri

Int. J. Environ. Res. Public Health 2022, 19(7), 3807; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19073807 - 23 Mar 2022

Cited by 5 | Viewed by 2003

Abstract

The COVID-19 pandemic has caused an overabundance of valid and invalid information to spread rapidly via traditional media as well as by internet and digital communication. Health literacy (HL) is the ability to access, understand, appraise, and apply health information, making it fundamental for finding, interpreting, and correctly using COVID-19 information. A cross-sectional study of a sample of 3500 participants representative of the Italian adult population aged 18+ years was conducted in Italy in 2021. A validated HL questionnaire was employed, including sections on coronavirus-related HL, general HL, sociodemographic characteristics, risk factors, and respondents’ lifestyle. Of our sample, 49.3% had “excellent” levels of coronavirus-related HL and 50.7% had “sufficient” (20.7%) or “limited” (30.0%) levels. Although the overall HL-COVID level was high, many participants reported difficulties dealing with COVID-19 information; in particular, participants older than 65 years, with a low education level, living in southern regions of Italy, and with high financial deprivation. Targeted public information campaigns and the promotion of HL are required for better navigation of health information environments. The COVID-19 pandemic has highlighted the need to improve HL and to prepare the general population for future emergency and non-emergency situations, confirming that HL can be considered a social vaccine. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

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Review

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25 pages, 743 KiB

Open AccessReview

Nutrition and Food Literacy in the MENA Region: A Review to Inform Nutrition Research and Policy Makers

by Hala Mohsen, Yonna Sacre, Lara Hanna-Wakim and Maha Hoteit

Int. J. Environ. Res. Public Health 2022, 19(16), 10190; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph191610190 - 17 Aug 2022

Cited by 8 | Viewed by 3775

Abstract

Background: Improving food and nutrition literacy is fundamental to tackling the Middle East and North Africa (MENA) region’s enormous challenges, including malnutrition and food insecurity. To direct initiatives, it is crucial to assess the region’s food and nutrition literacy. Thus, we aimed to review studies on food/nutrition literacy status in the MENA countries and illuminate the region’s research gaps in these areas, in terms of assessment, policy, and program implementation. Methods: PubMed and Google Scholar databases were searched between 18 December and 8 May 2022, to identify relevant articles published up to 2022 in the MENA region. Results: Twelve studies were included in this review. Lebanon, Palestine, and Iran are the only three MENA countries where nutrition and/or food literacy were assessed. People in these countries mostly had inadequate food and/or nutrition literacy levels, especially in the skills rather than the cognitive domain. Food and/or nutrition literacy showed associations with food habits, food-label use, food-consumption patterns, school performance, food security, dietary diversity, and nutrient adequacy. The MENA countries developed no policies or programs to address food and nutrition literacy. Conclusion: This review is a wake-up call for researchers and policymakers to develop a robust approach to combat food and nutrition literacy concerns in the MENA region. Full article

(This article belongs to the Special Issue Health Literacy in the Mediterranean Countries)

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