With many countries facing restructuring of medical and healthcare institutions, increasing healthcare costs, and the threat of various infectious diseases and epidemics, such as avian influenza and dengue haemorrhagic fever, it is inevitable that healthcare information be a major tool in addressing these issues. Doctors and healthcare providers may not always be available to attend to the needs of the masses with regard to health information. Thus, health information must be made easily accessible so that preventive action and proactive measures can be carried out by patients and their families. The proliferation of the Internet and swift developments in Information Technology (IT) can effortlessly expedite this accessibility. In this exploratory study, twelve individuals with medium to high IT competencies and substantial experience in using the Internet were interviewed on their health information needs and expectations. The paper presents their responses and suggestions to improve health information provision and literacy and how IT can be exploited to achieve these objectives.

While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low (n = 13) and adequate (n = 14) health literacy patients, and health professionals (n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today?s complex modern health systems. This information may be provided in a variety of forms ? ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy. Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.

This study was conducted to explore whether racial/ethnic differences exist in treatment discussed, preferred, and ultimately received for localized prostate cancer (PCa) as epidemiological data are scant on this issue. The authors recruited 640 localized PCa patients from the Texas Medical Center, Houston, Texas, between 1996 and 2004. The authors used a structured questionnaire to collect data through personal interviews. Three main treatment modalities for localized PCa, consisting of surgery, radiation therapy, and watchful waiting, were considered for this study. It was found that health professionals were less likely to discuss surgery (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.18-0.68) and watchful waiting (OR = 0.53, 95% CI = 0.34-0.83) with Hispanics than Whites. However, African Americans were less likely to receive watchful waiting (OR = 0.22, 95% CI = 0.05-0.93). They were more likely to prefer (OR = 1.23, 95% CI = 0.78-1.94) and receive (OR = 1.27, 95% CI = 0.87-1.86) radiation therapy, although they did not achieve statistical significance (p < .05). Higher age was associated with lower likelihood of discussing, preferring, and receiving surgical treatment. Higher Gleason sum was associated with lower likelihood of discussing treatment. A comparison of concordances between treatment preferred by patients and what was actually received, in general, showed a higher agreement for surgery and radiation therapy. More exploration needs to be done in other settings to confirm these findings.

This study examines a national survey of U.S. health journalists (N = 774) to ascertain how journalists' perceptions of audience use of health news shapes their journalistic practices. We establish a framework through attribution theory and expectancy-value theory for how journalists choose to fulfill their roles as providers of health information. Using these theoretical lenses, we look at whether health journalists' audience orientation is associated with their use of accessibility-oriented or credibility-focused practices. Our findings show that, overall, journalists believe readers are individually responsible for their health outcomes and that journalists focus on providing accessibility-oriented information when they feel their audience's ability to understand information may be compromised. Journalists' beliefs about audience behavior are associated with their attitudes toward communication practices.

This report reviews some of the extensive literature in health literacy, much of it focused on the intersection of low literacy and the understanding of basic health care information. Several articles describe methods for assessing health literacy as well as methods for assessing the readability of texts, although generally these latter have not been developed with health materials in mind. Other studies have looked more closely at the mismatch between patients' literacy levels and the readability of materials intended for use by those patients. A number of studies have investigated the phenomenon of literacy from the perspective of patients' interactions in the health care setting, the disenfranchisement of some patients because of their low literacy skills, the difficulty some patients have in navigating the health care system, the quality of the communication between doctors and their patients including the cultural overlay of such exchanges, and ultimately the effect of low literacy on health outcomes. Finally, the impact of new information technologies has been studied by a number of investigators. There remain many opportunities for conducting further research to gain a better understanding of the complex interactions between general literacy, health literacy, information technologies, and the existing health care infrastructure.

This article examines the nature of patients’ preferences for healthcare and whether clinician accommodation of patient preferences influences health outcomes. First, we provide a conceptualization of patient preferences along with their key attributes. Second, we review research on the relationship between health outcomes and patient preferences for treatments and for the process of care (e.g., preferred involvement in decision-making). Third, following a critique of this literature, we present an ecological model of patient preferences that, while acknowledging that patient preferences may emerge from various contexts (e.g., family or media exposure), we focus on the important role that clinical encounters and patients’ health-related experiences play in the elicitation and construction of patient preferences. Fourth, we propose two pathways, one behavioral (adherence) and the other psychological (sense of autonomy or satisfaction with decision), through which meeting patient preferences could lead to better health outcomes. Fifth, we discuss how preferences can be elicited and clarified through patient-centered conversations. We conclude with implications for future research and clinical practice.

There is a general need for high-quality, easily accessible, and comprehensive health-care information on epilepsy to better inform the general population about this highly stigmatized neurological disorder. The aim of this study was to evaluate the health literacy level of eight popular English-written websites that provide information on epilepsy in quantitative terms of readability. Educational epilepsy material on these websites, including 41 Wikipedia articles, were analyzed for their overall level of readability and the corresponding academic grade level needed to comprehend the published texts on the first reading. The Flesch Reading Ease (FRE) was used to assess ease of comprehension while the Gunning Fog Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Automated Readability Index, and Simple Measure of Gobbledygook scales estimated the corresponding academic grade level needed for comprehension. The average readability of websites yielded results indicative of a difficult-to-fairly-difficult readability level (FRE results: 44.0±8.2), with text readability corresponding to an 11th academic grade level (11.3±1.9). The average FRE score of the Wikipedia articles was indicative of a difficult readability level (25.6±9.5), with the other readability scales yielding results corresponding to a 14th grade level (14.3±1.7). Popular websites providing information on epilepsy, including Wikipedia, often demonstrate a low level of readability. This can be ameliorated by increasing access to clear and concise online information on epilepsy and health in general. Short "basic" summaries targeted to patients and nonmedical users should be added to articles published in specialist websites and Wikipedia to ease readability.

The recent push towards patient-centered health care has put a greater emphasis on patient health literacy. Health literacy is influenced by communication between physicians and patients. We conducted research at a local health clinic to examine communication between physicians, patients, and interpreters that were present to assist patients with limited English proficiency (LEP). We used the framework of Distributed Cognition to broaden our unit of analysis beyond individuals to include artifacts and the physical environment. We analyze three factors influencing communication: the availability of electronic medical records (EMR), the use of paper documents, and the presence of an interpreter. The physical space and artifacts are shown to impose constraints upon interaction and the flow of information throughout the exam room. We discuss implications for redesigning medical examination rooms and information technologies to create collaborative spaces that better support physician-patient communication, enhance patient understanding, and improve health literacy.

The purpose of this study was to examine connections between health literacy and social communication skills in older adults, a population that experiences chronic health conditions but is reported to have low health literacy and declines in communication skills. Sixty-three older adults were administered the Social Communication subtest of the Functional Assessment of Communication Skills in Adults and the Short Test of Functional Health Literacy in Adults. Correlational statistics indicated significant relationships between social communication skills and health literacy in older adults. Aspects of social communication that involve initiating discourse, facial expressions, and voice tone were positively related to reading comprehension items that involve informing, naming, and requesting information. Results of the study suggest that social communication skills may possibly serve as predictors of health literacy. Further study of the potential relationships between these variables is needed to improve health literacy assessment and intervention for older adults.

The period following discharge from the hospital is a vulnerable time for patients. About half of adults experience a medical error after hospital discharge, and 19%-23% suffer an adverse event, most commonly an adverse drug event. This article reviews several important challenges to providing high-quality care as patients leave the hospital. These include the discontinuity between hospitalists and primary care physicians, changes to the medication regimen, new self-care responsibilities that may stress available resources, and complex discharge instructions. We also discuss approaches to promoting more effective transitions of care, including improvements in communication between inpatient and outpatient physicians, effective reconciliation of prescribed medication regimens, adequate education of patients about medication use, closer medical follow-up, engagement with social support systems, and greater clarity in physician-patient communication. By understanding the key challenges and adopting strategies to improve patient care in the transition from hospital to home, hospitalists could significantly reduce medical errors in the postdischarge period.

The overall effectiveness of any medical reporting instrument is tied to its ability to serve as a method for communication of data, ideas, and concepts in a clear and unambiguous fashion. In addition to these functional requirements, a number of practical and technical requirements should be considered; which involve elements of timeliness, security, confidentiality, accessibility, transmission, and verification. Regardless of how “functionally” accurate and complete the report is, its overall value in positively effecting medical care is limited if the information is not received by its intended recipients in a timely fashion, with a complete and thorough understanding of its contents. In the present form, most medical reports serve as a method of notification, in which one party (e.g., radiologist) interprets a dataset (e.g., imaging) and composes a report (e.g., radiology), in which the interpreted findings are conveyed to a recipient (e.g., referring clinician), who in turn utilizes this report information to direct patient care decision making. In this common scenario, the medial report serves a method of one-way notification. Once it has been sent (and presumably received), the sender of the report (e.g., radiologist) assumes the recipient will correctly assimilate these report data into a timely and accurate care plan. This is often an erroneous assumption given the current state of report ambiguity and uncertainty [1, 2], not to mention the increasing workload demands and data overload facing radiologists [3]. As a result of these existing challenges and deficiencies, the report should be viewed not as an end-all, but instead as a first step in the communication and decision-making process. In the “old” analog days of medical imaging practice restrictions on imaging data accessibility, workflow, and delays in report turnaround fostered a more collaborative working environment than currently exists. A referring clinician wanting timely information regarding a recently performed imaging study would literally have to travel to the radiology department, request access to the corresponding images, and then engage in a direct consultation with the interpreting radiologist. While this dynamic presented a number of workflow limitations (for all participants), it also presented a number of distinct advantages relating to direct information exchange, bidirectional understanding, and collaboration. In most cases, once the radiologist–clinician consultation had been completed, both parties had a better and more complete understanding of the clinical scenario, imaging data analysis, and follow-up requirements. This interpersonal dialogue also involved interdepartmental imaging staff (e.g., radiologists, technologists, clerical staff, and administrators) who were encouraged to routinely dialogue with one another over matters regarding imaging exam selection, scheduling, protocoling, quality assurance, clinical/imaging history, and imaging data findings, all of which indirectly or directly affected the radiology report. In addition, analog report workflow was far different, with report transcription outsourced to third party transcriptionists. This introduced significant time delays (and transcription errors) into report turnaround, which was measured in days as opposed to hours. While these reporting delays created frustration on the part of referring clinicians (and their staff), they did come with a positive effect, in fostering a greater degree of consultation and interpersonal communication between the parties. With the digitization of medical imaging and the introduction of digital information system technologies such as the picture archival and communication system (PACS) and radiology information system, a number of dramatic changes occurred in practice which profoundly affected radiology reporting. On a positive note, imaging data were instantaneously and ubiquitously accessible to medical staff, both in and outside of the healthcare enterprise. This meant that a referring clinician (with the appropriate credentials) could access imaging data in his/her office, obviating the need to physically travel to the imaging department, which was far more workflow efficient. At the same time, the widespread adoption of speech recognition software changed report transcription and turnaround, which was now measured in hours (or even minutes). These combined factors not only caused a dramatic change in imaging and report accessibility and timeliness, but indirectly modified report evaluation, from reporting content and consultation, to reporting workflow. In the analog imaging practice, essentially all reports required days to receive, thereby promoting radiologist–physician consultations. As a result, many physicians evaluated radiologist performance by the perceived quality of the report and consultations. Once the transition to digital imaging was complete and images/reports made readily available, these consultations became less necessary [4]. While report content remained important, an increasing focus of imaging performance evaluation was on report turnaround time and efficiency of report delivery. In addition to these changes in imaging data accessibility and timeliness, other profound technologic and economic changes were taking place inside of the radiology department affecting deliverables. The advent of PACS provided a mechanism in which radiologist service was no longer required on site, and more service providers utilized teleradiology for radiology outsourcing. This assisted in addressing practical challenges related to increasing exam complexity and volume, but made radiologists less accessible to consultations. While phone conversations remained a viable alternative, the increasing workload demands and time constraints facing clinicians, lack of familiarity between the parties, and relative lack of technologic support (regarding remote consultation functionality) have made remote consultations relatively inefficient and less desirable. While radiologists would normally be expected to proactively promote consultations to address these practice changes, the increasing workload, exam complexity, and service demands placed upon them have created an environment of relative indifference. This indifference has arguably been further aggravated by continued declines in reimbursement and the commoditization of radiology services [5]. In an attempt to maintain revenue, many radiology providers opt to optimize productivity and workflow, which has the potential to further reduce consultations. The lack of interpersonal communication (among multiple stakeholders) has adversely affected data accessibility and understanding, which in turn has the potential to negatively impact clinical outcomes. While encouraging more face-to-face communication would serve as an important step to counteract these trends, this would be the equivalent of trying to put the genie back in the bottle. Technology has served as the principle catalyst of negative change in reporting and communication and, if properly channeled, can also serve as the catalyst for improvement. Reporting strategies (and technologies) must begin to adapt to these changing needs by serving as a proactive source of collaboration, consultation, education, and customization.

The nation's leading sources of morbidity and health disparities (eg, preterm birth, obesity, chronic lung disease, cardiovascular disease, type 2 diabetes, mental health disorders, and cancer) require an evidence-based approach to the delivery of effective preventive care across the life course (eg, prenatal care, primary preventive care, immunizations, physical activity, nutrition, smoking cessation, and early diagnostic screening). Health literacy may be a critical and modifiable factor for improving preventive care and reducing health disparities. Recent studies among adults have established an independent association between lower health literacy and poorer understanding of preventive care information and poor access to preventive care services. Children of parents with higher literacy skills are more likely to have better outcomes in child health promotion and disease prevention. Adult studies in disease prevention have suggested that addressing health literacy would be an efficacious strategy for reducing health disparities. Future initiatives to reduce child health inequities should include health-promotion strategies that meet the health literacy needs of children, adolescents, and their caregivers.

The increasing importance of genomic information in clinical care heightens the need to examine how individuals understand, value, and communicate about this information. Based on a conceptual framework of genomics-related health literacy, we examined whether health literacy was related to knowledge, self-efficacy, and perceived importance of genetics and family health history (FHH) and communication about FHH in a medically underserved population. The analytic sample was composed of 624 patients at a primary care clinic in a large urban hospital. About half of the participants (47%) had limited health literacy; 55% had no education beyond high school, and 58% were Black. In multivariable models, limited health literacy was associated with lower genetic knowledge (β = −0.55, SE = 0.10, p < .0001), lower awareness of FHH (odds ratio [OR] = 0.50, 95% confidence interval [CI; 0.28, 0.90], p = .020), and greater perceived importance of genetic information (OR = 1.95, 95% CI [1.27, 3.00], p = .0022) but lower perceived importance of FHH information (OR = 0.47, 95% CI [0.26, 0.86], p = .013) and more frequent communication with a doctor about FHH (OR = 2.02, 95% CI [1.27, 3.23], p = .0032). The findings highlight the importance of considering domains of genomics-related health literacy (e.g., knowledge, oral literacy) in developing educational strategies for genomic information. Health literacy research is essential to avoid increasing disparities in information and health outcomes as genomic information reaches more patients.

The elderly and African Americans are groups sometimes described as vulnerable or at risk for health complications, and both are communities for whom consumer health information is believed to be important. A review of recent research literature on the information behaviors of these two special populations is provided, and information is presented from the research literature about the use of the Internet by the elderly and by African Americans. Both groups seem to prefer information from their health care providers and/or from established sources, but both groups do seek consumer health information and are increasingly using the Internet for information searches. The characteristics of desirable Web-based consumer health information for these groups are presented, as well as tools or tips that are available for evaluating Web-based consumer health information for these special populations. Finally, specific consumer health Web sites that provide quality information and that are especially useful for the elderly and for African Americans are identified. In order to understand the use of Internet-based consumer health information by vulnerable groups, it is helpful to look at current research and data on specific information behaviors and Internet use by two special communities—the elderly and African Americans. These groups are often described as vulnerable and as having distinct consumer health information needs. The formats for, and methods of, disseminating consumer health information via the Internet to these two communities are especially important. Ellen Gay Detlefsen, Associate Professor, Department of Library and Information Science, School of Information Sciences Core Faculty, Center for Biomedical Informatics, School of Medicine, University of Pittsburgh, 646 SIS Building, Pittsburgh, PA 15260 284 library trends/fall 2004 In reviewing the problem, three issues stand out: • What do we know about the information behaviors of the two special populations, and what is known about their use of the Internet? • What are the characteristics of desirable Web-based consumer health information for these groups, and what tools or tips are available for evaluating Web-based information for them? • Can specific Web sites be identified as useful for these groups? Context A recent study done by the Bill and Melinda Gates Foundation pointed out that 95 percent of public libraries in the United States offer free access to computers and the Internet, often providing the only Internet access for residents of the nation’s poorest areas. The report went on to posit that “public library computers are reaching the disadvantaged groups consistently identified as lacking technology access and skills” (Bill & Melinda Gates Foundation, 2004, p. 6). Another report on the impact of computers in public libraries states that 31 percent of library computer users wanted to “learn more about [a] medical problem” (Bill & Melinda Gates Foundation, 2004, p. 24). As another research team found, significant percentages of the public are already using the Internet to get health information, and surveys show that the Internet is already a useful vehicle for reaching large numbers of lower-income, less-educated, and minority Americans (Brodie, Flournoy, Altman, Blendon, Benson, & Rosenbaum, 2000; Rainie & Packel, 2001). Researchers at the Pew Internet and American Life project have pointed out that more Americans look for health information online than see a doctor on a typical day. Search engines are their most common entry point rather than specialized sites such as health portals, despite the growth of the latter. Internet-connected Americans also report that email is used for advice and support, especially for the chronically ill and their caregivers (Fox & Fallows, 2003). If, as these studies show, health information delivered via the Internet to Americans at home, at work, and in public libraries is commonplace, then it is time to see if similar patterns or activities can be identified in specialized subgroups of Americans. Two groups often identified as being “vulnerable” or “at risk” are the elderly and African Americans. While there is a great deal of consumer health information on the World Wide Web, its presentation is not necessarily useful to a minority community or a community of senior citizens. Family caregivers for these groups may be able to find and use currently available Web-based consumer health information that is culturally sensitive and formatted for an adult audience, but members of the target communities themselves are not well served by much of the Internet-accessible consumer health information. 285 detlefsen/where am i to go? What is needed is information targeted to minority and elder communities whose members search the Web themselves from home or access the Web through public libraries and other community sites. Web-based information has distinct advantages over more traditional print resources and media: it can be updated instantly and disseminated widely; once a Web page is written and mounted on a server, it is widely accessible without regard to the time or place of the searcher; it also can be printed out easily to serve as an “instant handout” that can be taken home, read and re-read, and posted on a refrigerator door, cupboard, or bulletin board. The same information can be presented in different formats as well to accommodate the needs of those who may have a variety of handicaps and disabilities. The Elderly Government data assert that by 2010 the average life expectancy will be up to 86 years of age for a woman and 76 for a man; the first baby boomers will turn 65 in 2010, and “the 55 years and older segment is the fastest growing Internet demographic group” (Bill & Melinda Gates Foundation, 2004, p. 10). It does seem clear that a distinction needs to be made among groups of elders, particularly because the information behaviors of the young-old and the old-old may differ. The Medical Subject Headings—the MeSH, from the National Library of Medicine (NLM)—distinguish between the Aged, defined as those who are 65 through 79 years of age, and those who are Aged, 80 and over. In 2002 the terms Middle Aged and Adult Children were added to MeSH to further define the populations between 45 and 65 years of age; MeSH defines an adult as a person from 18 to 44 years of age (NLM, n.d.). Anecdotal reports from the WordSpy document the appearance of new words to describe these shifting generations. McFedries carefully provides citations to the first appearance of terms such as “supercentenarian,” “grand boomer,” “grey nomad,” “elder orphan,” “club sandwich generation,” and “geezer glut” (McFedries & Logophilia Limited, n. d.). What Do We Know about the Information Behaviors of the Elderly? Poor health literacy is common, especially among elderly patients. One researcher claims that the “lack of adequate literacy is twice as common for older Americans and inner-city minorities” (Williams, Davis, Parker, & Weiss, 2002, p. 384). Wagner and Wagner published research in 2003 that found that older adults were no less likely (and were sometimes more likely) than other age groups to use health information. In addition, there are many small studies of information seeking and information behavior in the elderly who have specific medical problems; most conclude that information is sought and that a variety of sources are used. Preferred sources range from health care providers and family members to the mass media and the Internet. 286 library trends/fall 2004 What Do We Know about the Elderly and Their Use of the Internet? A recent Robert Wood Johnson Foundation report indicates that the elderly are “better-informed through health information on the Internet, interactive TV, and other communications media” (Robert Wood Johnson Foundation, 2002). American Association of Retired Persons (AARP) data from 2004 show that 47.1 percent of the population fifty years of age and over have Internet access at home, compared with less than 15 percent in 1998 (AARP, 2004). Dr. Vivian Pinn, speaking while at the National Institutes of Health in 1998, said that “Assisting senior citizens in utilizing the wealth of health resources available on the Internet can have important ramifications in enabling them to better understand their health concerns and their health care options” (NLM, 1998). Williams and his colleagues also wrote that “the Internet is a potentially attractive method for patients to get specific health information [but] current formats are not suitable for audiences with low literacy skills,” and “interactive computer-based multimedia represents an approach that appears successful in educating patients with inadequate health literacy” (Williams et al., 2002, p. 384). The director of a National Library of Medicine–funded project on Internet use among senior citizens concluded that “more elders are using the Internet all the time. Looking for health information is one of the most common activities on the Internet” (Devlin, 2003). Wagner and Wagner also found that the use of computers by the elderly was not significantly different from other age groups. They felt that this was convincing evidence to counter the stereotype that older adults are resistant to trying new technologies (Wagner & Wagner, 2003). In a study of elders in a midland city in the United Kingdom, the investigators found that a small percentage of the elderly were avid Web surfers; a larger number were Web users primarily for email but did not do much surfing. While many of their respondents did not yet use the Web, these individuals did believe that “the most popular form of sites which non-users anticipated to be of interest concerned health and medicine” (Millward, 2003). For many elderly persons, their family caregivers served as surrogate Web users. Morrell and colleagues conducted a survey to document World Wide Web use patterns in middle-aged (ages 40–5

The effect of symbols on conveying health information has been studied in a variety of contexts and populations. This investigation assessed whether short-term recall of prescription medication information could be enhanced in a low health literate population through the use of symbols. Participants recruited from various nonpharmacy educational service locations were randomly assigned to receive a prescription medication information leaflet in either a text-only, text with symbols, or symbols-only format and then administered the Rapid Estimate of Adult Literacy in Medicine (REALM). Only those with REALM scores indicative of a sixth grade or lower reading level were included in data analysis. An 8-item, interviewer-administered questionnaire was used to assess participants' recall of information contained in the leaflet. A fictitious medication was used to control for participants' past experiences with medications. Results of statistical testing revealed that the three groups did not differ with respect to their ability to recall the medication information, F(2, 157) = 0.943, p = .392. The symbols used in this investigation were not found to enhance the short-term recall of the medication information presented. These findings should not be considered a wholesale indictment of the use of symbols within health care and in pharmacies. Rather, they should serve as a caution to their widespread use without careful consideration.

The U.S. surgeon general issued a landmark report in 2000, Oral Health in America, which described the poor oral health of our nation as a “silent epidemic.” While there have been notable improvements in the oral health of Americans, oral diseases remain prevalent across the country, posing a major challenge for the U.S. Department of Health and Human Services (HHS). These dire circumstances could be improved if HHS strengthened its commitment to oral health, made it a national priority, and partnered with other stakeholders. In 2009, the Health Resources and Services Administration (HRSA) asked the Institute of Medicine (IOM) to assess the current oral health care system and recommend strategic actions for HHS agencies. The IOM convened a committee to explore how HHS can enhance its role as a leader in improving the oral health and oral health care of the nation.

Purpose The aim of this study was to psychometrically validate the translation of a questionnaire on patient understanding of cardiology terminology (TERM) to Brazilian Portuguese. Design After piloting the translation and cross-cultural adaptation, the 16-item TERM questionnaire was psychometrically tested. Methods Internal and test–retest reliability, as well as validity, were assessed in 322 cardiac patients. Findings Internal (&agr; = .88) and test–retest reliability (all weighted Kappa > 0.63) exceeded the minimum recommended standards. Criterion validity was supported by significant differences in mean scores by socioeconomic indicators (p < .01). Discriminant validity was supported in that cardiac rehabilitation participants had significantly higher TERM scores (p < .001). Participants did not correctly define any of the terms, and a floor effect was identified in all terms. Conclusions The Cardiac TERM Scale was demonstrated to have good reliability and validity. Clinical Relevance The scale can be used by healthcare professionals, such as nurses. Results can be used to inform patient education, which could in turn impact patient adherence to medical advice and hence outcomes.

Poor health literacy, or the ability to interpret and make judgments about one’s health, affects the effectiveness of healthcare services and people’s quality of life. We explored design principles on how to design visually salient, legible and interpretable medical graphics to promote comprehension and recall of electronic medical diagnostic information, an essential component of personal health records, for populations with limited health literacy. We first conducted a two-stage investigation to confirm that people can comprehend pictorial representations of medical conditions and treatments and improve their health literacy. We then designed a set of medical diagnostics graphics, based on the principles of information design derived from a large set of information graphics in various domains. Evaluated in a lab study, our medical diagnostic graphics were found to be capable of improving people’s perceived comprehension and recall, and were considered easy to understand and very useful for individuals with limited health literacy. RESEARCH HIGHLIGHTS • Medical graphics in electronic personal health records can improve people’s comprehension and recall of diagnostic information, and enhance their health literacy. • People are good at recognizing simple symptoms and actions from medical graphics, but have difficulty in integrating pieces of information to make differentiation and judgment. • Photo-realistic illustrations provide the most details to support interpretation, but can be disturbing; animations better depict procedure and change of status, but require patience in viewing; while clipart type of representations make good use of visual cues to convey details and process, and are quick to perceive. • It is important to properly design visual features that highlight important facts, reveal details, demonstrate cause–effects, elicit terminology and measurements, e.g. color, line, symbols, text and numbers, frames, view and perspective, change of scale, style, as well as the presence and design of human character.

Pharmaceutical management of HIV infection is complex, and proper adherence to antiretroviral regimens is contingent on active patient involvement in treatment. We examined the relationship between patient understanding of HIV and its treatment and health literacy. Structured interviews were conducted with 157 HIV-infected individuals receiving care at a community-based clinic in Shreveport, Louisiana, USA. In all, 48% of patients were reading below a 9th grade level. One-third of patients could not name their HIV medications and this was significantly related to low literacy (P < 0.01). Two-thirds of those reading below the 9th grade level did not know how to take their medications correctly (P < 0.05), and 75% did not know the meaning of a CD4 count or viral load (P < 0.001). Patients with low literacy skills were more likely to state that their physician was their sole source of HIV information (P < 0.005). Physicians may require training to appropriately convey health information to patients of low literacy.