Health Literacy

For foreign-born populations, difficulty in finding health care information in their primary language is a structural barrier to accessing timely health care. While such information may be available at a national level, it may not always be relevant or appropriate to the living situations of these people. Our objective was to explore the quality of online multilingual health information environments by pilot-testing a framework for assessing such information at the prefectural level in Japan. The framework consisted of five health care domains (health system, hospitals, emergency services, medical interpreters, and health insurance). Framework scores varied considerably among prefectures; many resources were machine-translated. These scores were significantly associated with foreign population proportion and the number of hospitals in each prefecture. Our multilingual health care information environment (MHCIE) framework provides a measure of health access inclusivity, which has not been quantified before. It is adaptable to other international contexts, but further validation is required.

Keywords: Japan; communication barriers; health resources; information dissemination.

Highlights •Choice of health information sources differs across sociodemographic groups.•Health care providers are used most frequently as information source.•Immigrants and low-educated are more likely to obtain information from emergency departments.•Results highlight the importance of low-threshold health information sources.

Methods Cross-sectional, paper-based, multilingual survey of a random sample of enrolees of two statutory health insurers in Hamburg, Germany. Data were collected from September to December 2017. Multivariable logistic regression was used to examine sociodemographic and health-related individual characteristics and their associations with participants’ choice of ten sources of health information.

Findings Participants’ choice of information sources differed significantly across the following sociodemographic and health-related characteristics: age, gender, immigration status, education, employment status, marital status and general state of health. Immigrants and individuals with low educational attainment were most likely to use emergency departments as sources of health information.

Conclusion Policy interventions aiming to manage the use of health information sources should focus on immigrants and individuals with low educational attainment. Providing multilingual, low-threshold counselling and information services could be an efficient way to reduce short-term costs of health information seeking behaviour to health insurers or other payers of care while improving patient empowerment.

ighlights •Negative health information-seeking experiences are common in a low-income cohort.•Health literacy and language preference impact information-seeking experiences.•Health communication efforts should consider language preference & health literacy.

Methods We administered a modified Health Information National Trends Survey in English, Spanish, and Chinese to a sample of San Francisco city/county residents. Using multivariable logistic regression analyses, we assessed how language and health literacy impact health information-seeking experiences (confidence, effort, frustration, quality concerns, and difficulty understanding information), adjusting for age, gender, race/ethnicity, education, usual place of care, health status, information-seeking behaviors, and smartphone ownership.

Results Of 1000 participants (487 English-speaking, 256 Spanish-speaking, 257 Chinese-speaking), 820 (82%) reported at least one negative health information-seeking experience. Chinese-language was associated with frustration (aOR = 2.56; 1.12–5.86). Difficulty understanding information was more likely in Spanish-language respondents (aOR = 3.58; 1.25–10.24). Participants with limited health literacy reported more effort (aOR = 1.97; 1.22–3.17), frustration (aOR = 2.09; 1.28–3.43), concern about quality (aOR = 2.72; 1.60–4.61), and difficulty understanding information (aOR = 2.53; 1.58–4.05). Language and literacy impacted confidence only in the interaction term between Chinese-speakers and health literacy.

Conclusion We found that negative health information-seeking experiences were common in non-English speaking populations those with limited health literacy.

Practice implications Health communication efforts should consider both language preference and health literacy to ensure accessibility for all patients.

Mental health literacy (MHL) is linked to help-seeking behaviours. Although lay people are not always well aware of mental health conditions, few international campaigns and interventions have been developed to raise awareness across cultures. To investigate MHL cross-culturally and to identify factors that are associated with MHL. Using an online survey, 506 participants (103 Greek, 108 UK, 146 USA, 149 other nationality) read and labelled five vignettes of individuals with Autism, ADHD, Schizophrenia, Bipolar disorder and a healthy control. Factors influencing response, confidence and accuracy were compared across all participants, and the effect of various demographics on accurate labelling was compared between countries. Recognition rates were higher than in previous investigations: 75.5% of participants recognised the Healthy vignette, 71.1% ADHD, 61.7% Autism, 56.6% Schizophrenia and 31.6% Bipolar. MHL varied across different countries, with religion, language spoken, and education having the greatest effects. Personal experience of mental illness partially affected MHL. MHL is relatively high for some mental health conditions, but public knowledge of other conditions is still poor. Factors influencing MHL vary across countries.