Health literacy assessment in a Portuguese sample

A Literacia para a Saúde (LS) está relacionada com a capacidade de lidar com a informação sobre saúde, nomeadamente no que diz respeito ao seu acesso, compreensão, interpretação, avaliação, aplicação e utilização em diversas situações e ao longo do ciclo de vida. Em 2012, o European Health Literacy Project Consortium (Consórcio HLS-EU) avaliou o nível de LS em oito Estados-Membros europeus. Nesse contexto, foi recolhida informação sobre os níveis de LS de uma amostra da população portuguesa (n=1180) seguindo a metodologia do consórcio anteriormente referido. Os resultados obtidos mostram uma prevalência de LS limitada (representando 55,9% dos inquiridos) na amostra portuguesa, apresentando assim o segundo nível mais baixo de LS comparativamente aos oito países incluídos no estudo desenvolvido pelo Consórcio HLS-EU, precedido da Bulgária. Uma vez que um nível LS inadequado em termos populacionais tem implicações negativas nos ganhos em saúde, na utilização dos serviços de saúde e, consequentemente, nos gastos em saúde, é indispensável e urgente colocar a promoção da LS na agenda das políticas públicas.Health Literacy (HL) is related to the ability to deal with relevant information about health, namely the ability to access, understand, appraise and apply health information in several situations along the life cycle. In 2012, the European Health Literacy Project Consortium (HLS-EU Consortium) assessed the level of HL in eight EU member states. In this context, it was collected information for the HL levels in a sample of the Portuguese population (n = 1180) following the methodology of the Consortium referred above. The results showed a prevalence of limited HL in the Portuguese sample (representing 55.9% of the respondents), thus presenting the second lowest level of HL compared to eight countries included in the study developed by HLS -EU Consortium, preceded by Bulgaria. Once an inadequate HL level in terms of population has negative implications for health gains in the use of health services and, consequently in health costs, is indispensable and urgent to promote HL in the public policy agenda

Renasceres®: Embodying health citizenship with a health literacy argument

INTRODUÇÃO Neste artigo exploram-se os conceitos de saúde, literacia para a saúde e cidadania em saúde. A partir de uma discussão focando a sustentabilidade social é integrado o paradigma salutogénico e o constructo do sentido de coerência como estruturas de pensamento e ação na concretização do devir social. DESENVOLVIMENTO Utilizando uma metodologia de tracer focando a cessação tabágica é feita uma aplicação deste paradigma ao exercício da cidadania em saúde. Articulando um conjunto de recursos gerais de resistência, que na linguagem do paradigma salutogénico são os elementos favoráveis à negantropia, é desenvolvida uma abordagem focalizando a máxima funcionalidade, identificada nas letras do acrónimo renasceres®. CONCLUSÕES Cada letra do acrónimo renasceres® representa um domínio de intervenção no âmbito da promoção da saúde que, numa perspetiva salutogénica, acentua a progressão da pessoa rumo ao polo de máxima funcionalidade: Resiliência, Exercício, Nutrição, Água, Sol, Confiança, Equilíbrio, Repouso, Empoderamento e Sentido de coerência. Deste modo contribui-se para uma discussão de boas práticas no campo da promoção da literacia para a saúde (www.literacia-saude.info) favorável ao exercício de uma cidadania em saúde que contribua para a sustentabilidade ambiental, social e cultural.info:eu-repo/semantics/publishedVersio

Education for health, dietary habits, nutritional status and indicators of metabolic risk

Introduction: A low level of functional education is a risk factor for lower levels of health literacy which in turn is considered to be a mediator in health results, currently representing an issue of interest in research on the management of the individual’s state of health. Objectives: To determine the effects of literacy on health through the mediation of dietary habits on nutritional status - Body Mass Index (BMI) and indicators of metabolic risk – Abdominal Perimeter (AP), Neck Circumference (NC), Capillary glycaemia. Methods: Descriptive study carried out on an objective sample of 508 Portuguese citizens (52.2% males and 47.8% females) with an average age of 44.48 years. The Questionário Europeu de Literacia em Saúde (HLS-EU-PT) (Nunes & Sorensen, 2013) (The European Questionnaire on Health Literacy) was applied and the dietary habits were assessed and the BMI, AP, NC and glycaemic levels were established. Results: The majority of participants (73.62%) were shown to have a health literacy deficit. The effect of the interaction between health literacy and dietary habits has a direct effect on abdominal perimeter and on neck circumference, although it is not found to be associated with variation in BMI. Conclusion: Differences in the level of health literacy were consistently associated with an increase in metabolic and cardiovascular risk. It is accepted that health literacy may affect disparities in indicators for the state of health. Priorities for future action to promote behaviours leading to the observation of healthy lifestyles including health literacy programmes.info:eu-repo/semantics/publishedVersio

Toxinfeções alimentares: da investigação à prevenção

Objetivos: Este artigo tem como objetivos descrever como os dados de investigação de toxinfeções alimentares podem ser usados como evidência científica para identificar boas práticas de segurança alimentar para o consumidor e divulgar o material educativo elaborado com base na informação dos perigos, fatores contributivos e condições associadas às toxinfeções alimentares que ocorreram em casas particulares em Portugal nos últimos anos (2009-2013), visando contribuir para a diminuição do risco destas doenças para a saúde dos consumidores, através da educação e literacia para a saúde

European health literacy scale (HLS-EU-BR) applied in a Brazilian higher education population of Rio Grande do Sul (RS)

ESERA Conference Proceedings series, vol. 4Several scales have been built to evaluate the health literacy levels of populations. For this study the European Health Literacy Survey (HLS-EU) (Sorensen, 2012) was selected to assess the health literacy levels in a diversified sample of higher education students and lecturers. The main goal was to evaluate whether this European HLS-EU scale is appropriate for discriminating health literacy levels in a higher education population, including university and polytechnic students and lecturers of different scientific fields and educational levels, since undergraduates up to university lecturers. Four groups of participants were obtained: (i) 21 undergraduate students in agribusiness, (ii) 40 undergraduate students in computational science, (iii) 31 master students and professionals in the field of health; (iv) 87 master, PhD students and lecturers holding a master or PhD degree, most of them in the field of Education. The Cronbach's alpha test showed that the global HLS-EU-BR, the Disease Prevention items and Health Promotion items had “Excellent” internal consistency (0.95, 0.90 and 0.90, respectively) and Healthcare items had “Good” internal consistency (0.89). The majority of the respondents exhibited “Problematic” (37.4%) and “Sufficient” (34.7%) health literacy. “Inadequate” health literacy was found in 17.3% of the respondents and only 10.6% showed “Excellent” health literacy. No differences (p>0.05) were found between age groups. Females had higher levels of health literacy as compared with men (p<0.05). As expected, strong differences (p<0.0001) on health literacy were found between groups having and having not experience in working in the health sector or having health training. Having in mind that this sample is mainly composed of teachers and teachers to be, these results indicate that more emphasis in health issues should be given in teachers training in order to make teachers more sensitive to healthy issues and to get better competencies for teaching these issues in basic education.CIEC - Centro de Investigação em Estudos da Criança, IE, UMinho (UI 317 da FCT)UID/CED/00317/201

A tale of two pandemics in three countries: Portugal, Spain, and Italy

This chapter explores the structural similarities and differences between these three countries: on the one hand, in their respective health sectors’ capacities and reorganization; and on the other hand, in the different degrees of state capacity to respond to the pressing needs of their populations. In the last great epidemic, the 1918 flu, there was a transparent north-south gradient in the extent to which European countries were hit by the pandemic, with Portugal, Spain, and Italy among those that were hit the hardest (Ansart et al., 2009). How was it this time? To what extent does the impact of COVID-19 reflect resilient societal and institutional vulnerabilities in these countries? And to what extent have national specificities interacted with those shared vulnerabilities, leading to different outcomes?info:eu-repo/semantics/publishedVersio

an action-research project in primary health care

ABSTRACT – Background: Primary Health Care (PHC) is usually the first contact with the health system, and health professionals are key mediators for enabling citizens to take care of their health. In Portugal, great improvements have been achieved in the biometric indicators of maternal and child health during the last decades. Nevertheless, scant attention has been paid to the mental health dimension, in spite of the recognition of its importance, being pregnancy and early childhood crucial opportunities in the lifecycle for mental health promotion, especially in the early years of life, with a strong impact in the health of the child. The impact of early attachment between mother and baby on maternal and child health has long been recognized. This attachment can be influenced by some factors, as the mother’s emotional adjustment. Attention to these factors may facilitate implementation of both positive conditions and preventative measures. Family support during the transition to parenthood has been highlighted as an effective measure and PHC professionals are in a privileged position as information sources as well as mediators. Aims: The project we present describes an action-research process developed together among academic researchers and health professionals to embrace these issues. We intend to enable health professionals to support families in the transition to parenthood thereby promoting children’s mental health. Approach: The project is driven by a participatory approach intended to lead to reorganization of health care during pregnancy and early childhood. Effective change happens when those involved are interested and motivated, what makes their participation so important. Reflection about current practices and needs, and knowledge about evidence-based interventions have been guiding the selection of changes to introduce in clinical practice for family support and development of parenthood skills and self-confidence. Development: We summarize the main steps in development: the initial assessment and the picture taken from the community under study; the decision making process; the training programme of PHC professionals in action; the review of the protocols of maternal consultation, home visits and antenatal education; the implementation planning; the plan for evaluation the effectiveness of the changes introduced in the delivery of maternal and child health care units. The already developed work has shown that motivation, leadership and organizational issues are decisive for process development.-------------------------- RESUMO - Os Cuidados de Saúde Primários são habitualmente o primeiro contacto com o sistema de saúde e os profissionais de saúde são mediadores chave na capacitação dos cidadãos para cuidarem da sua saúde. Em Portugal, nas últimas décadas, têm-se alcançado grandes melhorias nos indicadores biométricos de saúde materno-infantil. Contudo, tem-se dedicado pouca atenção à dimensão de saúde mental, apesar do reconhecimento da sua importância. A gravidez e primeira infância têm sido apontadas como uma oportunidade crucial no ciclo de vida para a promoção da saúde mental. É dado especial enfoque aos primeiros tempos de vida, dado o forte impacto na saúde da criança. O impacte da vinculação precoce entre a mãe e o bebé na saúde da mãe e da criança há muito que é reconhecido. Esta vinculação pode ser influenciada por vários factores, nomeadamente pelo ajustamento emocional da mãe. A focalização nestes aspectos pode facilitar a criação de condições favoráveis e a implementação de medidas preventivas. O suporte familiar durante o período de transição para a parentalidade tem sido enfatizado como uma medida eficaz e os Cuidados de Saúde Primários estão numa posição privilegiada como fontes de informação e como mediadores. O projecto que apresentamos descreve um processo de investigação- acção desenvolvido em parceria entre investigadores académicos e profissionais de saúde para abordar os aspectos referidos. Pretende-se capacitar os profissionais de saúde para apoiarem as famílias na transição para a parentalidade, promovendo assim a saúde mental das crianças. O projecto baseia-se numa abordagem participativa, direccionada para a reorganização dos cuidados durante a gravidez e primeiros tempos de vida. A mudança efectiva acontece quando os envolvidos estão interessados e motivados, o que torna a sua participação tão importante. A reflexão acerca das práticas e necessidades actuais e o conhecimento acerca de intervenções baseadas na evidência têm guiado a selecção das alterações a introduzir na prática clínica, no sentido de promover o suporte familiar e o desenvolvimento de competências parentais e auto-confiança. Neste artigo, apresentamos as etapas principais do desenvolvimento do projecto: avaliação inicial da comunidade em estudo; processo de tomada de decisão; programa de formação dos profissionais dos Cuidados de Saúde Primários; revisão dos protocolos da consulta de saúde materna, visita domiciliária e educação pré-natal; planeamento da implementação; plano de avaliação da efectividade das alterações introduzidas na prestação de cuidados. O trabalho já desenvolvido tem mostrado que a motivação, liderança e aspectos organizacionais são decisivos para o processo de mudança e de criação de um novo paradigma de cuidados a prestar às famílias.publishersversionpublishe

LITERACIA PARA A SAÚDE EM ALUNOS DO ENSINO SECUNDÁRIO: RELAÇÃO COM A PARTICIPAÇÃO NA SAÚDE ESCOLAR

Objetivo: i) Caraterizar em termos sociodemográficos os alunos da amostra; ii) Analisar a relação entre o nível de Literacia para a Saúde (LS) e a participação dos alunos nas atividades de Saúde Escolar (SE). Materiais e métodos: Estudo descritivo-correlacional, transversal, de abordagem quantitativa, no qual participaram 499 alunos, do ensino secundário público. Foi aplicado um questionário de autopreenchimento, que incluía a escala HLS-EU-PT destinada a avaliar o nível de LS. No tratamento de dados utilizamos o SPSS. Resultados: A maioria dos alunos era do sexo feminino (58.3%) e enquadrava-se no grupo etário dos 16 aos 17 anos (64,5%). Participaram nas atividades de SE 39,1% da amostra, dos quais o maior grupo no âmbito da educação sexual (23%) e alimentação saudável (12,6%). O maior grupo enquadrou-se na LS Suficiente (39,1%). A categoria de LS designada Alfabetização limitada para a saúde atingiu mais de 50% em todos os domínios, exceto, no domínio Promoção da Saúde. O índice de LS Geral não difere significativamente quanto à participação nos programas de SE. Conclusão: Os alunos da amostra apresentam um baixo nível de LS, inferior ao dos participantes noutros estudos. A participação dos alunos da amostra nos programas de SE é baixa, sendo que estas atividades parecem não estar relacionadas com o nível de LS. A equipa de SE deverá estender as suas atividades a mais alunos desta população, procurando aumentar a sua eficácia para elevar o nível de LS

Web-assisted tobacco intervention in Portuguese: intentions to make behavioural changes and behavioural changes

ABSTRACT - The problem of how to support “intentions to make behavioural changes” (IBC) and “behaviour changes” (BC) in smoking cessation when there is a scarcity of resources is a pressing issue in public health terms. The present research focuses on the use of information and communications technologies and their role in smoking cessation. It is developed in Portugal after the ratification of WHO Framework Convention on Tobacco Control (on 8 November 2005). The prevalence of smokers over fifteen years of age within the population stood at 20.9% (30.9% for men and 11.8% for women). While the strategy of helping people to quit smoking has been emphasised at National Health Service (NHS) level, the uptake of cessation assistance has exceeded the capacity of the service. This induced the search of new theoretical and practical venues to offer alternative options to people willing to stop smoking. Among these, the National Health Plan (NHP) of Portugal (2004-2010), identifies the use of information technologies in smoking cessation. eHealth and the importance of health literacy as a means of empowering people to make behavioural changes is recurrently considered an option worth investigating. The overall objective of this research is to understand, in the Portuguese context, the use of the Internet to help people to stop smoking. Research questions consider factors that may contribute to “intentions to make behavioural changes” (IBC) and “behavioural changes” (BC) while using a Web-Assisted Tobacco Intervention Probe (WATIP). Also consideration is given to the trade-off on the use of the Web as a tool for smoking cessation: can it reach a vast number of people for a small cost (efficiency) demonstrating to work in the domain of smoking cessation (efficacy)”? In addition to the introduction, there is a second chapter in which the use of tobacco is discussed as a public health menace. The health gains achieved by stopping smoking and the means of quitting are also examined, as is the use of the Internet in smoking cessation. Then, several research issues are introduced. These include background theory and the theoretical framework for the Sense of Coherence. The research model is also discussed. A presentation of the methods, materials and of the Web-Assisted Tobacco Intervention Probe (WATIP) follows. In chapter four the results of the use of the Web-Assisted Tobacco Intervention Probe (WATIP) are presented. This study is divided into two sections. The first describes results related to quality control in relation to the Web-Assisted Tobacco Intervention Probe (WATIP) and gives an overview of its users. Of these, 3,150 answered initial eligibility questions. In the end, 1,463 met all eligibility requirements, completed intake, decided on a day to quit smoking (Dday) and declared their “intentions to make behavioural changes” (IBC) while a second targeted group of 650 did not decide on a Dday. With two quit attempts made before joining the platform, most of the participants had experienced past failures while wanting to stop. The smoking rate averaged 21 cigarettes per day. With a mean age of 35, of the participants 55% were males. Among several other considerations, gender and the Sense of Coherence (SOC) influenced the success of participants in their IBC and endeavour to set quit dates. The results of comparing males and females showed that, for current smokers, establishing a Dday was related to gender differences, not favouring males (OR=0.76, p<0.005). Belonging to higher Socio-economic strata (SES) was associated with the intention to consider IBC (when compared to lower SES condition) (OR=1.57, p<0.001) and higher number of school years (OR=0.70, p<0.005) favoured the decision to smoking cessation. Those who demonstrated higher confidence in their likelihood of success in stopping in the shortest time had a higher rate of setting a Dday (OR=0.51, p<0.001). There were differences between groups in IBC reflecting the high and low levels of the SOC score (OR=1.43, p=0.006), as those who considered setting a Dday had higher levels of SOC. After adjusting for all variables, stages of readiness to change and SOC were kept in the model. This is the first Arm of this research where the focus is a discussion of the system’s implications for the participants’ “intentions to make behavioural changes” (IBC). Moreover, a second section of this study (second Arm) offers input collected from 77 in-depth interviews with the Web-Assisted Tobacco Intervention Probe (WATIP) users. Here, “Behaviour Change” (BC) and the usability of the platform are explored a year after IBC was declared. A percentage of 32.9% of self-reported, 12-month quitters in continuous abstinence from smoking from Dday to the 12-month follow- up point of the use of the Web-Assisted Tobacco Intervention Probe (WATIP) has been assessed. Comparing the Sense of Coherence (SOC) scores of participants by their respective means, according to the two groups, there was a significant difference in these scores of non smokers (BC) (M=144,66, SD=22,52) and Sense of Coherence (SOC) of smokers (noBC) (M=131,51, SD=21,43) p=0.014. This WATIP strategy and its contents benefit from the strengthening of the smoker’s sense of coherence (SOC), so that the person’s progress towards a life without tobacco may be experienced as comprehensible, manageable and meaningful. In this sample the sense of coherence (SOC) effect is moderate although it is associated with the day to quit smoking (Dday). Some of the limitations of this research have to do with self-selection bias, sample size (power) and self-reporting (no biochemical validation). The enrolment of participants was therefore not representative of the smoking population. It is not possible to verify the Web-Assisted Tobacco Intervention Probe (WATIP) evaluation of external validity; consequently, the results obtained cannot be applied generalized. No participation bias is provided. Another limitation of this study is the associated limitations of interviews. Interviewees’ perception that fabricating answers could benefit them more than telling the simple truth in response to questions is a risk that is not evaluated (with no external validation like measuring participants’ carbon monoxide levels). What emerges in this analysis is the relevance of the process that leads to the establishment of the quit day (Dday) to stop using tobacco. In addition, technological issues, when tailoring is the focus, are key elements for scrutiny. The high number of dropouts of users of the web platform mandates future research that should concentrate on the matters of the user-centred design of portals. The focus on gains in health through patient-centred care needs more research, so that technology usability be considered within the context of best practices in smoking cessation