Philip M. Massey

Contextualizing an expanded definition of health literacy among adolescents in the health care setting

The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and practices relevant when managing ones health environment. It is an emerging area of inquiry especially among adults and those with chronic conditions; however, it has been less studied among adolescent populations. To begin operationalizing this concept in a manner appropriate for teens in a health systems context, we explored knowledge, attitudes and practices related to health and preventive health care in 12 focus groups with publicly insured adolescents (N = 137), aged 13-17 years, as well as eight key informant interviews with physicians who serve publicly insured teens. Five dimensions emerged that provide a preliminary framework for an expanded definition of health literacy among adolescents. These include: (i) navigating the system, (ii) rights and responsibilities, (iii) preventive care, (iv) information seeking and (v) patient-provider relationship. This robust definition of health literacy contextualizes the concept in a health environment where individuals must be informed and skilled health care consumers.

Findings toward a multidimensional measure of adolescent health literacy.

OBJECTIVE To explore a multidimensional measure of health literacy that incorporates skills necessary to manage ones health environment. METHODS We designed a questionnaire to assess variation in an expanded understanding of health literacy among publicly insured adolescents in California (N = 1208) regarding their health care experiences and insurance. RESULTS Factor loading and item clustering patterns reflected in the exploratory principal components factor analysis suggest that the data are parsimoniously described by 6 domains. CONCLUSION This multidimensional measure becomes relevant in an era of health care reform in which many will for the first time have health insurance requiring them to navigate a system that uses a managed care model.

Where Do U.S. Adults Who Do Not Use the Internet Get Health Information? Examining Digital Health Information Disparities From 2008 to 2013

With more people turning to the Internet for health information, a few questions remain: Which populations represent the remaining few who have never used the Internet, and where do they go for health information? The purpose of this study is to describe population characteristics and sources of health information among U.S. adults who do not use the Internet. Data from 3 iterations of the Health Information National Trends Survey (n = 1,722) are used to examine trends in health information sources. Weighted predicted probabilities demonstrate changes in information source over time. Older adults, minority populations, and individuals with low educational attainment represent a growing percentage of respondents who have looked for health information but have never used the Internet, highlighting trends in digital information disparities. However, 1 in 10 respondents who have never used the Internet also indicate that the Internet was their first source of health information, presumably through surrogates. Findings highlight digital disparities in information seeking and the complex nature of online information seeking. Future research should examine how individuals conceptualize information sources, measure skills related to evaluating information and sources, and investigate the social nature of information seeking. Health care organizations and public health agencies can leverage the multifaceted nature of information seeking to better develop information resources to increase information access by vulnerable populations.

Human papillomavirus (HPV) awareness and vaccine receptivity among Senegalese adolescents.

To examine HPV vaccine awareness and receptivity among adolescents and young adults in Senegal.

Health-related media use among youth audiences in Senegal.

Lower- and middle-income countries (LMICs) are experiencing rapid changes in access to and use of new internet and digital media technologies. The purpose of this study was to better understand how younger audiences are navigating traditional and newer forms of media technologies, with particular emphasis on the skills and competencies needed to obtain, evaluate and apply health-related information, also defined as health and media literacy. Sixteen focus group discussions were conducted throughout Senegal in September 2012 with youth aged 15-25. Using an iterative coding process based on grounded theory, four themes emerged related to media use for health information among Senegalese youth. They include the following: (i) media utilization; (ii) barriers and conflicts regarding media utilization; (iii) uses and gratifications and (iv) health and media literacy. Findings suggest that Senegalese youth use a heterogeneous mix of media platforms (i.e. television, radio, internet) and utilization often occurs with family members or friends. Additionally, the need for entertainment, information and connectedness inform media use, mostly concerning sexual and reproductive health information. Importantly, tensions arise as youth balance innovative and interactive technologies with traditional and conservative values, particularly concerning ethical and privacy concerns. Findings support the use of multipronged intervention approaches that leverage both new media, as well as traditional media strategies, and that also address lack of health and media literacy in this population. Implementing health-related interventions across multiple media platforms provides an opportunity to create an integrated, as opposed to a disparate, user experience.

School-Based HIV Prevention in Dakar, Senegal: Findings from a Peer-Led Program

This evaluation study examines the effectiveness of a peer-led technology-focused HIV prevention program targeting in-school youth in Dakar, Senegal. A quasi-experimental design was used to examine differences in knowledge, attitudes, and behavioral intentions related to HIV testing among students at three intervention schools and a comparison school. Findings at the school level vary; however, results suggest that students exposed to intervention activities had a 1.5 greater odds of intending to get HIV tested compared with students not exposed to the program. As access to and use of digital technologies continue to increase throughout parts of sub-Saharan Africa, programs will continue to leverage this medium to diffuse effective health education and promotion messages for intervention.

Looking Back and Planning Ahead: Examining Global Best Practices in Communication for Inactivated Polio Vaccination Introduction in Rwanda

The global polio community is committed to ensuring that all countries currently using oral polio vaccination (OPV) add at least one dose of inactivated polio vaccination (IPV) to their immunization schedules. Globally, communication efforts have been at the forefront of polio eradication programs for more than 25 years. This article combines research from secondary and primary sources of information on country experiences in polio vaccination and from the polio vaccination program in Rwanda. Secondary data included a review of 20 global articles that describe and analyze communication efforts for polio eradication and highlight best practices in communication approaches to address polio. The primary research consisted of qualitative and participatory data gathered from various stakeholders in two rural sites in Rwanda regarding approaches that could be used to develop culturally sound communication strategies to introduce IPV into the current routine expanded program on immunization schedule. Findings from this research highlighted the importance of identifying multichannel and multiaudience approaches to polio eradication that cut across different levels of the social ecological model. Findings further emphasize the importance of evidence-based and audience-centered communication programming to build and sustain the next big programmatic push for strengthening global routine immunization systems and replacing OPV with IPV. This article provides insights into the critical role that communication efforts have played and will continue to play in polio eradication worldwide.

What Drives Health Professionals to Tweet About #HPVvaccine? Identifying Strategies for Effective Communication

Introduction We conducted this study to quantify how health professionals use Twitter to communicate about the human papillomavirus (HPV) vaccine. Methods We collected 193,379 tweets from August 2014 through July 2015 that contained key words related to HPV vaccine. We classified all tweets on the basis of user, audience, sentiment, content, and vaccine characteristic to examine 3 groups of tweets: 1) those sent by health professionals, 2) those intended for parents, and 3) those sent by health professionals and intended for parents. For each group, we identified the 7-day period in our sample with the most number of tweets (spikes) to report content. Results Of the 193,379 tweets, 20,451 tweets were from health professionals; 16,867 tweets were intended for parents; and 1,233 tweets overlapped both groups. The content of each spike varied per group. The largest spike in tweets from health professionals (n = 851) focused on communicating recently published scientific evidence. Most tweets were positive and were about resources and boys. The largest spike in tweets intended for parents (n = 1,043) centered on a national awareness day and were about resources, personal experiences, boys, and girls. The largest spike in tweets from health professionals to parents (n = 89) was in January and centered on an event hosted on Twitter that focused on cervical cancer awareness month. Conclusion Understanding drivers of tweet spikes may help shape future communication and outreach. As more parents use social media to obtain health information, health professionals and organizations can leverage awareness events and personalize messages to maximize potential reach and parent engagement.

Understanding where and why Senegalese adolescents and young adults access health information: A mixed methods study examining contextual and personal influences on health information seeking

ABSTRACT Background: Adolescent and young adult years are critical to the development of behaviors that influence health across the life course. To reveal which health communication channels should be used to effectively reach and influence younger populations in Senegal, we used a mixed methods approach to identify and interpret the multifaceted influences surrounding where and why this population accesses health information. Methods: We conducted 16 focus group discussions among adolescents and young adults in Senegal in September 2012. We then collected survey data from a larger, more diverse sample of Senegalese youth in October–November 2014. Results: Our results demonstrate that information sources vary by health topic, differential access, age, and other demographics. While there is a greater perception of credibility and usefulness in information received from health professionals, stigma remains a barrier for obtaining information about HIV/AIDS from health centers. Older youth are also less likely to seek health information from adults, which may be influenced by preferred use of information technologies, especially for information about taboo health topics. Conclusions: Our findings support multi-pronged, targeted approaches to health communication efforts. We recommend that doctors continue to provide actionable information about preventing or treating specific diseases, whereas teachers should educate youth about general health topics and health promotion behaviors. The results suggest that traditional mass media, such as radio and television, are the best communication channels for information about HIV and sexual/reproductive health, especially for older adolescents and young adults.

Visualizing Patterns and Trends of 25 Years of Published Health Literacy Research

Background: With an increase in the number of disciplines contributing to health literacy scholarship, we sought to explore the nature of interdisciplinary research in the field. Objective: This study sought to describe disciplines that contribute to health literacy research and to quantify how disciplines draw from and contribute to an interdisciplinary evidence base, as measured by citation networks. Methods: We conducted a literature search for health literacy articles published between 1991 and 2015 in four bibliographic databases, producing 6,229 unique bibliographic records. We employed a scientometric tool (CiteSpace [Version 4.4.R1]) to quantify patterns in published health literacy research, including a visual path from cited discipline domains to citing discipline domains. Key Results: The number of health literacy publications increased each year between 1991 and 2015. Two spikes, in 2008 and 2013, correspond to the introduction of additional subject categories, including information science and communication. Two journals have been cited more than 2,000 times—the Journal of General Internal Medicine (n = 2,432) and Patient Education and Counseling (n = 2,252). The most recently cited journal added to the top 10 list of cited journals is the Journal of Health Communication (n = 989). Three main citation paths exist in the health literacy data set. Articles from the domain “medicine, medical, clinical” heavily cite from one domain (health, nursing, medicine), whereas articles from the domain “psychology, education, health” cite from two separate domains (health, nursing, medicine and psychology, education, social). Conclusions: Recent spikes in the number of published health literacy articles have been spurred by a greater diversity of disciplines contributing to the evidence base. However, despite the diversity of disciplines, citation paths indicate the presence of a few, self-contained disciplines contributing to most of the literature, suggesting a lack of interdisciplinary research. To address complex and evolving challenges in the health literacy field, interdisciplinary team science, that is, integrating science from across multiple disciplines, should continue to grow. [Health Literacy Research and Practice. 2017;1(4):e182–e191.] Plain Language Summary: The addition of diverse disciplines conducting health literacy scholarship has spurred recent spikes in the number of publications. However, citation paths suggest that interdisciplinary research can be strengthened. Findings directly align with the increasing emphasis on team science, and support opportunities and resources that incentivize interdisciplinary health literacy research.