bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond the like button: how european public health institutions use social media in 2024?
Authors: Vital Brito D , Garcia A 
Published: October 2024

Abstract

Background
In 2024, 62% of world’s population actively use social media (SM), with people aged 16 to 64 spending an average of 2 hours and 23 minutes daily across 6,7 SM platforms - most people use Facebook but spend more time on TikTok. While these platforms are essential for disseminating public health information, this study aims to explore their use by public health institutions in European countries.

Methods
We analysed the SM engagement of 32 health institutions recognized by ECDC across 29 European countries. Data collected focused on Facebook, Instagram, X, LinkedIn, TikTok, and YouTube, including SM presence on official websites, number of followers, and posts from January to March 2024. Additional data included followers per 100.000 residents, with population statistics from Worldometer and SM usage from DataReportal.

Results
Most institutions (30) are active on SM, particularly on Facebook (28), X (23), Instagram (22), YouTube (22), and LinkedIn (21). Spain and Slovenia’s institutions are active on all analysed platforms, while only four institutions are on TikTok. The most used platforms were Facebook and X, with averages of 59,7 and 58,1 publications, respectively. There are disparities in engagement across platforms, with Facebook having the highest average followers (177.241) and TikTok the lowest (1.961) among all platforms. Notably, the most followed platform within ten institutions did not match country’s most popular platform, indicating a misalignment in SM platforms’ strategy. There was an average of 2.756 followers per 100.000 residents among analysed countries.

Conclusions
Public health institutions in Europe are actively using SM platforms to disseminate health information, mainly Facebook, X, LinkedIn, and Instagram. Despite high engagement on Facebook and X, there is a need for strategic alignment with audience’s preferences, particularly in underutilized platforms like TikTok, to optimize the effectiveness of public health communication.

Key messages
• The majority of European public health institutions actively use social media, with Facebook leading; however, newer platforms like TikTok are underutilized.
• There is a need for public health institutions to realign their social media strategies to better match the platforms preferred by their audiences to maximize the effectiveness of their communication.
Defining digital health literacy profiles in Spanish adults: a latent class analysis
Authors: Hernández Encuentra E , Bas-Sarmiento P , Fernández-Gutiérrez M , González-Caballero J L , Montagni I 
Published: October 2024

Abstract

Background
According to different reports, Spain is among the European countries that use digital health technologies the most. However, to develop inclusive and fair digital health services, there is the need to feature digital health knowledge, skills, confidence, and a positive attitude about their significance. This work aims to draw a picture of digital health literacy levels in Spain.

Methods
A stratified sample of the Spanish population regarding gender, age group and area of residence was used. Participants were recruited from an online panel and by direct approach to balance quotas. Between May 2021- May 2022, participants filled a self-administered online survey, including the Spanish version of the eHealth Literacy Questionnaire (eHLQ) and the eHealth Literacy Scale (eHEALS).

Results
Digital health literacy showed similar mean scores, between 2.6-2.7 out of 5 with similar SD on each of the 7 dimensions of the eHLQ. The highest scores were related to knowledge about filling data in digital health services and knowledge about health and how the body works, and feelings about the usefulness of digital technology for health. In contrast, lower scores were related to sharing health information by technology, thinking that using technology gives access to better health services, and the possibility to contact usual health professionals with technology. Latent profile analysis identified 5 user profiles. Significant differences were found according to age, inhabitants per municipality, technology use, self-perceived health status, educational level, socioeconomic index and eHEALS scores; not by gender.

Conclusions
As the scores are similar in the different subscales, competencies, attitudes and confidence in digital health that they measure are balanced. However, the main challenge appears in granting users access to digital services that work, which involves the definition and monitoring of strategies until the final implementation.

Key messages
• Digital Health literacy in Spain differs according to different aspects, not only age, educational or socioeconomic level.
• Confidence in usefulness is a common denominator among the five digital health service user profiles identified.
The empowering role of health literacy in combatting fake news, misinformation and infodemics
Authors: Beese A-S , Guggiari E , Jaks R , De Gani S M 
Published: October 2024

Abstract

Background
In times of the rapid digital transformation, people need to acquire specific knowledge, skills and attitudes to deal with data, digital information and technology. Such skills are particularly important in times of crisis, as the COVID-19 pandemic has shown. Alongside the pandemic, a so called “infodemic” has emerged, i.e., an overabundance of information, accompanied by misinformation, which impedes sound decision-making processes, affects health literacy (HL) and impacts public health. However, while misinformation poses a well-known threat to our health and well-being, we still lack viable concepts and approaches to satisfactorily solving this issue. Thus, we aimed at reviewing the concept of HL in view of the infodemic and health-related challenges.

Methods
In a 12-month participatory process in Switzerland in 2023, we investigated the empowering role of HL in light of the polycrisis. On behalf of the Swiss Federal Office of Public Health, we conducted a literature review on existing HL definitions. Then, we conducted 6 expert interviews and 2 focus group interviews with other 10 experts in HL and associated domains, which guided and informed the review process.

Results
As a result, HL can be understood as a bundle of competencies to proactively deal with health-related information, services, and challenges and thereby empowers people to manage their and other’s health and well-being. Thus, HL empowers people to better manage digital information and services and promotes critical thinking. This in turn is necessary to assess information quality, uncover misinformation and to adequately manage health data and information.

Conclusions
HL represents a crucial prerequisite for individuals, professionals, and decision-makers to find trustworthy health information, to reflect upon the quality and credibility of sources and content, and to understand the complex interrelations of the determinants of health and is therefore crucial for public health.

Key messages
• Health literacy empowers people to adequately deal with fake news, misinformation and infodemics.
• Strengthening health literacy offers great potential for public health to promote critical thinking and to rebuild trust.
Development and validation of a tool for assessing breast cancer health literacy among Chinese women
Authors: Chenyang P , Yuanli L 
Published: October 2024

Abstract

Background
Breast cancer (BC) is a major malignancy that seriously threatens women’s health. No unified, evidence-based, standardized assessment tools for BC literacy are available in China yet.

Objectives
We sought to develop an assessment tool to measure BC health literacy among Chinese women and to test the tool’s reliability, validity, and feasibility.

Methods
Group discussion, expert consultation, and small-sample pilot investigation were conducted to develop an initial assessment tool. A multi-stage stratified random-sampling process was used to select women aged 18-64 years in Yichang City, Hubei Province, China, for an onsite survey. Project analysis and exploratory factor analysis were used to screen the questions to create a formal assessment tool, which was further evaluated by feasibility analysis and the measurement of reliability and validity.

Results
The official version of the assessment tool for Chinese female BC health literacy includes 32 items. Nine common factors (policy knowledge, uncorrectable risk factors, modifiable risk factors, identification of early warning signs #1 and #2, screening methods, breast self-awareness and examination behaviors, timely seeking of medical help and standardized treatment, and rehabilitation) were extracted through exploratory factor analysis with factor loadings of 0.511-0.873 and a cumulative explained variance of 65.989%. Confirmatory factor analysis revealed χ2/df = 1.61, CFI = 0.91, TLI = 0.90, RMSEA = 0.04, and SRMR = 0.06. The overall Cronbach’s α coefficient was 0.875, and the split-half reliability was 0.770 (both &gt;0.700).

Conclusions
An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity. The application of this tool can help to promote BC prevention and control in China and may also benefit other countries.

Key messages
• An assessment tool for Chinese female BC health literacy was developed with acceptable feasibility, reliability, and validity.
• The application of this tool can help to promote BC prevention and control in China and may also benefit other countries.
Factors Influencing Health Literacy among South Korean Adults: A Nationwide Study
Authors: Kim J E , Bae Y , Song I H 
Published: October 2024

Abstract

Background
Health literacy is crucial for health knowledge, behaviors, and outcomes, but research on health literacy has been limited to specific populations and settings in South Korea. This study aimed to identify factors influencing health literacy in a nationally representative sample of South Korean adults to inform public policies.

Methods
This cross-sectional study utilized data from the 2020 Korea Health Panel survey (10,262 adults aged 18-84 years). Sociodemographic factors (age, gender, education level, monthly household income, employment status, marital status, household characteristics, and region) and health (subjective health status, presence of chronic diseases, depression, and health insurance status) factors were examined. Health literacy was assessed using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Linear regression analysis was performed to identify factors associated with health literacy.

Results
The mean health literacy score was 9.1 (SD 1.60), with significant differences across age groups (p &lt; 0.001). Linear regression analysis (adjusted R2=0.287, F = 322.83, P &lt; 0.001) revealed that higher age, female gender, lower education, lower household income, being single, living outside a metropolitan area, having chronic diseases, lower subjective health, depression, and being uninsured or receiving medical aid were significantly associated with lower health literacy (all p &lt; 0.001).

Conclusions
This study identified several socio-economic and health-related factors significantly associated with health literacy among South Korean adults. The findings suggest that older individuals, who may require more time to understand and use health information, are particularly vulnerable to low health literacy. These results provide valuable insights for developing targeted interventions and public health policies aimed at promoting health literacy and successful aging in the context of a rapidly aging society.

Key messages
• Various socio-economic and health-related factors significantly influence health literacy among South Korean adults.
• Older individuals are particularly vulnerable to low health literacy, which has implications for successful aging in a rapidly aging society.
How to measure Organizational Vaccine Literacy: an exploratory cross-country survey
Authors: Bellini A , Russo M L , Aloise I , Marchetti G , Scarso S , De Marchi C , Bartolucci C , Tosti M E , Declich S , Marceca M 
Published: October 2024

Abstract

Background
The project AcToVax4NAM (Grant No. 101018349-3° EU Health Programme) aims to ensure equal and guaranteed access to vaccination services for Newly Arrived Migrants (NAMs). The working group developed a tool that measured the level of Organizational Vaccine Literacy (OVL), defined as an organizational effort to make the Health System easier to access and navigate, thereby facilitating informed decision-making regarding vaccinations for individuals, families and communities.

Methods
A systematic literature review was undertaken to identify validated tools for measuring OVL, but none was found. Consequently, the review was broadened to include tools for assessing Organizational Health Literacy, which were then adapted to define OVL. A questionnaire consisting of 22 questions divided into 7 sections was developed, utilizing a scale of 1 to 5 to gauge OVL. The survey was then distributed among healthcare services in 8 countries of the AcToVax4NAM consortium.

Results
We received 88 responses, mainly from Italy (26%), Spain (23%) and Greece (12%), encompassing 17 facilities, primarily vaccination centers and health prevention departments. Questions about the clarity and easy access to vaccination information provided by organizations had high mean scores, except the questions on the navigability of websites for foreign patients (mean scores &lt; 3). Notably, responses related to the issue of cross-sectoral collaboration between health services and other partners (e.g., patient associations, NGOs), had a mean score of 2.56. Low scores were observed in the area related to the perception of possible individual contribution to systemic organizational efforts.

Conclusions
Shifting to an approach in which organizations prioritize equity and address complex needs, rather than leaving it to individuals to navigate the complex world of healthcare providers, could bring benefits to population groups, particularly those at risk of not accessing prevention services, such as NAMs.

Key messages
• After conducting a systematic review to identify validated instruments for the measure of Organizational Vaccine Literacy (OVL), a tool consisting of 22 questions was developed to measure OVL.
• Shifting to an approach where organizations prioritize equity and address complex needs, rather than leaving it to individual responsibility, could significantly benefit vulnerable population.
Project Health Resilience: a health literacy programme for 16–19-year-olds delivered by doctors
Authors: Grindlay A , Marks D , Zuriaga Alvaro A , Rau C , Lewis C , Landy G , Cross A , Dillon C , Mortlock M , Weil L 
Published: October 2024

Abstract

Background
Project Health Resilience is an education-setting based health literacy pilot for Londoners aged 16-19. This is a transitional age when young people independently engage with health services. Greater health literacy levels improve use of preventive services, successful management of long-term health conditions and reduce emergency service use. Research during the COVID pandemic also demonstrated the importance of building trust with health professionals to reduce health inequalities. The impact of poor health literacy is observed universally. This intervention was developed to empower young people at a critical time.

Methods
3 bespoke modules (healthcare access; medical emergencies; mental health resilience) were co-produced with young people and delivered by doctors. During 2023, 46 sessions were carried out with 712 attendances across 8 London settings. A mixed-methods approach, including questionnaires and interviews, was used for the evaluation. The study explored whether taking part resulted in increased awareness of services, knowledge, confidence and trust in health professionals.

Results
Participants reported that topics filled a crucial gap in their learning. Awareness and confidence increased for: awareness of different health services (increase of 18%) and mental health services (38%), confidence calling emergency services (13%), confidence dealing with medical (34%) or mental health emergencies (40%). Knowledge questions answered correctly increased across the 3 modules (46% pre vs 60% post). Trust levels increased and findings suggest that doctors delivering sessions was a key component.

Conclusions
Findings add to the evidence base around education-setting based health interventions improving health literacy. Providing a unique opportunity for adolescents to engage with health professionals can increase trust levels. Doctors delivering health education at this critical age is a pioneering model which can be replicated in other settings.

Key messages
• Health literacy education is particularly impactful at this critical age of transition; this can contribute to reducing health inequities across the life course.
• Trust, collaboration, and co-production were core principles upon which this pilot thrived. Without input from young people, it is difficult to design appropriate and impactful interventions.
Co-designed Health Literacy Activities for Children in Primary Schools
Authors: van Boxtel W , Jerković-Ćosić K , Chin A Paw M 
Published: October 2024

Abstract

Early exposure to health literacy (HL) and fostering children’s HL development for health promotion purposes is believed to positively influence their ability to lead healthier lives during adulthood (WHO, 2021). Our qualitative study on children’s perspectives on health and HL showed that children perceive health in a broader context emphasizing aspects of everyday life. When engaging with health information, they often encounter irrelevant information and struggle to discern its trustworthiness (van Boxtel et al., in preparation). In this study, we aim to co-design HL activities with children in primary school for the context of health promotion. Children, aged 9-12 years, formed co-design teams and participated in six 1-hour sessions. Initially, they discussed what HL is and selected the most relevant HL skills to address. Through activities like body mapping, they explored ways to learn these skills. Subsequent sessions involved brainstorming ideas for the designing, and prototyping activities. A larger group of children tested these prototypes, followed by evaluations and improvements by the design team. Preliminary results indicate that children prefer designing HL activities that resonate with their everyday experiences. However, they often relied on familiar ideas unless aided to think creatively, therefore we used AI tools for ideation. The final designs, such as life-sized board game about healthy food, show potential to learn HL in schools. Results of the learning outcomes from these activities are pending and will be presented at the conference. Co-designing with children leads to meaningful HL activities that encourage active engagement with health information. This study inspired us to build a toolbox for learning HL skills for children aged 9-12-years-old in primary schools or childcare settings. We also aim to co-design other identified HL skills and competencies from our Delphi study (Van Boxtel et al., in preparation).

Key messages
• HL activities co-designed by children reflect daily life relevance, fostering deeper engagement and learning.
• Using co-design, we enable children to actively engage with health information and learn specific HL skills.
Systematic review of the Health Literacy Questionnaire (HLQ) for global health literacy development
Authors: Hawkins M , Cartner S , Cheng C , Osborne R H 
Published: October 2024

Abstract

Background
The Health Literacy Questionnaire (HLQ) is used to inform programs and policies in more than 80 countries. It is a key needs assessment in the Ophelia (Optimising Health Literacy and Access) process, a codesign process to build effective interventions. Ophelia is applied in the European Commission Joint Action on Cardiovascular Diseases and Diabetes initiative (25 projects/13 countries). Given growing demand, an Ophelia digital platform is being developed, and confirmation of robust HLQ psychometric evidence is needed for user confidence in the interpretation and use of HLQ scores in their contexts. This study is a review of the HLQ.

Methods
Developed in Australia in 2013, the HLQ measures nine health literacy domains and is translated to 40 languages. A March 2024 PRISMA systematic search (PROSPERO CRD42022361966) identified 257 articles, which were screened for evidence about internal structure and reliability.

Results
Across 15 countries/languages, 22 articles were included. Study samples included diverse groups, settings and contexts. Out of the 18 studies that used factor analysis, three used the Bayesian approach. All 15 classical factor analysis studies reported satisfactory fit indices in restricted 9-factor models (range CFI=0.841 to 0.995, TLI=0.826 to 0.969, RMSEA=0.048 to 0.084), except two required correlated residuals for acceptable fit indices. Factor loadings were significant except for five items across five studies (range .20 to .99). Three studies used Rasch modelling and found all domains had unidimensionality except for Domain 9 in one study. Most studies reported Cronbach’s alpha (range .57 to .95) across all domains, with only three studies reporting α&lt;.7.

Conclusions
The HLQ has exceptional robust psychometric properties across cultures and languages, paving the way for users to have confidence in HLQ psychometric validity evidence on the upcoming Digital Ophelia platform to support scaling up of health literacy development.

Key messages
• The HLQ has robust psychometric properties across countries and languages.
• The HLQ 9-domain profiles can inform intervention development for equitable health outcomes.