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Background Healthcare professionals have been slow to adopt health literacy practices. With the focus on organizational health literacy increasing, there is a need for accompanying workforce training. Aims: The Innovate to Communicate workshop aimed to increase participants’ knowledge and skills to (1) communicate using evidence-based health literacy practices e.g., plain language, chunking information, teach back, medicine review, and (2) integrate health literacy into structures, processes, and quality measures.Methods Health Literacy Collaborative of the Dallas Fort Worth Hospital Council, developed the ITC modules and workshop informed by the 10 Attributes of a Health Literate Organization and adult learning principles. We developed an interactive, engaging workshop that includes a didactic slide deck, exemplar videos, role-play scenarios, a Kahoot® game, and the Agency for Healthcare Research and Quality [AHRQ] Communication Observation Form.Results The ITC workshop was delivered at 7 virtual or in-person conferences with 250 participants. Of the total participants, 104 completed the workshop evaluation. Most reported that they see themselves using health literacy strategies in direct patient care (90%) with many participants feeling mostly or completely confident about using health literacy strategies such as plain language, chunking information, and teach back (81%) and doing one health literacy action in the next week (89%). The majority (92%) reported that the ITC workshop introduced them to at least one new health literacy resource that they had not used before. Most (93%) reported that they see themselves using the ITC workshop to train others and almost all (97%) reported that they were likely to recommend the ITC workshop to their colleagues. While 89% reported that the 1½ h workshop was the right amount of time, 11% reported that it was too short.Discussion The ITC was an interactive, engaging workshop that is available at no cost to others who are training healthcare professionals in health literacy.

BackgroundThis study will pilot-test an innovative just-in-time adaptive intervention to reduce severe respiratory illness among children with severe cerebral palsy (CP). Our intervention program, Respiratory Exacerbation–Plans for Action and Care Transitions (RE-PACT), delivers timely customized action planning and rapid clinical response when hospitalization risk is elevated. ObjectiveThis study aims to establish RE-PACT’s feasibility, acceptability, and fidelity in up to 90 children with severe CP. An additional aim is to preliminarily estimate RE-PACT’s effect size. MethodsThe study will recruit up to 90 caregivers of children with severe CP aged 0 to 17 years who are cared for by a respiratory specialist or are receiving daily respiratory treatments. Participants will be recruited from pediatric complex care programs at the University of Wisconsin–Madison (UW) and the University of California, Los Angeles (UCLA). Study participants will be randomly assigned to receive usual care through the complex care clinical program at UW or UCLA or the study intervention, RE-PACT. The intervention involves action planning, rapid clinical response to prevent and manage respiratory illness, and weekly SMS text messaging surveillance of caregiver confidence for their child to avoid hospitalization. RE-PACT will be run through 3 successively larger 6-month trial waves, allowing ongoing protocol refinement according to prespecified definitions of success for measures of feasibility, acceptability, and fidelity. The feasibility measures include recruitment and intervention time. The acceptability measures include recruitment and completion rates as well as intervention satisfaction. The fidelity measures include observed versus expected rates of intervention and data collection activities. The primary clinical outcome is a severe respiratory illness, defined as a respiratory diagnosis requiring hospitalization. The secondary clinical outcomes include hospital days and emergency department visits, systemic steroid courses, systemic antibiotic courses, and death from severe respiratory illness. ResultsThe recruitment of the first wave began on April 27, 2022. To date, we have enrolled 30 (33%) out of 90 participants, as projected. The final wave of recruitment will end by October 31, 2023, and the final participant will complete the study by April 30, 2024. We will start analyzing the complete responses by April 30, 2024, and the publication of results is expected at the end of 2024. ConclusionsThis pilot intervention, using adaptive just-in-time strategies, represents a novel approach to reducing the incidence of significant respiratory illness for children with severe CP. This protocol may be helpful to other researchers and health care providers caring for patients at high risk for acute severe illness exacerbations. Trial RegistrationClinicalTrials.gov NCT05292365; https://clinicaltrials.gov/study/NCT05292365 International Registered Report Identifier (IRRID)DERR1-10.2196/49705

Objective To understand caregiver, healthcare professional and national expert perspectives on implementation of a just-in-time adaptive intervention, RE-PACT (Respiratory Exacerbation-Plans for Action and Care Transitions) to prevent respiratory crises in severe cerebral palsy.Design Qualitative research study.Setting Paediatric complex care programmes at two academic medical institutions.Participants A total of n=4 focus groups were conducted with caregivers of children with severe cerebral palsy and chronic respiratory illness, n=4 with healthcare professionals, and n=1 with national experts.Methods Participants viewed a video summarising RE-PACT, which includes action planning, mobile health surveillance of parent confidence to avoid hospitalisation and rapid clinical response at times of low confidence. Moderated discussion elicited challenges and benefits of RE-PACT’s design, and inductive thematic analysis elicited implementation barriers and facilitators.Results Of the 19 caregivers recruited, nearly half reported at least one hospitalisation for their child in the prior year. Healthcare professionals and national experts (n=26) included physicians, nurses, respiratory therapists, social workers and researchers. Four overarching themes and their barriers/facilitators emphasised the importance of design and interpersonal relationships balanced against health system infrastructure constraints. Intervention usefulness in crisis scenarios relies on designing action plans for intuitiveness and accuracy, and mobile health surveillance tools for integration into daily life. Trust, knowledge, empathy and adequate clinician capacity are essential components of clinical responder-caregiver relationships.Conclusions RE-PACT’s identified barriers are addressable. Just-in-time adaptive interventions for cerebral palsy appear well-suited to address families’ need to tailor intervention content to levels of experience, preference and competing demands.

Background: There exists a paucity of literature about teenager health literacy in general and teenagers are likely to turn to the internet for health information. Therefore, they need good e-health literacy to properly understand and apply the information obtained. Yet, many have limited e-health literacy, lacking the knowledge and skills to filter and distinguish reliable from unreliable health information and searches return large amounts of information, making it difficult to recognize whether information is reputable and raising concerns regarding teenagers' safety. Brief Description of Activity: We developed a toolkit in collaboration with community-based organizations serving teenagers and teenagers themselves usable with brief training to present a 1-hour, interactive workshop. We transformed current adult information for locating and appraising online health information into a teenager friendly format using relevant health topics to engage participants. Implementation: We met teenagers in teenager-friendly settings where they already gather to engage them and leverage the relationship fostered within those settings to bridge positive and negative social determinant influences on health literacy and e-health literacy as well as cross potential cultural, economic, political, and demographic barriers. Using the “train the trainer” method to build sustainability, we trained teenagers and group leaders to use the toolkit to run workshops with teenagers and placed the components in an easily available online format. Results: After completing the workshop, teenager participants expressed a high level of confidence in using Medline Plus, locating health information online, identifying Truth versus Trash and making health decisions. Most teenagers reported they would recommend the WebLitLegit workshop to their friends and it improved their ability to find credible online health information. Lessons Learned: The workshop's practical application provided participants with real-life examples for evaluating online information using the “LEGIT” acronym. The integration of this community-based program fostered relationships between the teenager participants, community organizations, and university students and faculty. All of the organizations involved benefited through exposure to health literacy concepts and knowledge of evaluation criteria, which may help expand e-health literacy in the community because the students, teenagers, and community partners are able to sustainably share the toolkit within their social network. [HLRP: Health Literacy Research and Practice. 2022;6(2):e151–e158.] Plain Language Summary: Teenagers use the internet to find health information but have difficulty deciding if the information is correct and safe. WebLitLegit workshops help teenagers find correct and safe information to make health decisions. Teenagers completing the workshop thought their ability to find correct information and make good health decisions improved. This best practice adds to the literature by addressing needed teenager e-health literacy.

The concept of a Health Literate Healthcare Organization (HLHO) is a relatively new approach to health literacy that moves the focus from the individual patient to the overarching health care system. The HLHO-10 questionnaire was developed internationally to assess the 10 Attributes of HLHOs as described by participants of the Institute of Medicine Roundtable on Health Literacy. The purpose of this study was to establish reliability and validity of the HLHO-10 among a sample of United States hospitals. Reliability and validity were established through assessing the factor structure for the HLHO-10 and psychometric evaluation. The HLHO-10 was found to be reliable with a Cronbach's alpha of .855 and a two-factor structure was revealed through exploratory factor analysis. Additional research is needed to further validate use of the HLHO-10 in the U.S., but initial findings of this emerging tool are promising and timely as the issue of health literacy comes to the forefront of U.S. health care systems and associated regulatory agencies. [HLRP: Health Literacy Research and Practice. 2022;6(2):e137–e141.]

Background/Aims: The epidermal growth factor receptor-tyrosine kinase inhibitor gefitinib is effective against several malignancies and is mainly utilized in the treatment of epidermal growth factor receptor mutation positive non-small cell lung cancer. The anti-cancer effect of the drug involves stimulation of apoptosis. Side effects of gefitinib include anemia. At least in theory, the development of anemia during gefitinib treatment could result from triggering of eryptosis, the suicidal erythrocyte death characterized by cell shrinkage and by cell membrane scrambling with phosphatidylserine translocation to the erythrocyte surface. Signaling potentially stimulating eryptosis include increase of cytosolic Ca2+ activity ([Ca2+]i) and generation of oxidative stress. The present study explored, whether gefitinib stimulates eryptosis and, if so, whether its effect involves Ca2+ entry and/or oxidative stress. Methods: Flow cytometry was employed to quantify cell volume from forward scatter, phosphatidylserine exposure at the cell surface from annexin-V-binding, [Ca2+]i from Fluo3-fluorescence, and reactive oxygen species (ROS) abundance from 2’,7’-dichlorodihydrofluorescein diacetate (DCFDA) dependent fluorescence. Results: A 48 hours exposure of human erythrocytes to gefitinib (≥ 2 µg/ml) significantly decreased forward scatter and significantly increased the percentage of annexin-V-binding cells. Gefitinib did not significantly increase Fluo3-fluorescence but the effect of gefitinib on annexin-V-binding was significantly blunted by removal of extracellular Ca2+. Gefitinib further significantly increased DCFDA fluorescence. Conclusions: Gefitinib triggers erythrocyte shrinkage and phospholipid scrambling of the erythrocyte cell membrane, an effect at least in part dependent on extracellular Ca2+ and paralleled by oxidative stress.

Adult learners attend English as a second language (ESL) classes to improve their skills in specific areas. They may desire to read and write better, learn to spell, communicate in English, or build their vocabulary. These goals have a multitude of purposes such as getting a better job, helping their children with their homework, dealing more effectively with their health and the health care system, or gaining ability to hold conversations (Bryson, 2013). Embedding health literacy content into adult learner classes helps promote understanding and application of health information to stay healthy and well. In addition, most adults learn best if the knowledge, skills, and strategies to be acquired are linked to real-life contexts that either mirror their own circumstances or illustrate a reality they would like to know (Bryson, 2013). In a study by Rowlands, Shaw, Jaswal, Smith, and Harpham (2017), adult learners recognized that their health and that of their families depends greatly on their level of health literacy. For this reason, learners are highly motivated to study health-related topics in the classroom.

Overview: In 2012, the Institute of Medicine Roundtable on Health Literacy established 10 attributes of a health literate health care organization that, if instated, would improve health information and empower patients to make more informed health decisions. Few studies have assessed how well organizations meet these attributes., Purpose: This study sought to describe the extent to which health care systems in North Texas were adopting policies and practices that address the 10 attributes of a health literate health care organization. More specifically, we sought to describe key organizational leaders' and clinicians' perceptions in this regard., Study Design and Methods: This was a mixed-methods study, conducted with a convenience sample of 74 key informants from 13 hospitals across five health care systems. Informants provided demographic data, and their perceptions of the extent to which their hospital met the 10 attributes were measured via the Health Literate Health Care Organization 10-item questionnaire (HLHO-10) and semistructured interviews., Results: Mean scores for HLHO-10 items ranged from 3.74 to 5.39, with 7 as a maximum score. Qualitative data provided richer content, elaborating on the survey results. Workforce training in health literacy, patient inclusion in health information development and evaluation, and communication about health care costs were rated the lowest and were described as issues of concern., Conclusion: Study findings indicated limited leadership and little systemic promotion of efforts to ensure health literate health care organizations, although individual health literacy champions sometimes stepped up with creative initiatives.