Bo J. A. Haglund

Readability of online health information: implications for health literacy

Accessibility is one of six quality criteria articulated by the European Commission in its code of conduct for health websites. Readability plays an integral part in determining a websites accessibility. Health information that is hard to read may remain inaccessible to people with low health literacy. This study aimed to calculate the readability of websites on various causes of disease. The names of 22 health conditions were entered into five search engines, and the readability of the first 10 results for each search were evaluated using Gunning FOG, SMOG, Flesch-Kincaid and Flesch Reading Ease tests (n = 352). Readability was stratified and assessed by search term, search term complexity, top-level domain and paragraph position. The mean reading grade was 12.30, and the mean FRE was 46.08, scores considered ‘difficult’. Websites on certain topics were found to be even harder to read than average. Where conditions had multiple names, searching for the simplest one led to the most readable results. Websites with .gov and .nhs TLDs were the most readable while .edu sites were the least. Within texts, a trend of increasing difficulty was found with concluding paragraphs being the hardest to read. It was also found that some of the most frequent search results (such as Wikipedia pages) were amongst the hardest to read. Health professionals, with the help of public and specialised libraries, need to create and direct patients towards high-quality, plain language health information in multiple languages.

Social capital does matter for adolescent health: evidence from the English HBSC study.

Social capital has grown out of the recognition that health-related behaviours are shaped and constrained by a range of social and community contexts and that the ways in which an individual relates to social networks and communities has important effects on their health and well-being. Given the strong and complex inequalities that exist in adolescent health at both the national and international levels, social capital, acting a protective factor (or asset), may help reduce poor outcomes. The aim of this study was to measure and assess the relative importance of a range of social indicators representing the different domains of social capital on the health, wellbeing and health-related behaviours of young people. The study population was a random sample of 6425 school children aged 11-15 years old in 80 schools in England. Data were collected by a standardized questionnaire under supervised conditions in the classroom developed as part of the WHO Health Behaviour in School Aged Children (HBSC) study. This study has shown that social capital matters for young peoples health, statistically significant relationships were found between the range of social capital indicators and the health and health-related outcomes selected for study. For example, young people with a low sense of family belonging and low involvement in the neighbourhood were almost twice as likely to report poor health (OR = 1.87 and 1.96, respectively). Low involvement in the neighbourhood was also highly associated with low consumption of fruit (OR = 2.48) and vegetables (OR = 2.62). Overall, however the strength of associations found varied across health behaviours and indicators of social capital and this requires further examination.

Socioeconomic differences in smoking in an urban Swedish population. The bias introduced by non-participation in a mailed questionnaire.

Stockholm Health of the Population Study is a cross-sectional study carried out from 1984–85. Postal questionnaires, telephone interviews and health interviews were used to get information from a sample of 5,199 persons, 18–64 years of age, on health status, risk exposures, healthcare consumption and social factors. Non-participation with respect to the postal questionnaire was 36.8%. With subsequent telephone interviews and an invitation to a health interview, non-participation was reduced to 17.8%. The estimated prevalence of daily smoking increased from 36.1% to 38.7. The non-responders had a higher prevalence of daily smoking in all sub-groups. This effect of the efforts to reduce non-participation differed socially. The prevalence of smoking for men, 40–64 years of age, who were reached by telephone was 60.3%. Male professionals and intermediate non-manual workers, 40–64 years of age reached by telephone had a prevalence of smoking, which was twice as high as for the responders of the questionnaire (62.5 and 26.8%, respectively). In the younger age-group, non-responders had the same socioeconomic pattern in smoking as the responders. Independent of socioeconomic group, there was a tendency of ill or disabled smokers to respond more quickly than healthy smokers. Using a postal questionnaire with a high non-response rate might lead to an overestimation of socioeconomic differences and an underestimation of smoking prevalence.

Who is a successful quitter? One-year follow-up of a National Tobacco Quit and Win Contest in Sweden

The first nation-wide Quit and Win Contest in Sweden was held in 1988 with 12,840 participants. This corresponds to a participant rate of 6.4 per 1,000 daily tobacco users in Sweden. In order to follow up the long-term effects of cessation and to analyse the determinants for successful cessation, a panel (n = 946) of randomized participants were followed-up at 6 and 12 months with a mailed questionnaire. This gave a complete set of data for 557 (panel) respondents. Available baseline data from the participants’ entry forms included sex, age, occupation, specific tobacco habits, quitting attempts during the previous year, and place of residence. At the 12-month follow-up 21% had been tobacco-free for the whole year. In addition 9% of the participants relapsed into tobacco-use, then quit again and were tobacco-free at the 12-month follow-up. The success rate for those participants (14%) who used smokeless tobacco (oral snuff) was similar to that of smokers. The logistic regression showed a significantly better prognosis for success among those without any earlier quitting attempts during the previous year (OR 2.35), if the subjects participated of their own volition rather than having been recruited by a non-tobacco user (OR 1.74), and if they were married/co-habiting (OR 1.92), the results were also significantly improved. The results also show that as a population-based method, Quit and Win produced many successful tobacco quitters, and one year after the contest one-fifth of the participants were still abstinent.

Estimating road traffic mortality more accurately: Use of the capture–recapture method in the West Azarbaijan Province of Iran

The study estimates the rate of fatal road traffic injuries (RTIs) by population and road-users group in one Iranian province. The capture – recapture method was employed, using both the death register and the forensic medicine register over one year. They recorded totals of 669 and 665 RTIs respectively, giving a non-overlapping number of 897 cases. An estimate of 1018 fatalities occurred, at rates of 34 per 100,000 of the population for all road users aggregated, 10 per 100,000 for pedestrians and 25 per 100,000 for other road users. Coverage was somewhat better for victims less than 15 years of age, and also for males. The method showed 121 under-reported cases in both sources; however, it can help Iranian policy-makers to produce a good estimation of fatal RTIs number each year, when following up current RTIs-prevention programmes. Yet, given that each registry operates separately, optimum coverage will only be obtained when both sources are integrated and work together.

Higher education and more physical activity limit the development of obesity in a Swedish rural population. The Skaraborg Project.

Objective:To investigate the prevalence and the secular trends of obesity in a rural Swedish community with emphasis on the association with socioeconomic status and lifestyle.Design:The Skaraborg Project cross-sectional population surveys were conducted in Vara, a rural community in the southwest of Sweden, every fifth year between 1977 and 2002.Subjects:A total of 3365 residents (1634 men and 1731 women) aged 30–60 years.Measurements:Obesity was defined as body mass index⩾30 kg m−2. Information on ethnicity, marital status, socioeconomic status and lifestyle was collected by a questionnaire.Results:In 1977–1982, the average prevalence of obesity was 14% in both men and women, and in 2002, the prevalence of obesity was 19% in men and 21% in women. The age-adjusted odds ratio (OR) of obesity in 2002 was 1.48 (1.00, 2.20) in men and 1.41 (0.97, 2.05) in women. Without the simultaneous increase in the level of education and leisure-time physical activity (LTPA), the risk of developing obesity could have been considerably higher; in men OR=3.08 (1.88, 5.03) and in women OR=2.72 (1.66, 4.44). In multivariate models, higher levels of education and LTPA were associated with protective effects on obesity in both men (OR=0.60 (0.43, 0.83) and OR=0.50 (0.45, 0.79)) and women (OR=0.73 (0.54, 0.98) and OR=0.57 (0.42, 0.78)), respectively.Conclusions:This study revealed an upward secular trend in the prevalence of obesity in a rural community in Sweden. Increasing levels of education and LTPA limit this ongoing development of obesity. Public health strategies for the prevention of obesity should consider the special condition in rural environments.

Health communication in primary health care - A case study of ICT development for health promotion

BackgroundDeveloping Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel.MethodsA qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis.ResultsHealth communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel.ConclusionsHealth communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate health communication for promoting health, i.e. ‘health promoting communication’.

Leadership, organization and health at work: a case study of a Swedish industrial company

The application of knowledge on organization and leadership is important for the promotion of health at workplace. The purpose of this article is to analyse the leadership and organization, including the organizational culture, of a Swedish industrial company in relation to the health of the employees. The leadership in this company has been oriented towards developing and actively promoting a culture and a structure of organization where the employees have a high degree of control over their work situation. According to the employees, this means extensive possibilities for personal development and responsibility, as well as good companionship, which makes them feel well at work. This is also supported by the low sickness rate of the company. The results indicate that the leadership and organization of this company may have been conducive to the health of the employees interviewed. However, the culture of personal responsibility and the structure of self-managed teams seemed to suit only those who were able to manage the demands of the company and adapt to that kind of organization. Therefore, the findings indicate that the specific context of the technology, the environment and the professional level of the employees need to be taken into consideration when analysing the relation between leadership, organization and health at work.

Geographical and socioeconomic distribution of overweight and morbidity in a rural Swedish county.

This report on overweight is based on a cross-sectional study in Skaraborg County, Sweden, in 1977. Mean values of Body Mass Index (BMI) are higher in this county than in other areas studied in Sweden and abroad. In correlation analysis the strongest association was found between overweight and hypertension. This is of particular interest since other studies have shown that Skaraborg county, has one of Swedens highest proportions of treated hypertensives and also higher mortality during the 1970s in hypertension and obesity related diseases. The BMI varied between the municipalities of the county. Overweight was most common in the agricultural municipalities. The mean value of the BMI was higher among workers and persons with less formal education. This is contradictory to earlier Swedish studies with regard to men but not women. Physically demanding jobs accounted for more overweight individuals whereas high physical activity during leisure time was correlated with low body weight.

Geographical and Socioeconomic Distribution of Physical Activity at Work and Leisure Time and Its Relation to Morbidity in a Swedish Rural County

The article is an account of physical activity at work and during leisure time in a Swedish rural county based on a cross-sectional study of a selection of 7986 individuals in the age range 25–75, at 5-year intervals. 70% of the men and 71% of the women participated in the study—carried out in the spring of 1977—comprising a health examination and a combined inquiry/interview poll. 50% of the men and 22% of the women perform either moderately heavy or heavy work, with little variation between age groups. 20% of the men and 8% of the women engage in regular physical exercise and hard training. 14% of the men and 15% of the women are inactive during their leisure hours. Physical activity at work and physical exercise habits vary in different municipalities. Thus in the rural districts, physical activity at work is greater than elsewhere. Any differences between municipalities disappeared after adjustment for age, sex and occupation. Greater physical activity at work is positively correlated to somatic disturbances, one being a high diastolic blood pressure. A high level of physical activity in leisure time is correlated to low total morbidity of somatic disorders and fewer mental disturbances—irrespective of age, sex, physical activity at work and socioeconomic group. An astonishing finding is that there is no correlation between physical activity during leisure time and at work. Nevertheless, there are differences between socioeconomic groups regarding physical activity during leisure hours. Civil servants are those characterized as most active.