In the News
On this page you will find the latest news on what’s happening in the world of patient engagement and health literacy.
COVID-19 Is Connected with Lower Health Literacy in Rural Areas
May 27, 2021 (PubMed)
The relationship between social determinants of health (SDoH) and health outcomes is established and extends to a higher risk of contracting COVID-19. Given the factors included in SDoH, such as education level, race, rurality, and socioeconomic status are interconnected, it is unclear how individual SDoH factors may uniquely impact risk. Lower socioeconomic status often occurs in concert with lower educational attainment, for example. Because literacy provides access to information needed to avoid infection and content can be made more accessible, it is essential to determine to what extent health literacy contributes to successful containment of a pandemic. By incorporating this information into clinical data, we have isolated literacy and geographic location as SDoH factors uniquely related to the risk of COVID-19 infection. For patients with comorbidities linked to higher illness severity, residents of rural areas associated with lower health literacy at the zip code level had a greater likelihood of positive COVID-19 results unrelated to their economic status.
Access COVID-19 Is Connected with Lower Health Literacy in Rural Areas
How Medical Jargon Can Make COVID Health Disparities Even Worse
May 24, 2021 (NPR)
When cases of COVID-19 began rising in Boston last spring, Pooja Chandrashekar, then a first year student at Harvard Medical School, worried that easy-to-understand information about the pandemic might not be available in the many languages spoken by clients of the Family Van, the health services and health literacy program where she was working at the time.
Access How Medical Jargon Can Make COVID Health Disparities Even Worse
If hospitals want to cut readmission rates, do a better job teaching patients about self-care
May 24, 2021 (Medical Economics)
A fundamental reason why hospitals consistently fall short on readmissions is a failure to empower and educate patients.
An older man is rushed to the emergency room suffering from a rapid pulse, severe thirst, and drowsiness — classic symptoms of a diabetic crisis.
After a few days of treatment, he’s discharged by an overworked nurse with some written instructions and a hasty explanation of how to care for himself and avoid a relapse. A few weeks later, the patient is back in an acute-care hospital bed.
It’s a cycle that’s repeated day-in and day-out across the United States, and one that is imposing a heavy financial burden on the nation’s hospitals and health systems.
Access If hospitals want to cut readmission rates, do a better job teaching patients about self-care
Digital Health Literacy Considerations for RPM in Senior Care
May 21, 2021 (Patient Engagement)
Boosting remote patient monitoring (RPM) use in senior care is going to require a strategy for addressing digital health literacy and patient navigation.
As remote patient monitoring (RPM) gains a toehold in the healthcare industry, it will be essential for medical professionals to address the digital health literacy issues that could come with it, especially when using RPM for senior care.
Access Digital Health Literacy Considerations for RPM in Senior Care
The Impact of Health Literacy on Knowledge and Attitudes towards Preventive Strategies against COVID-19: A Cross-Sectional Study
May 19, 2021 (PubMed)
The coronavirus disease 2019 (COVID-19) pandemic introduced a set of mitigation measures based on personal behavior and attitudes. In the absence of vaccination or specific treatment, it became essential to comply with these measures to reduce infection transmission. Health literacy is the basis for changing behaviors.
Better health literacy is associated with better attitudes towards preventive strategies against COVID-19. We should invest in ways to improve health literacy, so we can improve people’s attitudes and consequently reduce coronavirus’ transmission.
Relationship between eHealth literacy and psychological status during COVID-19 pandemic: A survey of Chinese residents
May, 2021 (PubMed)
To investigate the eHealth literacy and the psychological status of Chinese residents during the COVID-19 pandemic and explore their interrelationship.
The score of eHealth literacy was 48.88 ± 8.46, and 11.4%, 6.8% and 20.1% of respondents experienced moderate to severe depression, insomnia and post-traumatic stress disorder. eHealth literacy negatively correlated with depression (r = -0.331), insomnia (r = -0.366) and post-traumatic stress disorder (r = -0.320).
eHealth literacy is closely related to psychological status. Improving eHealth literacy may contribute to maintaining good psychological well-being.
Dissociation, Cognitive Reflection and Health Literacy Have a Modest Effect on Belief in Conspiracy Theories about COVID-19
May 11, 2021 (PubMed)
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. We investigate how psychological and cognitive characteristics influence general conspiracy mentality and COVID-related conspiracy theories. 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. Sixteen percent of respondents believed that COVID-19 is a hoax, and 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. Belief in conspiracy theories related to COVID-19 was influenced by experience with dissociation, cognitive reflection, digital health literacy and bullshit receptivity.
Health literacy in people with venous leg ulcers: a protocol for scoping review
May 11, 2021 (PubMed)
Chronic venous leg ulcer (VLU) healing is a complex clinical problem. It requires intervention from skilled, costly, multidisciplinary wound-care teams, working with patients to manage their care. Compression therapy has been shown to help heal venous ulcers and to reduce recurrence, with some evidence suggesting the value of exercise as well. These activities require health education and health literacy (HL) as patients must process, understand and consistently apply health information for successful self-management. Research suggests that those most vulnerable to VLUs also tend to have limited HL, but there have been no reviews examining the state of HL in patients with previous or active VLUs. This scoping review aims to examine the level of HL in VLU patients and how HL may link to self-management behaviours (particularly exercise and compression adherence), and their VLU healing generally.
Access Health literacy in people with venous leg ulcers: a protocol for scoping review
The association between Internet use and health-related outcomes in older adults and the elderly: a cross-sectional study
May 6, 2021 (PubMed)
Older adults and elderly persons can experience a significant digital divide. However, there are many studies reporting that the use of the Internet has benefits related to a person’s health status and social inclusion. It is not fully clear if Internet use and health-related outcomes share common antecedents or if using the Internet may have a favourable effect on the determinants responsible for good health. The main aim of this study was to assess the relationship between the use of the Internet and health-related outcomes in older adults and elderly people in Poland.
In conclusion, in contrast to earlier findings, Internet use is not associated with favourable patterns of lifestyle or higher self-rated health in older Polish adults. However, persons with chronic conditions or disabilities less frequently declare the use of the Internet. It was also revealed that older adults and the elderly who make use of the Internet are less likely to utilise health services.
May 4, 2021 (JAMA Network)
his cross-sectional study prospectively enrolled 97 parents of children diagnosed as having leukemia at Rady Children’s Hospital San Diego, a large tertiary academic center in California, from 2014 to 2017. Health literacy, contextual factors (acculturation, decisional regret, and satisfaction with informed consent), sociodemographic characteristics, and perception of voluntariness after consenting for a therapeutic clinical trial were measured. Univariable and multivariable regression were used to determine significant associations. The analyses for the present study were conducted from May 2019 to May 2020.
Health Literacy Regarding Infectious Disease Predicts COVID-19 Preventive Behaviors: A Pathway Analysis
May 3, 2021 (PubMed)
Health literacy has been identified as one vital determinant of public health and healthy behaviors, but very few studies regarding infectious disease prevention have been found. This descriptive cross-sectional study aimed to validate the pathway of infectious disease-specific health literacy (IDSHL), COVID-19 (coronavirus disease 2019) preventive behaviors, and their determinants. A sample of 1459 casino workers in Macao was eligible for analysis. The concept model was verified with a comparative fit index of 0.937 and goodness-of-fit index of 0.971. Government responses was a significant determinant of situational factors (helpfulness of health information, resource accessibility, and organizational training adequacy), while situational factors showed a direct effect on COVID-19 preventive behaviors. Education and organization training adequacy was the strongest influencing factor of IDSHL, which should be a key target of intervention programs for COVID-19.
Health Literacy and Hearing Healthcare Use
May, 2021 (PubMed)
Objective: To assess whether health literacy is associated with: 1) degree of hearing loss at initial presentation for audiogram and 2) hearing aid adoption for hearing aid candidates.
Conclusions: In our population, patients with low health literacy are more likely to present with higher degrees of hearing loss, but no less likely to obtain hearing aids compared with patients with adequate health literacy. Hearing loss severity and hearing aid coverage by insurance appear to be the main drivers of hearing aid adoption.
Access Health Literacy and Hearing Healthcare Use
A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial
May, 2021 (PubMed)
Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care–based intervention on the prevalence of overweight at age 24 months.
A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02.
Serving Culturally and Linguistically Diverse Patients in Audiology-Part 2: Promoting Health Literacy
May, 2021 (The Hearing Journal)
A growing body of evidence indicates poorer outcomes in health care are associated with lower health literacy.1 Patients need to understand their personal health care information so they can make informed decisions as to how they should act upon it. However, the 2003 National Assessment of Adult Literacy, which surveyed over 19,000 individuals 16 years or older, found that 36% of respondents had health literacy skills rated as “basic” or “below basic.” Additionally, more than 80% of adults with health literacy skills in the “below basic” category were unlikely to seek out information from a printed source or the internet.2 Health care professionals should view these findings as significant problems, as low health literacy leads to poor treatment compliance, poor management of chronic conditions, and poor use of preventative health services. Moreover, providers are not likely to know whether a patient has poor health literacy skills. In the latter half of this two-part culturally and linguistically diverse (CLD) patient feature, we present considerations and recommendations for addressing health literacy for practicing audiologists.
Lessons Learned: A Process Evaluation of the Rural Elder Awareness of Medication Safety (REAMS) Program
April, 2021 (PubMed)
This process evaluation of the Rural Elder Awareness of Medication Safety (REAMS) program provided identification of successful and unsuccessful elements along with barriers to and facilitators of this home-based pilot program. The REAMS program was developed to assist rural older adults aged >65 years and community health care organizations with strategies to improve health literacy related to medications. Recruitment of older adults, rurality of the program’s setting, time constraints, and the onset of the COVID-19 pandemic were the greatest barriers. The collaborative relationship developed with community health care partners was the greatest facilitator. This relationship promoted shared ideas and adjustments in program design to achieve the outcome goals. The lessons learned from process evaluation may benefit future researchers or community health promotion planners with designing community-based programs for older adults in rural areas. Future research should focus on expanding recruitment opportunities in acute care, primary care, and home health with the inclusion of all established health care providers in the community.
Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults
April, 2021 (PubMed)
Health literacy is often viewed as a static trait in longitudinal studies, which may over or underestimate an individual’s ability to manage one’s health.
We sought to examine health literacy over time among older adults using three widely used measures.
We found a negative relationship between age and health literacy over time as measured by the TOFHLA and NVS. Health literacy barriers appear to be more prevalent among individuals in later life, when self-care demands are similarly increasing. Clinicians might consider strategies to assess and respond to limited health literacy, particularly among patients 70 and older. REALM performance remained stable over 10 years of follow-up. This questions whether health literacy tools measure the same attribute. Prospective health literacy studies should carefully consider what measures to use, depending on their objective.
Access Change in Health Literacy over a Decade in a Prospective Cohort of Community-Dwelling Older Adults
Relationships between health literacy and quality of life among survivors with breast cancer
April, 2021 (PubMed)
The average health literacy score was 3.28. Education level and breast cancer stage were significant factors for the health literacy of survivors with breast cancer. Age, body mass index and health literacy were predictors of physical health-related QOL. Health literacy also was a predictor of mental health-related QOL.
The results provide the factors associated health literacy as well as health-related QOL. Nurses should understand the health literacy among survivors with breast cancer and improve health literacy to optimize their quality of life.
Access Relationships between health literacy and quality of life among survivors with breast cancer
Assessment of the Readability of Online Patient Education Material from Major Geriatric Associations
April, 2021 (PubMed)
An increasing number of patients are using the internet to supplement information provided by medical professionals. Online geriatric patient education materials (PEMs) should be written at or below a 6th grade reading level (GRL) that takes into account barriers unique to the geriatric population. The objectives of the study are to assess PEMs of geriatric associations’ websites and determine whether they are above the GRL recommended by the Centers for Disease Control and National Institutes of Health.
The mean of all PEMs using the numerical scales was 11.1 ± 2.4. Ninety-nine percent of PEMs are above the 6th GRL. PEMs ranged from a grade 3.0 to 19.0 reading level. Analysis of variance demonstrated a significant difference between associations (P < .0001), and multiple comparison analysis identified the National Institute on Aging as the content easiest to read (9.5 ± 1.6).
Access Assessment of the Readability of Online Patient Education Material from Major Geriatric Associations
Understanding and Responding to Health Literacy as a Social Determinant of Health
Spring, 2021 (Annu. Rev. Public Health)
Evidence of a social gradient in health literacy has been found in all reported national population surveys. Health literacy is a midstream determinant of health but not a panacea for addressing health inequities created by the maldistribution of opportunity and resources. It is possible to optimize the contribution health literacy makes in mediating the causes and effects of established social determinants of health. Existing interventions demonstrate the feasibility of improving health literacy among higher-risk populations,but research remains underdeveloped and effects on health inequity are largely untested. Future health literacy intervention research should focus on (a) improving the quality of health communication that reaches adiversity of populations, especially by improving frontline professional skills and support; (b) enabling people to develop transferable skills in accessing,understanding, analyzing, and applying health information; and (c) ensuring that priority is proportionate to need by reaching and engaging the population groups who are disproportionately affected by low health literacy
Access Understanding and Responding to Health Literacy as a Social Determinant of Health
Association of health literacy and medication adherence with health-related quality of life (HRQoL) in patients with ischemic heart disease
April 13, 2021 (PubMed)
Medication Adherence (MA) and Health Related Quality of Life (HRQoL) are two inter-connected concepts, co-influenced by Health Literacy (HL), with significant impact on patient management and care. Thus, we aimed to estimate the association of HL and MA with HRQoL in IHD patients.
Data suggested that adequate HL was significantly associated with adherence and both physical and mental dimensions of HRQoL were higher in IHD patients with adequate HL. Besides, HL and MA are independent predictors of HRQoL in IHD patients.
Impact of a Genomic Test on Treatment Decision in a Predominantly African American Population With Favorable-Risk Prostate Cancer: A Randomized Trial
April 9, 2021 (Journal of Clinical Oncology)
The Genomic Prostate Score (GPS), performed on biopsy tissue, predicts adverse outcome in prostate cancer (PCa) and has shown promise for improving patient selection for active surveillance (AS). However, its impact on treatment choice in high-risk populations of African Americans is largely unknown and, in general, the effect of the GPS on this difficult decision has not been evaluated in randomized trials.
Health literacy seen as an important tool in increasing COVID-19 vaccine uptake
April 8, 2021 (Healthcare Finance)
Healthcare professionals largely see vaccines as key tools in ending the COVID-19 pandemic, but they will only work to that end if enough Americans become inoculated in order to achieve herd immunity.
The vaccines themselves are largely effective. The challenge is in convincing the public to take them.
Skepticism about vaccines was high at first. Last fall, nearly half of older adults were on the fence about COVID-19 vaccination – or at least taking a wait-and-see attitude, according to a University of Michigan poll taken at the time.
Access Health literacy seen as an important tool in increasing COVID-19 vaccine uptake
Effective Cost Conversations: Addressing Financial Toxicity and Cost-Related Health Literacy
April 1, 2021 (PubMed)
Cancer survivors have greater risk of experiencing financial toxicity, or the undue financial burden and stress that patients face related to the costs of cancer care. Cost-related health literacy promotion should begin at the point of care with effective cost-of-care conversations that help to identify and manage patient financial needs. Nurses are uniquely positioned and often sought out as trusted sources of cost-of-care information and play a key role in engaging in effective cost conversations that help consumers to understand and manage their costs of care.
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Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study
March 29, 2021 (PubMed)
During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet. The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19-related knowledge, attitudes, and practices (KAPs).
This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills.
Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions
March 23, 2021 (PubMed)
The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease would negatively impact their life. On average, respondents discussed health with 4-5 people, which did not vary by HL or DHL measures. The usage of online information sources varied by HL and DHL. The study findings can inform future student-focused interventions, including identifying the distinct roles of HL and DHL in pandemic information access, attitudes, and behaviors.
Good things happening to support digital health literacy
March 22, 2021 (MirageNews)
A digital health literacy initiative funded by the Australian Digital Health Agency last year is reaping significant rewards and helping bridge the digital divide that precludes many Australians accessing improved health services.
Last year, 71 community organisations across Australia were selected by the Good Things Foundation to teach digital health literacy skills through the Health My Way program and improve digital inclusion.
Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews
March 15, 2021 (JMIR)
Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents.
Access Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews
Biden Invests $250M for Community-Based COVID-19 Vaccination, Equity
March 12, 2021 (xtelligent Healthcare Media)
The Biden Administration recently announced a $250 million investment to encourage COVID-19 vaccination using community-based care to improve health literacy. The funding will be offered as a health literacy grant to localities to reach racial and ethnic minority, rural, and other vulnerable or underserved populations. The initiative, called Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19, is expected to fund nearly 30 projects in urban communities and 43 projects in rural communities for two years.
Access Biden Invests $250M for Community-Based COVID-19 Vaccination, Equity
Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health
March 12, 2021 (PubMed)
Healthy People 2030…provides science-based national health objectives with targets to improve the health and well-being of Americans. For the first time since its 1979 establishment, the Healthy People framework aims to attain health literacy as an Overarching Goal and Foundational Principle to achieving health and well-being. Growing literature on health literacy describes it as a concept not solely reliant on individual capabilities but also on organizations’ ability to make health-related information and services equitably accessible and comprehensible.
The 2 separate analyses revealed plurality support for improving the definition to focus on both individual and organizational roles in health literacy. Results led HHS subject matter experts to update the definition to include definitions of personal health literacy and organizational health literacy. Healthy People 2030’s expanded health literacy definition reflects the most current science and input from the Secretary’s Advisory Committee, public comments, and HHS subject matter experts.
Approach to Improving Patient Safety: Communication
March 10, 2021 (Patient Safety Network)
Each one of the countless necessary communication points between providers and between providers and patients or family caregivers represents an unwelcome opportunity for a patient safety event. During a year when society has been focused on limiting the number of in-person interactions due to the risk of COVID-19, there is a need to acknowledge and prioritize the critical role communication still plays in the safe delivery of healthcare. In 2020, researchers explored current challenges to effective communication with patients, the impact of different techniques to improve communication between providers and with patients, and lessons learned from communication practices during the COVID-19 pandemic that may have applicability beyond the pandemic.
Access Approach to Improving Patient Safety: Communication
Federally Funded Research
March, 2021 (CDC)
The federal government supports and encourages health literacy research in several ways. On this page you can find funding opportunities, research findings, and training initiatives from several federal government agencies.
The Readability of Outpatient Plastic Surgery Clinic Letters: Are We Adhering to Plain English Writing Standards?
Jan-Mar, 2021 (PubMed)
This study aims to determine the quantity and quality of plastic surgery clinic letters sent to patients before and during the Covid-19 pandemic. Text was analyzed using a standardized set of commonly used readability formulae, including SMOG, Flesch Reading Ease, and the Coleman-Liao Index. A total of 100 pre-Covid and 58 peri-Covid letters were suitable for inclusion. Median results for formulae that output a U.S. grade score ranged between 9 and 12.9 for letters written prior to Covid-19 and 9 and 13.2 for those written during Covid-19. Eight percent of letters were sent to patients pre-Covid, increasing to 28% during the pandemic. Letters sent to patients had a median grade score of between 8 and 12 prior to Covid-19 and 8 and 10.6 during Covid-19. Letters sent to clinicians ranged between 9 and 13 and 9 and 13.3, respectively. Outpatient plastic surgery letters are written at a readability level too high to facilitate understanding among the general population. The increase in direct-to-patient contact during the Covid-19 outbreak has not led to a significant improvement in the readability of clinic letters. The authors suggest an increase in letter standardization and raising awareness of readability when writing clinic letters.
Examining the Relationship between Health Literacy and Hearing Health Care Use
March, 2021 (TheHearingJournal)
Access Examining the Relationship between Health Literacy and Hearing Health Care Use
The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery
February, 2021 (PubMed)
Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss.
Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health
Disparities in Research Participation by Level of Health Literacy
February, 2021 (PubMed)
We examined the independent association of patients’ health literacy with two steps in their research participation decision-making process: (1) research interest – willingness to hear more about a research study; and (2) research participation – the decision to enroll after an informed consent discussion. Best practices for effective health communication were implemented in recruitment approaches and informed consent processes. Using logistic regression models, we determined patient characteristics independently associated with patients’ willingness to hear about and participate in the study.
In unadjusted analyses, participants with higher health literacy, and those who were younger, female, or had more education had higher levels of both research interest and research participation. Health literacy remained independently associated with both outcomes in multivariable models, after adjustment for sociodemographic factors.
Because identical variables predicted both research interest and eventual consent, efforts to recruit broad populations must include acceptable methods of approaching potential participants as well as explaining study materials.
Access Disparities in Research Participation by Level of Health Literacy
“People play it down and tell me it can’t kill people, but I know people are dying each day”. Children’s health literacy relating to a global pandemic (COVID-19); an international cross sectional study
February 10, 2021 (PubMed)
Patients With Poor Health Literacy Less Likely to Elect Hospice
February 2, 2021 (Hospice News)
Access Patients With Poor Health Literacy Less Likely to Elect Hospice
An Intervention for Mental Health Literacy and Resilience in Organized Sports
January, 2021 (PubMed)
Purpose: In this study, we tested the effectiveness of a multicomponent sports-based program aimed at promoting early intervention, help seeking, and resilience among a sample of adolescent male sport participants.
Results: Significant positive group-time interactions were found for the primary outcomes of depression and anxiety literacy, intentions to seek help from formal sources, confidence to seek mental health information, and resilience. We also found a significant positive group-time interaction for the secondary outcome of well-being. There were no group-time interactions for social distance (stigma), intentions to seek help from informal sources, implicit beliefs about adversity, perceived familial support, or psychological distress.
Conclusions: Given the high rates of sport participation worldwide and the increasing focus on mental health in this domain, translation and dissemination of the program may be warranted after replication.
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Addressing Health Literacy Needs in Rheumatology: Which Patient Health Literacy Profiles Need the Attention of Health Professionals?
January, 2021 (PubMed)
Results: Among 895 participating patients, the lowest mean HLQ domain scores (indicating most difficulty) were found for “critical appraisal,” “navigating the health system,” and “finding good health information.” The 10 identified profiles revealed substantial diversity in combinations of strengths and weaknesses. While 42% of patients scored moderate to high on all 9 domains (profiles 1 and 3), another 42% of patients (profiles 2, 4, 5, and 6) clearly struggled with 1 or several aspects of health literacy. Notably, 16% (profiles 7-10) exhibited difficulty across a majority of health literacy domains. The probability of belonging to one of the profiles was independent of the hospital where the patient was treated or the type of rheumatic disease.
Conclusion: Ten distinct health literacy profiles were identified among patients with rheumatic diseases, independent of disease type and treating hospital. These profiles can be used to facilitate the development of health literacy interventions in rheumatology.
Health literacy in persons at risk of and patients with coronary heart disease: A systematic review
January, 2021 (PubMed)
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Considerations on Health Literacy and Hearing Aid Use
February, 2021 (The Hearing Journal)
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NATIONAL HEALTHCARE QUALITY AND DISPARITIES REPORT CHARTBOOK ON PATIENT SAFETY
February, 2021 (U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES)
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Health literacy in persons at risk of and patients with coronary heart disease: A systematic review
February, 2021 (PubMed)
Access Health literacy in persons at risk of and patients with coronary heart disease: A systematic review
Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study
January 27, 2021 (PubMed)
The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior.
Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy.
Access Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study
Healthy People 2030 Health Literacy Definition Tells Organizations: Make Information and Services Easy to Find, Understand, and Use
January 22, 2021 (Springer)
This summer, the U.S. Department of Health and Human Services (HHS) released Healthy People 2030, the fifth iteration of the nation’s 10-year plan to improve the health of all Americans. For the first time, Healthy People features health literacy as part of its framework. Specifically, attaining health literacy for all is one of Healthy People 2030’s five overarching goals. Further, Healthy People 2030 has released an expanded definition of health literacy. Healthy People previously identified health literacy solely in terms of individuals’ capacities to understand health information. Now Healthy People’s definition includes a new organizational component that recognizes the essential role organizations that provide health-related information and services play in improving health literacy. Physicians, as both clinicians and organizational leaders, have key roles to play in helping their organizations become health literate.
Testing the reliability of the Health Literacy Questionnaire with carers of older adults receiving hospital care
January 19, 2021 (PubMed)
Objective: To determine the re-test reliability of the Health Literacy Questionnaire (HLQ) with carers of older adults discharged from hospital or attending the outpatient clinic.
Results: Fifty-one carers of older patients participated. The HLQ showed good reliability (ICC = 0.75-0.90) for seven of the nine scales and moderate reliability (0.50-0.74) for the other two scales. Median completion time was 16.5 minutes (range 9-50), and acceptability was rated as 9.5/10.
Conclusion: The HLQ is a reliable tool for use with carers of older adults attending hospital. However, the length of time for completion of the HLQ may limit its feasibility for use by hospital staff and carers, given the high stress and time pressures of acute care.
Promoting social capital, self-management and health literacy in older adults through a group-based intervention delivered in low-income urban areas: results of the randomized trial AEQUALIS
January 7, 2021 (PubMed)
The Relationship Between Attitudes about Research and Health Literacy among African American and White (Non-Hispanic) Community Dwelling Older Adults
January 7, 2021 (PubMed)
Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19
Jan/Mar, 2021 (PubMed)
The coronavirus disease-2019 (COVID-19) pandemic is transforming the health care sector. As health care organizations move from crisis mobilization to a new landscape of health and social needs, organizational health literacy offers practical building blocks to provide high-quality, efficient, and meaningful care to patients and their families. This article provides practical guidance for systems and informs decisions around resource allocation and organizational priorities to best meet the needs of patient populations even in the face of financial and workforce disruption.
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Health literacy meets the life-course perspective: towards a conceptual framework
December 31, 2020 (PubMed)
This paper presents a novel conceptual framework combining the concepts of health literacy and life-course to guide public health planning and research. Health literacy is a key competence that enables individuals to navigate health-care systems and health promotion activities. The life-course perspective places emphasis on how disease risk accumulates along the life trajectory from fetal life onwards, and how it can even pass from one generation to the next. Our conceptual framework illustrates how different domains of health literacy are required, and how the unequal distribution of health literacy may be influenced by social determinants at different times in the life-course. Thus, it is essential to disaggregate health literacy into sub-themes and analyse them as they unfold in a long-term life-course perspective. The suggested framework would allow these patterns to be mapped, thereby enabling public health planners to strategically target health literacy promotion programmes to the right population segments at the right time.
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Interrelationships Between Patients’ Data Tracking Practices, Data Sharing Practices, and Health Literacy: Onsite Survey Study
December 22, 2020 (PubMed)
Although the use of patient-generated data (PGD) in the optimization of patient care shows great promise, little is known about whether patients who track their PGD necessarily share the data with their clinicians. Meanwhile, health literacy-an important construct that captures an individual’s ability to manage their health and to engage with their health care providers-has often been neglected in prior studies focused on PGD tracking and sharing. To leverage the full potential of PGD, it is necessary to bridge the gap between patients’ data tracking and data sharing practices by first understanding the interrelationships between these practices and the factors contributing to these practices.
Equity and health literacy: Using emerging evidence to inform the development of the National Preventive Health Strategy
December 7, 2020 (PubMed)
The term “health literacy” is used widely in global health promotion contexts. It is firmly embedded into Australian health research, policy and practice lexicon, although occasionally remains a contested space. While there are multiple definitions that encompass individual, population and environmental health literacy, the underlying tenet is that health literacy is critical for sustaining optimal health and well‐being. Indeed, health literacy is increasingly being viewed as a social determinant of health in its own right; and one which also powerfully influences other social determinants of health. Not surprisingly, health literacy scholarship is now synonymous with discussions about health equity. That is, vulnerable, disadvantaged, disempowered and marginalised populations throughout the world are reported to have poorer health literacy; and are often faced with health systems and service environments that are hard to access or difficult to navigate. We argue that this needs to change. And fast.
The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial
December, 2020 (PubMed)
Adolescents who are pregnant are a vulnerable population at risk for poor health literacy. Health literacy is an important determinant of health, and poor health literacy among adolescents is correlated with high-risk health behaviors and adverse health outcomes into adulthood. A review of the literature showed a significant gap in research related to health literacy in pregnant adolescents. The limited findings indicate the need for additional research attention on health literacy in pregnant adolescents and upstream approaches to improve adolescent health literacy, such as incorporating health literacy education into secondary schools. To strengthen approaches that build health literacy capacity, it is imperative that future research focuses on pregnant adolescents’ health literacy related to health behaviors, health outcomes, measurement instruments, health literacy frameworks, and targeted interventions.
The Effectiveness of an Active Learning Program in Promoting a Healthy Lifestyle among Older Adults with Low Health Literacy: A Randomized Controlled Trial
December 3, 2020 (PubMed)
The aim of this study was to examine the effects of an active learning program on health literacy, lifestyle behaviors, physical function, and mental health among community-dwelling older adults with low health literacy. When compared to the control group, the intervention group demonstrated a significant improvement in communicative health literacy, step count, engagement in moderate-to-vigorous physical activity, dietary variety, life-space mobility, social network size, grip strength, gait speed, and depressive symptoms. The active learning program can promote a healthy lifestyle and prevent functional decline among older adults who lack the confidence to engage in health communication.
Health Literacy for Cardiac Rehabilitation: An Examination of Associated Illness Perceptions, Self-Efficacy, Motivation and Physical Activity
November, 2020 (PubMed)
Health literacy has been shown to be lower in patients with cardiovascular disease, yet research into health literacy in this population is limited. This study used the Health Literacy Questionnaire (HLQ) to examine the health literacy and associated health, health behaviours and psychological profiles of cardiac rehabilitation patients from a remote and rural regional programme in the Scottish Highlands. Hierarchical cluster analysis grouped respondents based on their health literacy profile, and nonparametric methods were used to analyse differences between clusters on the other measures. A total of 282 participants responded (45.7%). Respondents were older (median: 71 years) and more likely to be from more affluent areas. Five health literacy clusters emerged with different profiles of health, physical activity, self-efficacy, motivation and illness perceptions. There was no difference in relation to cardiac rehabilitation attendance by health literacy cluster, but those with lower health literacy were less likely to be aware of the referral. Patterns of health literacy are associated with health, health behaviours and some psychological constructs. Knowledge of distinct cluster characteristics may help services better target interventions.
Health literacy on oral health practice and condition in an adult and elderly population
November 30, 2020 (PubMed)
The objective of this study was to investigate the impact of health literacy (HL) on health practices and oral health outcomes in an adult and elderly population in Brazil. A cross-sectional study nested in a cohort study was followed up over a period of four years (2011 and 2015) and assessed individuals between 23 and 69 years old from Piracicaba, São Paulo, Brazil. Based on age and sex, LHL was associated with use of public dental service and use of emergency dental visits. Based on age, sex and socioeconomic status, LHL was associated with use of emergency dental visits.
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Health Literacy and Preventive Behaviors Modify the Association between Pre-Existing Health Conditions and Suspected COVID-19 Symptoms: A Multi-Institutional Survey
November 19, 2020 (PubMed)
People with pre-existing health conditions (PEHC) are vulnerable to viral infection while health literacy (HL) and preventive behaviors (PB) have been shown to benefit people during the COVID-19 pandemic. The aim of this study was to examine the association between PEHC and suspected COVID-19 symptoms (S-COVID-19-S), and to investigate the modification effect of HL and PB. A cross-sectional study was conducted on 8291 participants visiting outpatient departments at 18 hospitals and health centers across Vietnam from 14 February to 31 May 2020. Higher HL and adherence to mask wearing can protect people from having S-COVID-19-S, especially in those with PEHC.
Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis
November 18, 2020 (PubMed)
Health literacy has yet to be described in a non-clinical, racially diverse, community-based cohort. Four questions assessing health literacy were asked during annual phone encounters with Multi-Ethnic Study of Atherosclerosis (MESA) participants between 2016 and 2018 (n = 3629). We used prevalence ratios (PRs) with 95% confidence intervals (CIs) to characterize how demographic and acculturation factors related to limited health literacy.
Limited health literacy was prevalent in 15.4% of the sample. Participants who were older, female, lower-income, or less acculturated were at greater risk for having limited health literacy. Chinese, Hispanic, and Black participants were more likely than White participants to have limited health literacy. Patterns were similar when stratified by race/ethnicity.
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Determinants of Health Literacy and Its Associations With Health-Related Behaviors, Depression Among the Older People With and Without Suspected COVID-19 Symptoms: A Multi-Institutional Study
November 16, 2020 (PubMed)
A cross-sectional study was conducted at outpatient departments of nine hospitals and health centers 14 February-2 March 2020. Self-administered questionnaires were used to assess patient characteristics, health literacy, clinical information, health-related behaviors, and depression. A sample of 928 participants aged 60-85 years were analyzed. The older people with higher health literacy were less likely to have depression and had healthier behaviors in the group with S-COVD-19-S. Potential health literacy interventions are suggested to promote healthy behaviors and improve mental health outcomes to lessen the pandemic’s damage in this age group.
Impact of health literacy on shared decision making for prostate‐specific antigen screening in the United State
November 9, 2020 (American Cancer Society)
Current guidelines endorse shared decision making (SDM) for prostate‐specific antigen (PSA) screening. The relationship between a patient’s health literacy (HL) and SDM remains unclear. In the current study, the authors sought to identify the impact of HL on the rates of PSA screening and on the relationship between HL and SDM following the 2012 US Preventive Services Task Force recommendations against PSA screening.
Measurement properties of self-report instruments to assess health literacy in older adults: a systematic review
November 9, 2020 (PubMed)
High health literacy (HL) is important to optimise health outcomes, particularly for older people (who are substantial consumers of health services) and their adult caregivers. The aim of this systematic review was to evaluate measurement properties of HL instruments tested with these population groups. From 4261 unique papers located, 11 met inclusion criteria; six reported measurement properties of three HL self-report tools administered to older people (HLQ, eHEALS, and HeLMS) so are reported in this review, none involved caregiver samples. The HLQ and HeLMS were rated “moderate,” and eHEALS “low” for tool development. The HLQ, examined in four included studies, had the highest ratings and quality of evidence across the three measurement properties investigated in included papers.
Improving health literacy: Lessons from clinical ethics
November 6, 2020 (Baylor College of Medicine)
“If you were in my position, what would you do?”
I still remember the first time I witnessed a patient ask this question. I was working with a physician at a local primary care clinic. We had given the patient a new diagnosis of a heart condition, and followed the diagnosis with a series of options for medications, referrals, imaging, and further diagnostics.
As we moved on to the next individual waiting to be seen at the clinic, my mind still lingered in the previous patient’s room. Had we performed our duty in explaining the diagnosis and giving the patient the tools he needed to make the best health decisions for himself?
For me, this experience was only the first of many to follow that highlighted the importance of promoting health literacy… More than 80 million people in the U.S. general population demonstrate low health literacy. To these individuals, new medical diagnoses and treatments represent new languages that must be learned – terminology, regimens, statistics, and specialists.
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Health Literacy and Emergency Department Utilization Among Community Adults With Mental and Chronic Health Conditions
October/December, 2020 (PubMed)
Reducing unnecessary emergency department (ED) utilization is a national health care priority. Low health literacy is a little explored but suggested cause of excess ED utilization. This study investigated the association between health literacy and ED utilization among a community sample of adults with common mental and chronic health conditions.
This study presented evidence that inadequate health literacy is common and independently associated with ED utilization among adults with mental health conditions. It supports an initiative to prioritize individuals with mental health conditions, and systematically screen, identify, and provide assistance to those with inadequate health literacy to reduce excess ED utilization. Several existing health literacy screening tools suitable for an emergency care setting are suggested.
Cardiovascular Diseases Health Literacy among Patients, Health Professionals, and Community-Based Stakeholders in a Predominantly Medically Underserved Rural Environment
October, 2020 (PubMed)
The central Appalachian region of the United States is disproportionately burdened with cardiovascular disease (CVD); however, the level of literacy about CVD among residents has not been well studied. This study aimed to examine the prevalence and factors of CVD health literacy (HL) among a sample of patients/caregivers, providers/professionals, and community stakeholders.
Of the total respondents (N = 82), <50% correctly answered all 5 CVD HL questions. Multiple logistic regression analyses showed that compared with respondents with advanced college degrees, those with a college degree or less were more likely to have low HL for “typical symptom of CVD,” “physical exercise and CVD,” “blood pressure and CVD,” and “stress and CVD.” In addition, compared with respondents younger than 50 years, those 50 years and older were 3.79 times more likely to have low HL for “physical exercise and CVD.”
These results suggest the incorporation of CVD HL into CVD care and that educational attainments should be part of CVD policies and programs in the region.
Research brief: Improving Health Literacy Could Prevent Nearly 1 Million Hospital Visits and Save of $25 Billion a Year
October 26, 2020 (Pew)
Findings from new UnitedHealth Group research illustrate the importance of increasing health literacy as a key component in driving better health outcomes and improving health care affordability. Seniors — who use more health care services, have more chronic conditions, and take more medications compared to other age groups — benefit from increased health literacy levels because it helps them make informed decisions and enhances their health care experience.
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Review of Organizational Health Literacy Practice at Health Care Centers: Outcomes, Barriers and Facilitators
October 16, 2020 (PubMed)
In this study, a systematic review of the literature was conducted to understand the evidence for the effectiveness of OHL and its health outcome, and the facilitators and barriers that influence the implementation of OHL. Evidence on the effectiveness of HL tools provides best practices and recommendations to enhance OHL capacities. Results indicated that shifting to a comprehensive OHL would likely be a complex process because HL is not usually integrated into the healthcare organization’s vision and strategic planning. Further development of OHL requires radical, simultaneous, and multiple changes.
ODPHP’s Health Literacy Custom List
October, 2020 (HealthyPeople2030)
Build a custom list of Healthy People 2030 objectives to use in your work. This custom list is publicly available to anyone with the link. If you add or remove an objective from the list, we’ll generate a new link.
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How Health Literate Are You? Put your knowledge to the test with our latest quiz
October 14, 2020 (DHHS)
Scholars and fellows across Pew’s three biomedical research programs are working to tackle some of the biggest challenges in human health by bolstering scientific knowledge. They’re focusing on issues that affect all Americans—from infectious diseases and cancer to gut health and beyond. Take this quiz to test your health literacy skills and learn more about scientists’ promising research.
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Organizational Health Literacy More Essential than Ever for Preventing and Managing Chronic Disease
October 14, 2020 (DHHS)
When healthcare consumers are unable find, understand, and use information to inform decisions about their care, the consequences can be dire. Because many healthcare interactions are happening remotely due to the COVID-19 pandemic, there is even greater risk for avoidable adverse outcomes due to misunderstanding.
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2020 Federal Plain Language Report Card
October 13, 2020 (CenterForPlainLanguage)
A decade ago, Congress passed the Plain Writing Act to ensure that people can understand the information they receive from federal agencies. Since 2012, the Center for Plain Language has issued a yearly report card evaluating how well agencies follow this law.
This year we evaluated 20 Executive Branch agencies, including all 15 cabinet-level departments. Agencies earned grades between A and F for both organizational compliance, covering the staffing, training, and annual reporting required by law, and writing, focusing on how easy it is to find, understand, and use information the public needs. For this year’s writing grade, we looked at two online pages from each agency.
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Center for Health Literacy Celebrates Health Literacy Month
October 13, 2020 (CenterForHealthLiteracy)
The UAMS Center for Health Literacy celebrates health literacy month with the Plain Pledge. The #PlainPledge is a social media campaign designed to engage health care professionals and students to pledge to use words that are easy to understand the first time someone hears or reads them. To take the pledge all you have to do is write a health-related word that you pledged to stop using in a word buster and take a selfie with it, and then share it on social media. A toolkit is available on our website.
With nearly 1 billion health-related Google searches each day, it is safe to say that many people use the internet to find health information. Unfortunately, due to the amount of misinformation on the internet some people don’t have the information they need to make appropriate health decisions for themselves. This is of significant importance given the current public health crisis with nearly 7 in 10 adults saying that searched for COVID-related information at the beginning of the pandemic. To address this need, we have created a new campaign with tips on finding health information online. Follow us on Facebook, Twitter, LinkedIn, or Instagram to learn more and share with your staff and the people you serve.
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Happy 10th Anniversary Plain Writing Act (Video)
October 12, 2020 (CenterForPlainLanguage)
The Plain Writing Act is turning 10 years old on October 13, 2020. The Act gave U.S. federal employees the legal oomph to turn the stereotype that government writing is overly complicated, stilted, and obtuse on its head. No longer was plain language just a good idea that could easily be tossed aside for lack of time or tacked on the end of a project as if it were synonymous with proofreading. Plain language was the law. Government now had the responsibility to ensure a reader could find, understand, and use the information it provided.
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Level of Health Literacy Among Patients With Thrombotic Thrombocytopenic Purpura
October 8, 2020 (HematologyAdvisor)
A team of investigators evaluated knowledge gaps among patients with thrombotic thrombocytopenic purpura (TTP) in remission and found a range of levels of understanding of the condition. Findings were published in Hemasphere, a journal powered by the European Hematology Association.
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Why Health – and Pancreatic Cancer – Literacy Matter
October 8, 2020 (PancreaticCancerActionNewtwork)
Patient navigators may be a valuable resource and are available at many hospitals and cancer centers across the country. These healthcare professionals can provide one-on-one guidance for patients as they face medical, legal or financial challenges, including helping you understand treatment options. Ask your healthcare team for patient navigators available to you.
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Will the Effect of New Federal Breast Density Legislation Be Diminished by Currently Available Online Patient Educational Materials?
October, 2020 (PubMed)
To evaluate readability of commonly accessed online patient educational materials (OPEM) on breast density in setting of recently passed federal breast density legislation. Fouty-one websites met inclusion criteria representing patient-directed OPEM on breast density. Readability of currently available OPEM on breast density may be written at a level too difficult for the general public to comprehend, which may represent a barrier to educational goals of newly passed federal breast density legislation.
Instrumental and affective communication with patients with limited health literacy in the palliative phase of cancer or COPD
October 7, 2020 (PubMed)
Patients have a ‘need to know’ (instrumental need) and a ‘need to feel known’ (affective need). During consultations with patients with limited health literacy (LHL) in the palliative phase of their disease, both the instrumental and the affective communication skills of healthcare providers are important. The study aims to explore instrumental and affective communication between care providers and LHL patients in the palliative phase of COPD or cancer.
A Select Bibliography of Actions to Promote Vaccine Literacy: A Resource for Health Communication
October 2, 2020 (PubMed)
In this bibliography, the researchers provide an introduction to the available evidence base of actions to promote vaccine literacy. The research team organized interventions to create a tool that can inform health communicators and practitioners seeking a resource focused on strategy and implementation design for actions that support vaccine literacy. This scoping bibliography is honed specifically to respond to the urgency of the current pandemic, when supporting and increasing vaccine literacy offers promise for achieving the critically needed high levels of vaccination. Over the course of the coming months and year, this bibliography will be a dynamic and “living” document hosted and maintained on vaccineliteracy.com.
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4 Main Barriers Diminishing Patient Activation Efforts
October 2, 2020 (PatientEngagement)
Driving meaningful patient-provider communication and addressing patient social determinants of health needs are key to patient activation. As the medical field pushes value-based care efforts, the concept of patient activation has become more critical. After all, it’s an activated patient who is able to fend off or manage illness in between clinic visits.
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October is National Health Literacy Month!
October, 2020 (Health Literacy Month 2020)
Health Literacy Month is a time for organizations and individuals to promote the importance of understandable health information. This annual, worldwide, awareness-raising event has been going strong ever since Helen Osborne founded it in 1999. Learn more about the importance of making health information easy to understand and making the health care system easier to navigate by going to Health Literacy Month 2020.
Parental education, health literacy and children’s adult body height
Jun-Sep, 2020 (PubMed)
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The paradox of the link between health literacy and health promotion: the case of COVID-19
Jun-Sep, 2020 (PubMed)
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A cluster-randomized study on the Risk Assessment and Management Program for home blood pressure monitoring in an older population with inadequate health literacy
September, 2020 (PubMed)
Improving mental health literacy in adolescents: systematic review of supporting intervention studies
September, 2020 (PubMed)
Health literacy and COVID-19
September, 2020 (PubMed)
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An app for supporting older people receiving home care – usage, aspects of health and health literacy: a quasi-experimental study
September, 2020 (PubMed)
Association Between Public Knowledge About COVID-19, Trust in Information Sources, and Adherence to Social Distancing:Cross-Sectional Survey
July-September, 2020 (JMIR)
Picture of a pandemic: visual aids in the COVID-19 crisis
September, 2020 (OxfordAcademic)
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The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model
November-December 2020 (ScienceDirect)
Answers to Coronavirus Questions
2020 (Georgia State University)
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