The2ndEuropeanHealthLiteracyConference10-11April2014,Aarhus,Denmark

Conferenceprogramme

“HealthLiteracyinpopulationsandsettings-developingtheresearchbase”

Contents

Welcome.................................................................................................................................................................................1

Programme............................................................................................................................................................................2

April10...............................................................................................................................................................................2

April11...............................................................................................................................................................................3

Organisers..............................................................................................................................................................................4

OrganisingCommittee.................................................................................................................................................4

ScientificCommittee....................................................................................................................................................4

Endorsingpartnersandsponsors..............................................................................................................................5

KeynotespeakersA-Z.....................................................................................................................................................6

Pre-conferences..................................................................................................................................................................8

Parallelsessionswithoralpresentations............................................................................................................10

I:HealthliteracystatusinpopulationsI.........................................................................................................10

II:Healthliteracyinterventions..........................................................................................................................10

III:HealthliteracystatusinpopulationsII.....................................................................................................10

IV:Promotinghealthliteracyinsettings.........................................................................................................11

Posterexhibition.............................................................................................................................................................11

Socialprogramme...........................................................................................................................................................12

AarhusbynightfromtheRainbowPanoramaatARoSArtMuseum................................................12

EveninglifeinAarhus...............................................................................................................................................12

PracticalinformationA-Z............................................................................................................................................13

Mapofthecampusareaandconferencevenues.............................................................................................15

Bookofabstracts.............................................................................................................................................................16

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WelcomeDearColleagues–WelcometoAarhusThe Department of Public Health, Aarhus University and The European Health LiteracyNetworkareveryhappytowelcomeyoutothe2ndEuropeanHealthLiteracyConferenceinAarhuson10-11April2014.TheScientificCommitteeand theOrganisingCommitteehavedonetheirbesttoprepareaninspiringprogramme–bothscientificallyandsocially.Wehopeyouwillfinduniqueopportunitiestoshareknowledge,engageinfruitfuldebates,andideallymakenewfriendsandconnectwithfuturecollaborators.ThankstotheparticipationofleadingNordicandinternationalexpertswehavebeenabletoformaprogrammewithavarietyofthemesrelatedtohealthliteracy.Withouroveralltheme:”HealthLiteracyinpopulationsandsettings-developingtheresearchbase”itisouraspirationthattheconferencewill:

· Facilitate sharing evidence-based research on health literacy measurement,interventions,andpolicies

· Provide aplatform forknowledge-exchange forprofessionalsworking in the fieldofhealthliteracyinEuropestimulatingwidercollaboration

· Provide a cross-sectorial, interdisciplinary approach to health literacy by creatingopportunities for capacitybuildingandprofessionalization in research,practice,andpolicy.

Theprogramme isorganised in threeplenary sessions, fourparalleloral sessionsand twoparallelteach-ins.Altogethertheconferenceoffers22oralpresentationsandseveralspeechesheld by leading health literacy researchers. Throughout the conference there is theopportunitytoexplorethenewand inspiringresearchprojectspresented inthe35posters.The fourpre-conferenceswill furtherprovide a valuableplatform forknowledgeexchangeandnetworking.Wehopethatyouwill findourdistinguishedpanelofspeakersandposterpresenterstobeasinspiring,aswedo.

TheconferencesettingisthebeautifulanduniqueUniversityParkofAarhusUniversity.Theyellow buildings scattered around in the green scenerymake up the dailywork place foraround50.000studentsandemployees.AarhusisacharmingcitysituatedclosetoforestsandtheseaandthecityisthesecondlargestinDenmark.Wehopeyouwillhavetheopportunitytoexperiencethefriendlyenvironmentwhichexistsinthenarrowstreetsandenjoyacoffeeinacozycafébytheriver.WecanofferyoufreeadmittancetotheartmuseumARoSthatwillalsohostourThursdaynightsocialevent.WehopeyouwillenjoyyourstayinDenmarkandlookforwardtosharingthescientificandsocialprogrammewithyou.

HelleTerkildsenMaindal,AarhusUniversity,DK.ConferenceChair

KristineSørensen,MaastrichtUniversity,NL.ExecutiveChairExecutiveChair,

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Programme

April10

08:0008:00-09:0011:00-17:00

RegistrationopenRegistration morning – situated by the entrance to the “Konferencecenter”(“ConferenceCentre”)inbuilding1421Registrationafter11:00-LakesideLectureTheatres,building1250,Foyer

12:30-17:00 Posterexhibition-LakesideLectureTheatres,WilliamScharfftheatre

09:00-12:00 Pre-conferences-Studenterhusfonden,building1421(seepages8-9)A.What is happening in the health literacy field in theNordic countries? –meetingroom2.2B.IntroductiontotheHLS-EU-Qmeasurements–meetingroom1.C.Healthliteracy,chronicdiseaseandhealthyageing–meetingroom2D.Takingchildren’shealthliteracyseriously–meetingroom1.3Abreakwillbeheldwhensuitableineachpre-conference

12:00-13:00 Lunch - Lakeside Lecture Theatres, hallway on the 3rd floor and WilliamScharfftheatre

13:00-15:00 Openingsessionday1–LakesideLectureTheatres,PerKirkebytheatre.Welcome:

· HelleTerkildsenMaindal,conferencechair· NickHaekkerup,DanishMinisterofHealth–videospeech· AllanFlyvbjerg,Dean,AarhusUniversity

Keynote:Health Literacy Research 2.0: towards theory guided measures and theircriticalapplication:

· ThomasAbel,BernUniversity,CHIntroductiontoEuropeanhealthliteracyresearch:

· Jürgen Pelikan, Ludwig Boltzmann Institute for Health PromotionResearch,AT

· AndreadeWinther,UniversityMedicalCenterGroningen,NL· StephanvandenBroucke,UniversityCatholicLouvain,BE· JanyRademakers,Netherlands Institute forHealthServicesResearch,

NL15:00-15:30 Break15:30-17:00 Parallelsession I:Health literacy status inpopulations I -LakesideLecture

Theatres,PerKirkebytheatreParallelsessionII:Healthliteracyinterventions-LakesideLectureTheatres,JeppeVontilliustheatre

17:15-17:45 GuidedwalktoARoSArtMuseum.Meetingpoint:Mainentrance,LakesideLectureTheatres

18:00-20:00 Aarhusbynight:fromtheRainbowPanoramaatARoSArtMuseumFestivespeechbyIlonaKickbusch,seesocialprogrammeonpage12

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programme

April11

08:00-12:00 Posterexhibition-LakesideLectureTheatres,WilliamScharfftheatre

08:30-08:55 Openingsessionday2-LakesideLectureTheatres,PerKirkebytheatreCriticalhealthliteracy:apre-requisiteforactiveparticipationinhealth?

· JaneWillsandSusieSykes,LondonSouthBankUniversity,UK

09:00-10:30 Parallel session III: Health literacy status in populations II - LakesideLectureTheatres,PerKirkebytheatreParallelsessionIV:Promotinghealthliteracyinsettings-LakesideLectureTheatres,JeppeVontilliustheatre

10:30-11:00 Break

11:00-11:45 Teach-in I: Health literacy measurements: matching tool and purpose -LakesideLectureTheatres,PerKirkebytheatre

· KristineSorensen,MaastrichtUniversity,NL, JürgenPelikan,LudwigBoltzmannInstituteforHealthPromotionResearch,AT

Teach-in II: Planning Health literacy interventions - Lakeside LectureTheatres,JeppeVontillius

· HelleTerkildsenMaindal,LoniLedderer,LiseJuul,AarhusUniversity,DK

11:45-12:30 Lunch - Lakeside Lecture Theatres, hallway on the 3rd floor andWilliamScharfftheatre

12:30-14:00 Closingsession-LakesideLectureTheatres,PerKirkebytheatrePosterawardPaneldiscussion:HowtocreateahealthliterateEurope?

· HelmutBrand,MaastrichtUniversity,NL· KarinFjeldsted,StandingCommitteeofEuropeanDoctors,IS· ThomaszSzelagowski,EuropeanPatientsForum,PL· BartoszHagbart,EuropeanCommission,BE

ThefuturevisionforEuropeanhealthliteracy

· IlonaKickbusch,GraduateInstituteGeneva,CH

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Organisers

OrganisingCommittee· HelleTerkildsenMaindal,ConferenceChair,AarhusUniversity· KristineSorensen,ExecutiveChair,MaastrichtUniversity· GillRowlands,AarhusUniversity· KirstenVinther-Jensen,AarhusUniversity· LindaEdge,AarhusUniversity· AnneBo,AarhusUniversity

ScientificCommittee· AlexandraJoves-Vranes,BelgradeUniversity,Serbia· DianeLevin-Zamir,HaifaUniversity/CLALIT,Israel· GerardineDoyle,UniversityCollegeDublin,Ireland· GillRowlands,AarhusUniversity,Denmark· HelleTerkildsenMaindal,AarhusUniversity,Denmark· HolgerPenz,CarinthiaUniversityofAppliedSciences,Austria· JürgenPelikan,LudwigBoltzmannInstituteHealthPromotionResearch,Austria· KjellSverre-Pettersen,OsloandAkerhusUniversityCollegeofAppliedScience,Norway· KristineSorensen,MaastrichtUniversity,Netherlands· LarsKayser,CopenhagenUniversity,Denmark· LuisSaboga-Nunes,SchoolofPublicHealthLisbon,Portugal· StephanVandenBroucke,UniversitéCatholiquedeLouvain,Belgium· ZofiaSlonska,CardinalStefanWyszynskiInstituteofCardiology,Poland

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Endorsingpartnersandsponsors

The 2nd European Health Literacy Conference is supported financially by Danish andinternationalsponsors.

Furthermore, the 2nd European Health Literacy Conference is endorsed by conferencepartners.

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KeynotespeakersA-Z

AndreadeWinterAndreadeWinter fromUniversityMedicalCenterGroningen is thescientificcoordinatorofthe IROHLAproject: “InterventionResearchonHealthLiteracyamongAgeingpopulations”,which focuses on improving health literacy for the older people in Europe. It is an EU-supportedprojectundertheFP7researchprogramme.AndreadeWinterwill introducetheaimandinitialresultsoftheproject.Furthermore,shewillreflectonpromisinginterventionstoimprovethehealth,participationandwellbeingofolderadults.

BartoszHagbart-EuropeanCommissionTheDirectorateGeneralforHealthandConsumers(DGSanco)issupportingthedevelopmentofhealthliteracyattheEU-agendathroughfundingofhealthliteracyprojects,integrationinstrategiesandsupportingknowledgesharingplatforms.AttheconferencethefutureEU-levelinitiativeswillbepresentedanddiscussed.

TheDirectorateGeneralforInformationandTechnologyhasbeenengagedinhealthliteracy,particularly fromane-healthandm-healthperspective.DGConnectwillprovide insights intheirfuturedevelopmentsintermsofhealthliteracypromotionintheinformationage.

HelmutBrandProfessorHelmutBrand fromMaastrichtUniversity, theNetherlandshasbeen leading theEuropeanHealth Literacy project to establish health literacy in Europe.He is involved inhealthliteracyEuropeanizationandhealthliteracyintegrationtobridgeresearchwithpolicyandpracticeatglobal,Europeanandnationallevelsthroughinternationalcollaborations.

IlonaKickbuschProfessor llona Kickbusch from the Graduate Institute in Geneva is one of the Europeanpioneerswithinthehealthliteracyfield.Shehasbeenpromotinghealthliteracyformorethantwodecades.ShewillbeaddressingthefutureperspectiveofEuropeanhealthliteracy.

JaneWillsProfessorJaneWillsfromLondonSouthBankUniversityfocusesonhealthliteracyandhealthpromotion. She will introduce her reflections concerning the promotion of critical healthliteracy.

JanyRademakersDr JanyRademakers is fromNIVEL, theNetherlands Institute forHealthServicesResearch.Herresearchfocusesonthediversityinhealthcare,morespecificallyonhealthliteracyandpatientactivation,and ingeneralonpatient involvementandempowerment inhealthcare.She is a foundingmemberof theDutchHealthLiteracyAllianceandof theHealthLiteracyKnowledgeCentre ofNIVEL andRIVM. Shewill introduce thenewEU-supported initiativewhichaimsatprovidingsoundevidence forabetterunderstandingofhealth literacy intheEU.

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JürgenPelikanProfessor Jürgen Pelikan from Ludwig Boltzmann Institute Health Promotion Research inVienna,Austriahas,asamemberoftheEuropeanHealthLiteracyConsortiumbeenthechiefanalyst of the HLS-EU survey. He has been leading additional health literacy populationstudies inAustria and has played a key role in the health literacy policydevelopments inAustria,wherehealth literacyhasbeen integratedas astrategicnationalhealthgoal forthecomingyears. JürgenPelikanwillsharethemainoutcomesoftheEuropeanHealthLiteracySurveyattheconferenceinAarhus.

KarinFjeldstedKarinFjeldsted ispresidentof theStandingCommitteeofEuropeanDoctors (CPME).CPMEconsidershealthliteracyasanimportantaspectforhealthprofessionalsandactsasadvocatesforhealthliteracyatEuropeanlevelbybeinginvolvedinprojects,EUpolicydevelopmentetc.

StephanVandenBrouckeProfessor Stephan Van den Broucke from Université Catholique de Louvain is leading theDiabetesLiteracyproject,which issupportedbytheEU'sFP7researchprogramme.Hewillprovideanoverviewofitsobjectivesandinitialresults.

ThomasAbelProfessorThomasAbel fromBernUniversity in Switzerland, a sociologist inpublichealth,callsforstrengtheninghealthliteracyapproachesthroughtheoreticalguidance.Hisownworkon health literacy is focused on the links between social inequality (cultural capital,capabilities)andhealthliteracymeasurement(atthepopulationlevel).

TomaszSzelagowskiTomaszSzelagowski'sacademicbackgroundisinpedagogicaleducation.Hehasworkedasaconsultantandtrainerintheareasofhumanrelationsandleadership.TomaszSzelagowskiiscurrently pursuing a line in further education in the field of Anthropology of Culture. AsGeneralDirectoroftheFederationofPolishPatients(FPP)heisresponsibleformanagingandimplementingtheoverallstrategyoftheorganisation.Hiscontributionattheconferencewillbetoraiseawarenessofhealtheducationandengineeringlarge-scaleorganisationalchangeamongpatient’senvironment.

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Pre-conferences

TheNordicHealthLiteracyNetwork(NorHLnet)wasfounded2012.Thenetworkisopentoallpeople interested in,workingwithand/orwanting toworkwithHealthLiteracyand/orconducting Health Literacy research in any of the Nordic countries. The network meetsregularlytwiceayeartodiscussdifferentHealthLiteracyissuesraisedbythemembersinthenetwork.SoifHealthLiteracynetworkinginterestsyou,pleasesignupforthispre-conferenceworkshop.ThepresentsituationofwhatisgoingonindifferentHealthLiteracyareasintheNordic countries will be presented, followed by discussions focusing on what theoverreachingaimofthenetworkshouldbeandhowworkwithinthenetworkwillcontinue.

Priortotheworkshopwewillcall forshortwrittenpresentations(max1A4page)onhowyouworkwith, or are interested in,Health Literacy andwant to focusupon itwithin thecontextofI:WhatishappeningintheHealthLiteracyfieldwithintheNordicCountries?

Those attending the workshop will form focus groups based on their interest in healthliteracy. These focus groups will draw up the framework for continued work within thenetwork.Thepre-conferenceisorganisedbytheNordicHealthLiteracyNetwork.

TheEuropeanHealthLiteracy Surveywas conducted in2011 in eight countries.Thispre-conferenceintroducestheHLS-EU-Q,whichwasdevelopedtomeasurehealthliteracyintheEuropeanHealth Literacy Survey. The aim is toprovideinsightsconcerning the underlyingconceptual framework, the application and the analysis of the data. TheHLS-EU-Qwill becomparedtootherhealthliteracyassessmenttoolsandadvantagesanddisadvantageswillbediscussed.

Thepre-conferenceisorganisedbytheHLS-EUconsortium.

A:WhatishappeningintheHealthLiteracyfieldwithintheNordicCountries?

Chairs:LenaMårtenssonandJosefinWångdahl

B:IntroductiontotheHLS-EU-Qmeasurements

Chairs:JürgenPelikanandKristineSørensen

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Theaimofthepre-conferenceistoexchangeviewsandexperiencesregardinghealthliteracyand self-management, on the basis of research conducted in the FP7 projects DiabetesLiteracyandIROHLA(InterventionResearchofHealthLiteracyintheAgeingPopulation).Theinteractiveprogrammeincludesdiscussionsconcerningconceptualmodels,bestpracticesandimplementationfidelityinbreak-outsessionsandinplenary.

The pre-conference is organised by the Diabetes Literacy consortiumand the IROHLAconsortium.

P

TheworkshopisorganizedbyWorkingInternationallyonSocialDevelopmentandHealthinEuropeanSchoolsandFamilies (WISHES) -anetwork that spansuniversity-based researchandschool-basedaswellascommunity-basedpractice,acrossEurope(wishesnetwork.eu).

How are skills required for healthy lifestyles developed and acquired in real life schoolsituations?Inwhatwaysdohealthliteracyprogrammesfacilitateorunderminetheskillsetscurrentlydisplayedbyvariousactorswithinschoolsettings?Whatroleisplayedbyexternalactorswhoinfluencetheworkingofschools,rangingfromparentstolocalauthorities?Whataresomerelevantprogrammes,modelsandcasesofgoodpractice?

If these questions excite you, please sign up for this pre-conference workshop, wherediscussions will beembedded within strong cross-disciplinary research that draws oneducation, health, socialization studies, social sciencemore generally and physical activityresearch.

Thepre-conferenceisorganisedbytheWISHESnetwork.

C:Healthliteracy,chronicdiseaseandhealthyageing

Chairs:StephanvandenBroukeandMennoReijneveld

D:Takingchildren’shealthliteracyseriously:innovativeperspectivesfromresearch,practiceandpolicy–amulti-

methodsworkshopChairs:EliseSijthoffandShantiGeorge

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Parallelsessionswithoralpresentations

I:HealthliteracystatusinpopulationsIChair:GillRowlands,AarhusUniversity,DK

a) Jany Rademakers: Patient activation and health literacy as predictors of healthinformationuseinDutchhealthcareconsumers

b) Anne Bo: National indicators of health literacy: Ability to understand healthinformation and to engage activelywith healthcare providers – a population basedsurveyamongDanishadults

c) JamesFullam:HealthliteracyandhealthbehavioursinIrelandd) IrisvanderHeide:TheRelationshipBetweenHealth,Education,andHealthLiteracy:

ResultsFromtheDutchAdultLiteracyandLifeSkillsSurveye) KjellSverrePettersen:Approachestomeasuringhealthliteracyinvariouscontextsin

Norway-from2007to2013

II:HealthliteracyinterventionsChair:AstridAustvoll-Dahlgren,NorwegianKnowledgeCentrefortheHealthServices,NO

a) Liesbeth de Wit: Older adults’ needs and perceptions regarding health literacycomponents:participatoryfocusgroupdiscussionsinthreeEuropeancountries

b) Andrea F. de Winter: Development and evaluation of taxonomy of health literacyinterventions

c) Eva-MariaBitzer:Patientattitudestoapersonalcontrolledhealthrecord-associationswithhealthliteracy?-Resultsfromsurveyamongchronicallyillpatients

d) GitteSusanneRasmussen:"Talkthemthroughit".Towardsaninterpretivedescriptionof context-specific health literacy ability in family members to young people withpsoriasis.

e) SusieSykes:Understandinganddevelopingcriticalhealthliteracy

III:HealthliteracystatusinpopulationsIIChair:JürgenPelikan,LudwigBoltzmannInstituteforHealthPromotionResearch,AT

a) JosefinWångdahl:FunctionalandcomplexhealthliteracylevelsinrefugeesinSwedenb) GudrunQuenzel:HealthLiteracy invulnerablepopulations inGermany - a followup

studyontheEuropeanHealthLiteracySurveyc) Lindsay Kobayashi: Ageing, cognition, and health literacy decline in the English

LongitudinalStudyofAgeingd) PeterChang:ThehealthliteracyofyoungadultsinTaiwanusingtheHLS-EU-Q

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e) DianeLevin-Zamir:UsingNationalHealthLiteracySurveyResultstoImprovePractice,DevelopPolicy,andStrengthentheResearchBaseforPromotingHealthandSelf-Care

f) MonikaMensing: False self-perception of functional health literacy inNorth Rhine-Westphalia:IdentifyingendangeredgroupsusingtheHLS-EUdata

IV:PromotinghealthliteracyinsettingsChair:JanyRademakers,NetherlandsInstituteforHealthServicesResearch,NL

a) Jorien C.H. Bakx: Quick Scan Health Literacy in hospitals. Development andimplementationofapracticebasedtoolboxinDutchhospitals

b) MirjamFransen:Equal opportunities for informedparticipation in colorectal cancerscreening

c) GillianRowlands:AddressingtheHealthLiteracyskillsmismatch inEngland:movingfromevidencetopolicychange

d) Anne Konring Larsen: Framing health literacy into the workplace - means andperspectiveofapreventiveintervention

e) ZofiaSlonska:Canweassumethatnursesarealwayssufficientlypreparedtosupportpatients in their health literacy development? The results of the Warsaw cross-sectionalstudy

f) Enrique Castro-Sánchez: Health literacy in migrants: an integrative review of theliterature

PosterexhibitionPosters will be exhibited during the whole conference. During lunch time we encourageeverybodytostudythesevaluablecontributionstotheconferencewhereauthorswillbe inthe near vicinity and ready to answer questions as well as take up fruitful lunch timediscussions about their research. The posters presented cover a variety of themes; Policy,measurements, health behaviour, chronic disease, older people, vulnerable groups,immigrants, health professionals, and communication/e-health. A prize for the best posterwillbeawardedinplenarysessiononFriday11April.

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SocialprogrammeAarhusbynightfromtheRainbowPanoramaatARoSArtMuseumThursdaynightyouareinforanextraordinaryexperiencewhenweascendtothe“RainbowPanorama”ontopoftheARoSArtMuseumatdusk.

ARoS Art Museum is situated in the heart of Aarhus and is one of Europe’s largest artmuseums.Themuseum,whichopenedin2004,pleases,enlightens,andchallengesitsguests.The architectureof themuseum itselfhasbeen internationally acclaimed, ashas the art itcontains.InMay2011thespectacularYourPanoramaRainbowopenedontopofthemuseum.ThisuniqueprojectwasdesignedandimplementedbyStudioOlafurEliasson,Berlin.

The museum staff will first take us on a short guided tour of the museum. Next, IlonaKickbuschwillgiveusan inspiring talkbeforewewillenjoy abuffetandan informal timetogether.

When:at18:00-20:00hrs.

Where:ARoSArtMuseum.ARoSAllé2,DK-8000AarhusC.10minutes’walkfromthetrainstation,25minutes’walkfromtheUniversityParkandconferencesite.

GuidancetoARoS:Conferencestaffwillheadthequickwalkfromtheconferencesitetothemuseum.OnourwaywewillpassthroughsomeofthemainwalkingstreetsofAarhus.

WeleavefromthemainentranceoftheLakesideLectureTheatresat17:15hrs.

Pleaseaskthestaffregardingtaxiesorbuses.

EveninglifeinAarhusAarhushasmanycozycafesandplacesforrelaxing,socializingandlisteningtomusic.Wearehappytoadviseyouaboutniceplacestovisit.

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PracticalinformationA-ZAddressesThe pre-conferences will be held in Studenterhusfonden, building 1421, entrance“Konferencecenter” (“Conference Center”), FredrikNielsensVej 4, 8000Aarhus C.Meetingroomsasallocated,1,2,1.3,and2.2.

ThemainconferencewillbeheldintheLakesideLectureTheatres,Building1250,BartholinsAllé3,8000AarhusC.Signswillbepostedandstaffwillbeavailable toassist findingbothlocations.

AbstractsAll participating abstracts are printed in this book from page 16. The abstracts can bedownloadedinpdfformatfromtheconferencewebpageatwww.healthliteracyeurope.net.

NametagsThe name tag issued to you upon registration is your admission to all scientific sessions,lunchesandcoffee.Youarekindlyrequested towearyourname tagonalloccasions. If thebadgeislost,pleasecontacttheregistrationdesk.

CateringAlightbreakfastwillbeservedduringthebreakduringthepre-conferences.

LunchwillbeprovidedThursdayasabuffetandFridayasalunchboxservedintheLakesideLectureTheatresinthehallwayonthe3rdfloorandintheWilliamScharfftheatre.

ThereceptiononApril10includesabuffetattheARoSArtMuseum.

CertificateofAttendanceA certificate of attendance can bedownloaded electronically after youhave completed theelectronic evaluation that will be sent to you by email. Please refer to the conferenceorganisersifyouhaveanyspecialneedsregardingdocumentationofattendance.

EvaluationWewouldverymuchappreciateyourfeed-backontheconferencecontentandorganisation.Therefore,wewillemailyouashortonlineevaluation form.Wekindlyaskyoutocompletethe form - preferably during, and immediately after the conference and byMay 5th at thelatest.PostersTheposterexhibitionislocatedintheLakesideLectureTheatres,WilliamScharfftheatre.ThepostersareexhibitedfromnoonApril10untilnoonApril11.Authorsarerequestedtobeinnearvicinitytotheirposterduringlunchbreaks.

Posters should be hung-up between 9:30 and 13:00hrs. on April 10 and taken down by12:15hrs.onApril11.

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PosterawardTheScientificCommitteewillpointout acandidate forbestposter.The candidate forbestposter will be announced, and a prize awarded, during the closing session on Fridayafternoon.

RegistrationIf you are attending one of the pre-conferences, registration will take place beforecommencementonThursdaymorningApril10.AllotherparticipantswillbeabletoregisterbeforetheopeningsessionofthemainconferenceonApril10.

Registration morning: April 10 at 08:00-09:30 hrs., Studenterhusfonden, building 1421,Fredrik Nielsens Vej 4. The Registration Desk will be situated by the entrance to the“Konferencecenter”(ConferenceCentre”),

Registrationlatemorning/earlyafternoon:April10at11:00-13:00hrs.TheRegistrationDeskissituatedinthefoyerbythemainentrancetotheLakeSideLectureTheatres,BartholinsAllé3.

SpeakersandpresentersWekindlyaskplenaryspeakerstomeet15minutesbeforethecommencementofthesessioninordertotestandsavethepresentationsontothelecturehallcomputer.

Presenters in the parallel sessions are also requested tomeetwith the session chairs 15minutesbeforethecommencementofsessionsinordertotestandsavethepresentationsontothelecturehallcomputer.

StaffStaffwillbeavailableduringallbreaks.Theywillbereadytohelpyouwithanyquestionsyoumighthaveorreferyoutoanotherpersonwhocanassist.

TransportationIt isapproximatelyahalf-hourwalk fromthemaintrainstation inAarhustotheUniversityPark,wheretheconferenceisbeingheld.

BussesfromthetrainstationtotheUniversityPark:Bus14towards“Skejbyparken”,bus18towards “Elev”, bus 1A towards Lystrup Øst. Get off at: “Aarhus University HospitalNørrebrogade” formain conference.Get off at “NordreRinggade” forpre-conferences.Thepriceis20Danishcrowns(20.00DKK),andyouwillneedcoins.

Taxiesareavailablefromthemaintrainstation.Youcanhireataxibycalling+4589484848.TheywillbeabletotakeyourcallinEnglish.Conferencestaffwillbehappytoassistyouatalltimes.

VouchersforAarhusartmuseumARoSVouchers for free entrance to the ARoS Art Museum are available upon request duringregistration.Alternatively,askconferencestaffatanytimeduringtheconference.

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Findyourwayaroundcampuswiththeapp“AUFind”for

IphoneorAndroid.http://www.au.dk/om/organi

sation/find-au/aufind/

Mapofthecampusareaandconferencevenues

LakesideLectureTheatre,building1250.

10 minutes’ walk to thecitycenter

Venueforpre-conferences,building1421

Secrettunnel

WalkingpaththroughthebeautifulUniversityParkfrompre-conferencesitetoLakesideLectureTheatre

“Dale’s”,smallcafé

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Bookofabstracts

This book contains all accepted abstracts for the 2nd European HealthLiteracyConference,April10-112014,Aarhus,Denmark

O-01-PatientactivationandhealthliteracyaspredictorsofhealthinformationuseinDutchhealthcareconsumersJanyRademakersDrsJessicaNijman1),DrMichelleHendriks1),DrsAnneBrabers1),DrJudithdeJong1),Dr.JanyRademakers1)1NIVEL-NetherlandsInstituteforHealthServicesResearch,Utrecht,theNetherlandsIntroduction: Indemand ledhealth care systems,consumers and patients are expected to play aninformed,active role in their ownhealth care, e.g.withrespecttothechoiceofhealthplans,providersand treatments, self-management, healthpromotion. In order for consumers to be able toplaythisrole,theyhavetobeadequately informedabout relevant aspects of health and health care.Thereforehealth informationand theuseof ithasbecome of significant importance. The ability toseek, use and comprehend health information isknowntoberelatedtospecificcharacteristics,suchas patient activation and health literacy. In thisstudy, the level of patient activation and healthliteracy in a sample of the Dutch populationwasmeasured.Furthermore,therelativecontributionofpatient activation and functionalhealth literacy tothe seeking and use of health information wasexamined.Methods: A questionnaire was sent to 2000members(18+)oftheDutchHealthCareConsumerPanel. Among other health related questions, thequestionnaire includedthefollowingmeasures:thePatient Activation Measure (PAM) 13-Dutch, theDutch version of the Set of Brief ScreeningQuestions (SBSQ-D), and a set of questionsassessingtheseekinganduseofhealthinformation.Results: Themean patient activation score in theDutch samplewas higher for younger health careconsumers and for thosewith a higher education,higherincomeandbetterself-reportedgeneralandmental health status. A substantial amount of therespondents reported problems with functionalhealth literacy: 9.4% frequently needs help withreading 17.7% doesn't feel confident in filling outmedical forms and 23.3% reports frequentproblemsinlearningabouttheirmedicalcondition.Both patient activation and functional healthliteracy were related to the seeking and use ofhealth information. However, patient activationproved to be a stronger predictor than functionalhealthliteracy.Conclusion:Health informationusedoesnot onlydepend on the level of reading skills, but also onother individual characteristics such as feelingresponsibleforone'sownhealth,motivationtolookforinformationandself-confidencetobeabletoaskquestions. Health communication strategies, both

onan individualandon apublic level,willhave toaddress these aspects aswell in order tobemoreeffective.O-02-NationalindicatorsofHealthLiteracy:Abilitytounderstandhealthinformationandtoengageactivelywithhealthcareproviders–apopulationbasedsurveyamongDanishadultsAnneBoMasterofScienceinPublicHealth(MScPH)AnneBo1),PhDKarinaFriis2),ProfessorRichardHOsborne3),AssociateProfessorHelleTerkildsenMaindal1)

1SectionforHealthPromotionandHealthServices,DepartmentofPublicHealth,AarhusUniversity,Aarhus,Denmark2PublicHealthandQualityImprovement,CentralDenmarkRegion,Aarhus,Denmark3PublicHealthInnovation,PopulationHealthStrategicResearchCentre,SchoolofHealthandSocialDevelopment,DeakinUniversity,MelbourneVictoria,AustraliaIntroduction: Health literacy covers a range ofskills and competencesnecessary forparticipationin health care and it is a determinant of healthinequity.Knowledgeofhealthliteracyinthegeneralpopulationislacking.Thepurposeofthisstudywasto examine aspects of health literacy related tounderstandinghealth informationandengagementwithhealthcareproviders.Methods: A cross sectional population-basedsurveywas conducted between January and April2013 in the Danish population. Postal invitationsweresenttoarandomsampleof46,354individuals>25 years of age residing in the CentralDenmarkRegion (22% of the totalDanishpopulation).TwokeyaspectsofhealthliteracywerederivedfromtheHealth Literacy Questionnaire (HLQTM): i)Understanding health information well enough toknow what to do" (5 items) and ii) Ability toactivelyengagewithhealthcareproviders(5items),with scores ranging from 1 (easy) to 4 (verydifficult). The distribution of these competencies,andassociationsbetweenthemandsocio-economiccharacteristicswereexplored.Results:Atotalof29,473(63.6%)respondedtothesurvey. A considerable part of the Danishpopulation perceives difficulties related tounderstanding health information and engagingwith healthcare providers. Low socio-economicposition is associated to lower levels of the twoinvestigatedhealthliteracyaspects.Theresultswillbepresented at the2ndEuropeanHealthLiteracyConferenceinAarhus.Conclusion: Danish estimates on health literacyaspectsarenowavailable.Our results indicate theneed to optimize the health system. The study

points to immediate responses that policy,prevention programs, and clinicians could take toimprovepopulationhealth,especiallyinvulnerablegroups. It is critical that future studies investigatemoreaspectsofhealthliteracyandtherelationshiptohealthoutcomes.O-03-HealthliteracyandhealthbehavioursinIrelandJamesFullamMrJamesFullam1),DrGerardineDoyle2),DrSarahGibney2)1SchoolofPublicHealth,PhysiotherapyandPopulationScience,UniversityCollegeDublin,Ireland2SchoolofBusiness,UniversityCollegeDublin,IrelandIntroduction: Health literacy has been on theperiphery of the public policy agenda in Irelandsince2002,howeveracademicinterestandrelevantdata have been relatively sparse until now. Datafrom The European Health Literacy Survey (HLS-EU) was used to determine the prevalence oflimited health literacy in the Irish population, todetermine themost importantpredictorsofhealthliteracyandtoexamineassociationsbetweenhealthliteracyandhealthbehaviours.Methods:Across-sectionalsurveywascarriedoutwith a nationally representative sample of Irishadults,datawascollectedinJuly2011.Multivariatelogisticregressionwasusedtodeterminethemostimportantpredictorsofhealth literacyandalso toexplore the relationship between health literacyandi)healthbehavioursandii)healthstatus.Results:Datawascollectedfromasampleof1005individuals (response rate 69%). Of those 10.3%had inadequate health literacy, 29.7% hadproblematic health literacy, 38.7% had sufficienthealth literacy and 21.3% had excellent healthliteracy. Multivariate logistic regression showedfunctionalhealth literacy,proxymeasuresofsocio-economicstatus,andagetobesignificantpredictorsof limited health literacy. Limited health literacywas associated with smoking and less frequentexercise in univariate analyses but significantassociationsdidnotpersistinmultivariateanalyses.Adequatehealth literacywas a strongpredictorofgood self-ratedhealth inunivariateanalysis,againhowever the association did not persist in amultivariatemodel.Conclusion: The results show that a largeproportionofIrishadultshavepoorhealth literacyand identifies thosemost at risk of limited healthliteracy.Examiningtheresultsofthisanalysisinthecontext of existing Irish data on literacy, healthbehaviours and health outcomes establishes afoundation for future research in the area. It alsohighlights potential targets for the integration of

health literacy into public health and educationpolicies.O-04-TheRelationshipBetweenHealth,Education,andHealthLiteracy:ResultsFromtheDutchAdultLiteracyandLifeSkillsSurveyIrisvanderHeideMAIrisvanderHeide1),PhDJenWang2),PhDMariëlDroomers3),PhDPeterSpreeuwenberg4),PhDJanyRademakers4),PhDEllenUiters1)1NationalInstituteforPublicHealthandtheEnvironment(RIVM),Bilthoven,TheNetherlands2InstituteforSocialandPreventiveMedicine,UniversityofZurich,3DepartmentofPublicHealth,AcademicMedicalCenter,Universityof4NetherlandsInstituteforHealthServicesResearch(NIVEL),UtrechtIntroduction:Healthliteracyhasbeenputforwardas a potential mechanism explaining therelationship between education and health.However, little empirical research has beenundertakentoexplorethishypothesis.Thepresentstudy aims to studywhether health literacy couldbe an explaining pathway by which level ofeducationaffectshealthstatus.Methods Health literacy was measured by theHealth Activities and Literacy Scale (HALS), usingdatafromasubsampleof5,136adultsbetweentheagesof25and65years,gatheredwithinthecontextof the 2007 Dutch Adult Literacy and Life SkillsSurvey (ALL). Education was measured by thehighest self-reported levelofeducation completed.Linear regression analyseswere used to estimatethe extent to which health literacy mediateseducational disparities in self-reported generalhealth, physical health status, and mental healthstatus as measured by the Short Form-12. Allanalyseswerecontrolledforageandsex.Results Level of education was significantlyassociated with health literacy; those whocompleted tertiary education showed the highestmean health literacy score. Mean health literacyscoresdecreasedgraduallywitheachlowerlevelofeducation. Being lower educated was alsoassociatedwithpoorerself-reportedgeneralhealth,physical health, and mental health. Theseassociationswere found tobemediatedbyhealthliteracy.Conclusion Health literacy partially mediates theassociation between education and self-reportedhealthstatus.Thefindingsofthisstudysuggestthatstrategiesforreducingeducation-relateddisparitiesin health may benefit from attention for healthliteracy.

O-05-ApproachestomeasuringhealthliteracyinvariouscontextsinNorway-from2007to2013KjellSverrePettersenPhDKjellSverrePettersen1)1OsloandAkershusUniversityCollegeofAppliedSciences,Oslo,NorwayIntroduction:DonNutbeam's (2000)definitionofhealth literacy (HL) has had amajor influence onhowresearchershaveattempted tomeasureHL invariouscontexts.Nutbeam'sdivisionofHLinthreedimensions; functional HL, interactive HL, andcritical HL has shaped the development ofquestionnaires that have been tested in varioustargetgroupsinNorwayduringtheperiodof2007-2013. Particular interest has been to try tooperationalize and measure interactive HL andcriticalHLinhealthpromotionsettings-andnotinclinical. However, these approaches are mainlyconducted as master theses and exclusivelypublishedinNorwegian.Itwasfurtherattemptedtooperationalize and measure nutrition-orientedhealth literacy, a sub-conceptwhichaccordingSilketal.(2008)might largelyoverlapwithNutbeam'sdefinitionofHL.Thepurposeofthispresentationisto report on how our research unit and studentsoperationalized and measured both HL andnutrition-related HL in various national contextsover a period of six years, aswell as show someresultsfromthesepilottest-likestudies.Methods:HLwasmeasured innationalsamplesofhigh school students; physicians; public healthnurses,anddiabetesnurses,whilenutrition-relatedHLwasmeasuredamongusersof a fitness studio;employees at three companies; nursing students,andyoungathletes.Allthesestudieswerebasedonself-developed questionnaires, which mainlyconsisted of standard Likert-scaled attitudestatements intended to build constructs reflectingthe three dimensions of HL and nutrition-relatedHL.Insomecases,itwasalsodevelopedknowledgetests to add new aspects of the functional andcriticaldimensionofbothHLandnutrition-relatedHL.Theanalyzesfollowedtherulesofclassicaltest-theory (conducting factor analysis and reliabilityanalysis measuring coefficient Cronbach's alpha -CCA-toestablishconstructs).Tocomparescoresontheestablishedconstructs,correlation tests, t-testsand ANOVAwere applied. To investigate possiblesignificant predictors of the variance in theconstructsasdependentvariables,both linearandlogisticregressionanalysiswereconducted.Results: In most contexts, the statistical analysissucceededinestablishingthreeseparateconstructsfor theoretical dimensions of HL and nutrition-relatedHL.However, furtheranalyzesshowed that

these three dimensions were not be strictlyhierarchical structured, as alleged by Nutbeam(2000) and Silk et al. (2008). Thiswas also laterpointed out by several researchers, for instanceSørensen et al. (2012) and Gutterud & Pettersen(2013). In a pair of studies, two interesting sub-constructsofthecriticaldimension(criticalHLandcritical nutrition-related HL) evolved through thefactor analysis. Eitherway, a consistent finding inourresearchwasthattherespondentsscoredloweron the critical dimension than the on other two(functional and interactive), and this wasparticularly true of the statements aboutwhetherthe respondents knew the difference betweenscientificandnon-scientificbasedhealth/nutritioninformation.Conclusion:OurNorwegianresearchapproachestomeasure HL and nutrition-related-HL show aninteresting 'historicaldevelopment',especiallyhowwe operationalized the concepts. This may be ofgeneral importance to the further development oftheHLconcept,itself,aswellasforconstructorsofHL-measurementtools.O-07-Olderadults’needsandperceptionsregardinghealthliteracycomponents:participatoryfocusgroupdiscussionsinthreeEuropeancountriesLiesbethdeWitMsLiesbethdeWit1),MsPaniaKarnaki2),MsArchontoulaDalma2),MsAgnesNovoszath3),MrPeterCsizmadia3),MsCharlotteSalter4),MsAndreaF.deWinter,MsIngeHutter,MsLouiseMeijering1)1PopulationResearchCentre,FacultyofSpatialSciences,UniversityofGroningen,Groningen,theNetherlands2InstituteofPreventiveMedicine,EnvironmentalandOccupationalHealth,Athens,Greece3NationalInstituteforHealthDevelopment,Budapest,Hungary4FacultyofMedicine&HealthSciences,UniversityofEastAnglia,Norwich,UnitedKingdomIntroduction: Health literacy (HL) is one of thedeterminantsofhealth.Physicalandmentaldeclineinherent to aging make people at older agesvulnerable for lowerHL,which is associatedwithlower quality of life. To promote older adult'sHLthere is aneed for effectiveHL interventions thattargetolderadultswithintheirlivingenvironments.Thesuccessofsuchinterventionsstronglydependsontheneedsandperceptionsofolderpeoplelivingwithin their particular socio-cultural context.Hardlyany research in the fieldofHLhas studiedthis essential topic. The aim of this study is toexplore the needs and perceptions regarding HLrelated components of people >50 years oldwholive in less privileged urban neighborhoods inHungary,GreeceandtheNetherlands.

Methods:Thisstudyincludedtheperspectivesofadiverse group of older adults as well as healthprofessionals.Ineachcountry2participatoryfocusgroupdiscussionswereconductedwithhealthyandless healthy older adults and 2 with healthprofessionals from different professions, such asnurses,socialworkers,GPsandphysicians.Intotal50 older adults and 30 health professionalsparticipated. The results were validated throughfollow-up sessions. A grounded theory approachwasusedtoallowthemostimportanttopicsemergefrom the data itself. Standardized protocols fordesigning thestudy,codinganddataanalysiswereusedtoassureconsistencybetweentheresearchersinthedifferentcountries.Results:Theparticipants'stories inall3countriesreflected three overarching main themes: 1)importance of autonomy for managing individualhealthandwellbeing;2)supportofsocialnetworkin care andwellbeing; and 3) trust in health careproviders, health services, the health care systemandthewidersystem.Conclusion: Having andmaintaining autonomy, asocialnetworkand trust inall levelsof thehealthcaresystemrelatetocomponentsofhealthliteracy,suchashealthseekingbehavior,andinfluenceolderadult'swellbeing.Thisempiricaldatacontributestothe understanding of and evidence for designingeffectivehealthliteracyinterventionsinEurope.O-08-DevelopmentandevaluationoftaxonomyofhealthliteracyinterventionsAndreaF.deWinterPhDAndreaF.deWinter1),PhDJeanetLandsman1),PhDCarelJansen2),MDJaapKoot1),PhDMDSijmenA.Reijneveld1)1DepartmentofHealthSciences,UniversityMedicalCenterGroningen,UniversityofGroningen,theNetherlands2DepartmentofCommunicationandInformationStudies,FacultyofArts,UniversityofGroningen,theNetherlandsObjectives: To develop and evaluate taxonomy todescribe interventions to improve outcomes ofolder adults with poor health literacy, targetingeither(older)adults,professionalsor theircontext(family,peers,and community,andhealth system,respectively). An intervention taxonomy may bedefined as a classification system that categorizesthe characteristics of interventions. Itmayhelp toimprove intervention research among older adultsbystandardizing thedescriptionsofhealth literacyinterventions, thus supporting communicationamong and between care providers andresearchers.Methods: The taxonomy was developed andevaluatedwithastepwiseapproach.First,weusedliterature on taxonomies or classifications of

interventions to develop draft taxonomy. Second,we tested the feasibility of the draft taxonomy byassessing whether two independent reviewerscouldclassifyhealthliteracyinterventionswiththistaxonomy in a reliable way. These interventionswere derived from a set of 25 articles on awiderange of interventions. Inter-rater agreementwasmeasured by Cohen's kappa, for each item of thetaxonomy. Third, the feasibility of the (adapted)draft taxonomywasevaluatedwithhealth literacyresearchersacrossEuroperegardingitssuitability.Results: The taxonomy classified objectives intosevencategories:1)toinformandeducate,2)toteachskills,3) to support behaviour change andmaintenance,4)tostrengthencontextualsupport,5) To facilitate involvement of individuals at thesystemlevel,6) to customize health literacy interventions orenhancetheimplementationoftheseinterventions,and7) to change the social, cultural or physicalenvironment in order to enhance the effects ofhealthliteracyinterventions.Furthermore, it enabled thedescription of specificcharacteristicsofinterventionsweredescribedsuchas complexity,mode and/ or intensity. To informand educate, to teach skills and to enablebehaviouralchangeswere themost frequent ratedobjectiveswith kappa values varying from0.46 to0.66 indicatingmoderate to good reliability. Veryfew interventions aimed to customize healthliteracy interventions to clients or to change theenvironment, making it impossible to computekappa's for these objectives. Researchersconsidered the taxonomy useful for practice andresearch, both regarding its application onobjectivesandoncharacteristicsofinterventions.Conclusion: A comprehensive taxonomy wasdevelopedforhealthliteracyinterventionstargetedat(older)adults,professionalsortheircontext.Thetaxonomy has proven to be easy to use, able toclassify the contents of a large range of healthliteracyinterventions,andreliableinclassifyingthemostfrequentlypursuedobjectives.Weexpectthatthis taxonomy ofhealth literacy interventionswillcontribute to describing and evaluating theevidenceregardingmultifacetedorcomplexhealthliteracy interventions. However, its reliability andadded value shouldbe further assessed in varioussettings.O-09-Patientattitudestoapersonalcontrolledhealthrecord-associationswithhealthliteracy?-ResultsfromsurveyamongchronicallyillpatientsEva-MariaBitzer

Prof.Dr.Eva-MariaBitzer1),Prof.Dr.UweH.Bittlingmayer2)1Dept.PublicHealth&HealthEducation,UniversityofEducation,Freiburg,Germany2InstituteofSociology,UniversityofEducationFreiburg,GermanyBackground:Electronichealth recordspromise tofacilitate exchange and availability of health andhealthcareutilisationrelated information inordertoimprovethequalityofcareand/ortosavecosts.WithaPersonallyControlledHealthRecord(PCHR)the patient controlswhat health information goesinto it, and who is allowed to access it. A PCHRmight be a powerful tool to enhance patientautonomy. A sensible use of a PCHR requirespatients to be health literate. In a pilot studyweexplored associations between the genral attitudetowards aPCHR, thewillingness toprovideaccesstohealth information,and avarietyofbackgroundvariables.Methods: In April 2012 we undertook a writtensurvey among patients with known chronicdiseases.Thestudypopulationcomprisedarandomsample of beneficiaries (born 1942 to 1994) of aGermansicknessfundwithahospitalisationin2011for either bronchial asthma (n=250), diabetesmellitus (n=250), or coronary artery disease(n=250).Thequestionnairecompriseditemson(1)attitudes towards a PCHR, (2) selected healthliteracy domains, (3) technology commitment, (4)experiences with health care, and (5) socio-demographic variables.We used items and scalesvalidated inGermanpopulationbasedsurveysandperformeddescriptiveandmultivariateanalyses.Results: 184 patients returned a validquestionnaire (response rate: 24,5%). 54,2% aremale (average age 54,8 years). The majority(58,6%)belongstotheworkingclass,20,7%totheupperclass,and20,7%comefromunderprivilegedclass.Thethreetargetconditionsarespreadevenly.Respondents judge their general health status aspoor in 10,2% (rather poor 36,9%, good 45,5%,very good/excellent 7,4%). Technologycommitment is low. Basically there is a positiveattitude towards a PCHR: 47,5% would definitelyliketohaveaPHCR,36,7%wouldconsiderhavingaPCHR,only9,2%areopposedandwouldnottakeaPCHR.BetterinformedhealthcareprovidersarethemainbenefitofaPCHRfromtheperspectiveoftherespondents (74,3%agreement). Improvedqualityof care or cost containment are judged to be lessobvious benefits (53,9% and 48,6% agreement).Surprisingly, least important respondentsperceivebeing better informed themselves (46,2%agreement). Agreement that unsolicited use ofpersonalhealth information,discriminationagainstillness,orreputationdamagearerisksofaPCHRis27%,19,4%rs.12,3%.Respondentswouldprovidepermanent PCHR-access to their general

practitioners (GP) in 87,2%, to specialists andhospitals in 67,4% and 68,8%, whereas topharmacistsandotherhealthcareprovidersonlyin10,9% rs. 10,0%. Tested multivariate a negativeattitudetowardsaPCHRismoststronglyassociatedwith theunwillingness toprovideaccess tohealthprofessionals other than GPs, specialists orhospitals. None of the included backgroundvariables shows consistent associations with thewillingness to provide access to a PCHR or thegeneralattitudetowardsthePCHR.Conclusions: Survey participants are positivetowards a PCHR, less convinced of a personalbenefit and sceptical to provide access to awiderrange of health professionals. The role of healthliteracyrelatedvariablesremainsunclear.However,the response rate of 24% does not preclude non-responsebias.Furtherresearchona largersamplesizeiswarranted.O-10–“Talkthemthroughit".Towardsaninterpretivedescriptionofcontext-specifichealthliteracyabilityinfamilymemberstoyoungpeoplewithpsoriasis.GitteSusanneRasmussenClinicalNurseSpecialist,PhDStudentGitteSusanneRasmussen1),AssociateProfessorHelleTerkildsenMaindal2),ProfessorKnudKragballe3),ProfessorKirstenLomborg4)1AarhusUniversityHospital,DepartmentofDermatology,andAarhusUniversity,SectionofNursing2AarhusUniversity,DepartmentofPublicHealth,SectionforHealthPromotionandHealthServices3AarhusUniversityHospital,DepartmentofDermatology4AarhusUniversity,DepartmentofClinicalMedicineandDepartmentofPublicHealth,SectionofNursingIntroduction: Young people struggle to integratepsoriasis intodaily life andminimize its influenceonappearanceand functioning.Psoriasis isa long-term condition with cumulative life courseimpairment which may impact the entire family.Familymembers'healthliteracyimpactsadherenceto treatment and self-management. Only a fewstudies report on family members' need foreducational support. The aim of this qualitativestudywas1) toachieveadeeperunderstandingofimplications of being a family member to youngpeoplewithpsoriasis,and2) toexplore theirneedforeducationtofacilitatetheabilitytosupporttheiryoung people inmanaging psoriasis and integratetreatmentindailylife.Method:ThedesignwasguidedbytheUKMedicalResearch Council's model for developing complexinterventions. Interpretive descriptionwas chosenas a research strategy and provided a logicalstructure and philosophic rationale intending to

generate credible and meaningful disciplinaryknowledge. Data were constructed through focusgroup discussions, individual interviews andquestionnairesincluding4relatedfamilymembers,all mothers. The analysis was conductedinductively: From the first translations to prosetelling the story of the familymembers, to broadcodes and finally conceptualizing newunderstanding.Findings: Decisionmakingwas themain concernformotherswhose young people had all sufferedfrompsoriasissinceearlychildhood.This includeddecisions about treatment and care, about therelationship to thehealthcareprofessionals,abouthowtocommunicateinrelationtoenvironmentandhow to understand the young people'sdevelopment. The mothers experienced a hugeresponsibility for the choices they had made,includingwhethertotreattheskinorabstainfromtreatmentdue toconcernsaboutsideeffects.Theyexperienced that it was difficult to obtainknowledgeaboutthedisease,andthedecisionstheymade were most often based on their ownexperience, beliefs about the disease and intuitiveattitudes towards pros and cons of treatment. Asthe disease and life progressed, they wereconfrontedwith the consequences of their choicesincluding the prize the young people paid for nothavingbeentreated.Throughthediseasetrajectory,thedecisionprocesswasassociatedwithfeelingsofloneliness,powerlessnessandhopelessnessand,attimes, guilt in relation to passing on a hereditarydiseaseandguiltinrelationtonotbeingabletohelptheyoungpeopleduringadolescence.Themothersargued their need for group-based interventionstargetedat1)familymembers,2)familymemberstogetherwiththeyoungpeople,and3)theyoungpeoplethemselves.Theinterventionsshouldbeofferedatdifferentlifestages,be an integratedpart of the treatment andfacilitate decision making ability, language skillsaboutpsoriasis,skillstomanagethe insideandtheoutside of the disease, and skills to support theiryoung people through adolescence into adulthoodwiththisdisease.Conclusion:This study argues thathealth literacymaybeanasset tobebuilt throughout life courseandanoutcomethatsupportsthefamilymembers'health decision making. Family members needskills,not least verbal skills, tobe able to interactwithandsupportthewholepersongettingthroughadolescence to early adulthood. Furtherinterventions should support the development ofcontext-specific health knowledge relevant topsoriasis.

O-11-UnderstandinganddevelopingcriticalhealthliteracySusieSykesMsSusieSykes1)1LondonSouthBankUniversity,London,UnitedKingdomBackground:Interestinanddebatesaroundhealthliteracyhavegrownover the last twodecadesandkey to the discussions has been the distinctionmade between basic functional health literacy,communicative/interactive health literacy andcritical health literacy. Of these, critical healthliteracy is the leastwell developedwith a lack ofconsensusdefinitionanddifferinginterpretationsofits constituents and relevance. The design,implementation and evaluation of interventionsdependupontherebeingatheoreticalframeworkinplace.This,inturn,dependsuponaclearlydefinedconceptualunderstanding.Method:Theresearchusedanappliedevolutionaryconcept analysismethod to systematically identifythe key features associated with this concept. Aunique characteristic of this method is that itcombines analysis of the literature with in depthinterviews with practitioners and policy makerswithaninterestinthefield.Finally,twocasestudieswere undertaken with health promotion andcommunity development projects to explore howcriticalhealthliteracyisdevelopedinpractice.Results: Findings revealed a unique cluster ofcharacteristics associated with critical healthliteracy including; advancedpersonal skills,healthknowledge, information skills, effective interactionbetween service providers and users, informeddecision making and empowerment includingpolitical action. The case study element of theresearch demonstrated that while there are fewprojects that claim tobedeveloping criticalhealthliteracy,therearehealthpromotionandcommunitydevelopment projects that are in fact doing so,through the specific development of thecharacteristicsidentified.Conclusions: This research shows that criticalhealth literacy has not been well defined orunderstood and needs to be so if it is to bemeasured.Findings showcriticalhealth literacy tobe a unique concept with characteristics distinctfrom the closely related conceptofempowerment.However, there remain significant contextualvariations in understanding particularly betweenacademics, practitioners and policy makers. Keyattributespresentedaspartofthisconceptwhenitwas first introduced in the literature, particularlythose around empowerment, social and politicalactionand theexistenceof the conceptatbothanindividual and population level, have been lost inmore recent representations. This has resulted incriticalhealthliteracybecomingrestricted,insome

interpretations, to a higher order cognitiveindividualskillratherthanadriverforpoliticalandsocial change. Examples from the case studyelementsof this researchdemonstratehowall theattributes of the concept, beyond the individualcognitive skills, can and are being developed inpractice, using participatory and deliberativeprocesses which are well established within thefieldofcommunitydevelopment.O-12-FunctionalandcomplexhealthliteracylevelsinrefugeesinSwedenJosefinWångdahlMScJosefinWångdahl1),PhDPerLytsy1),PhDLenaMårtensson2),ProfessorRagnarWesterling1)1SocialMedicine;DepartmentofPublicHealthandCaringSciences;UppsalaUniversity;Uppsala;Sweden.2InstituteofNeuroscienceandPhysiology/OccupationalTherapy;GöteborgUniversity;Göteborg;SwedenBackground:Worldwide there are more than 10millionrefugeesmanyofwhomhavepoorerhealthcompared with indigenous populations. Oneplausibleexplanationforthisinequalityinhealthispoorerhealthliteracyinrefugees,i.e.notbeingableto access, understand, appraise or apply healthinformation.Themainpurposesof thisstudyweretodeterminefunctionalandcomplexhealthliteracylevels among refugees in different subgroups inSweden. Further aims were to investigate socio-demographic andhealth related factors associatedwithinadequatehealthliteracy.Method:We performed a cross-sectional study in455adultrefugeesspeakingArabic,Dari,SomaliorEnglish.Datawerecollectedamongparticipants in16 strategically selected language schools forimmigrants across different regions in Sweden.Health literacy was measured using the SwedishFunctionalHealthLiteracyScale,andTheHLS-EU-Q16 questionnaire. Group differences wereinvestigated using uni- andmultivariate statisticalmethods.Results:About60%oftherefugeeshadinadequatefunctional health literacy, and about 80 % hadlimited functional (inadequate- or problematicfunctionalhealth literacy)health literacy.About27%ofthestudypopulationhad inadequatecomplexhealthliteracy,andabout62%hadlimitedcomplexhealthliteracy(inadequate-orproblematiccomplexhealthliteracy).Havingloweducationand/orbeingborn in Somalia were factors significantlyassociatedwithhavinginadequatefunctionalhealthliteracy. Having inadequate functional healthliteracy was further significantly associated withhavinginadequatecomplexhealthliteracy.Conclusions:Themajorityofrefugeesparticipatingin the language schoolshad limited or inadequatehealthliteracy.Thelevelsoffunctionalandcomplex

healthliteracyinthisstudyarelowerthanwhathasbeen seen inmany indigenouspopulations.Healthliteracyisanimportantfactorpossiblydeterminingthe health of vulnerable individuals and should,thus,betaken intoconsideration incontextaswellas planned activities. However, more research isneededfortobetterunderstandthelevelsofhealthliteracyamongrefugeesandfactorsdetermining it.Ultimately there is a need to develop targetedstrategiesandmethodsincreasinghealthliteracyaswell as facilitating life for those with low healthliteracy.O-13-HealthLiteracyinvulnerablepopulationsinGermany-afollowupstudyontheEuropeanHealthLiteracySurveyGudrunQuenzelDr.GudrunQuenzel1),DominiqueVogt1),MelanieMesser1),Prof.Dr.DorisSchaeffer1)1UniversityofBielefeld,FacultyofPublicHealthIntroduction: The European Health Literacy-Survey(EU-HLS)focusedonhealthliteracy-levelsofthe general population in eightmember states oftheEuropeanUnion(EU).Olderpeople,peoplewithchronicdiseases,migrants,andyoungpeoplewithlower educational backgrounds demonstratedexceptionally low health literacy levels - inconsequencethesegroupsexperiencedhigherrisksnot to receive necessary information or medicalaids.Atotalsamplesizeof1000participantsmadeit difficult to understand subgroups withproblematic health literacy-levels. Therefore, theaim of this study is to investigate health literacy-levels in thesepopulationswithhigh vulnerabilitybyconductingdifferentiatedanalyses.Methods: The faculty of Public Health of theUniversityofBielefeldconductsa follow-upsurveyontheEU-HLS.TheprojectstartedinOctober2013.The focus is on elder people between 65 and 80years (n=500) and younger people with lowereducational backgrounds between 15 and 25(n=500).Inaddition,halfoftheparticipantsinbothage-groupswill be immigrants orwith immigrantbackground.Thequestionnaire isbased on theHLS-EU-Q from2011. It is supplementedwithquestions regardinghealthbehavior,health careutilization,well-being,social support, and personal factors like copingstrategies, self-efficacy, and locus of control.AccordingtotheEU-HLStheinterviewswillbeheldascomputerassistedpersonal interviews(CAPI) intheGermanstateNorthRhine-Westphalia.Results:Firstpreliminaryresultswillbepresentedat the conference. In particular, the percentage ofpeople with problematic health literacy-levels in

different vulnerable groups such as less educatedyounger people or older people, migrants fromdifferent age groups, etc. Additionally, we willscrutinize the relationshipbetweenhealth literacyand health behavior. Further, the focus on olderpeople allows insight in the impact of chronicdiseasesonhealthliteracy.Conclusion: The survey offers insight, in healthliteracy-levels of populations with highvulnerability. Thus, it provides knowledge forpolitical action to improve access to health care,self-managementabilitiesandhealthcare.O-14-Ageing,cognition,andhealthliteracydeclineintheEnglishLongitudinalStudyofAgeingLindsayKobayashiMsLindsayKobayashi1),ProfJaneWardle1),DrChristianvonWagner1)1HealthBehaviourResearchCentre,DepartmentofEpidemiologyandPublicHealth,UniversityCollegeLondon,London,UnitedKingdomIntroduction:Althoughhealth literacy isassumedto decline with age, this relationship and thepotential contribution of cognitive changes duringaging have not yet been studied longitudinally.Therefore, we investigated the longitudinalassociationbetweenageandhealthliteracydecline,the role of cognitive decline, and thesociodemographic risk factors for ageing-relatedhealthliteracydecline.Methods: We used data from 5,253 participants(age >=52 years) from two waves of the EnglishLongitudinal Study of Ageing between 2004 and2011. Participants completed a four-item healthliteracy assessment based on a fictitiousmedicinelabel from the InternationalAdultLiteracy Surveyat baseline (2004-5) and follow-up (2010-11).Limitedhealthliteracywasdefinedasscoring<4/4items correct on the assessment, and decline as adecrease of >=1 item correct over the follow-upperiod. Multivariable-adjusted logistic regressionwas used to estimate odds ratios (OR) and 95%confidence intervals (CI) for the associationbetween age (by five-year age group at baseline)and health literacy decline over the follow-upperiod.Declines inmemoryandexecutive functionover the follow-up period were examined aspotential mediators of this association. Sex,ethnicity, occupational class, and educationalattainment were included in multivariableregressionmodelling.Results: Limited health literacy was linearlyassociated with age at the baseline assessment,going from 22% at 52-54 years to 36% at >=80years (p<0.0001). Over the six-year follow-up,health literacy declinewas observed from age 65,

with the greatest decline at the oldest ages (ptrend<0.0001). The multivariable-adjusted OR forhealth literacydeclineover follow-upamong thoseaged>=80years(vs.52-54)was2.86(95%CI:1.96-4.17). Although cognitive decline was associatedwith health literacy decline (memory decline:OR=1.36; 95% CI: 1.18-1.58; executive functiondecline: OR=1.33; 95% CI: 1.14-1.56), it did notexplain the association between health literacydecline and increasing age, which remainedsignificant. Independent of baseline age andcognitive decline, men (OR=1.20; 95% CI: 1.03-1.39), those from an ethnic minority background(OR=2.50; 95% CI: 1.53-4.09), from routine (vs.professional)occupations (OR=1.71;95%CI:1.41-2.07), and with no educational qualifications(OR=1.54;95%CI:1.24-1.91)weremore likely toexperiencehealthliteracydecline.Conclusions:Healthliteracyskilllossbeganaroundage 65 in this cohort of older adults and wasprofoundamongadultsaged>=80years.Cognitivedecline contributed to health literacy decline, butdidnotexplain therelationshipwithage.Menandthosefromdeprivedorminoritybackgroundswereat increased risk forhealth literacydeclineduringageing. Future research should clarify the role ofcognition in health literacy and examine potentialinterventions for older adults at risk of healthliteracyskillloss.O-15-ThehealthliteracyofyoungadultsinTaiwanusingtheHLS-EU-QPeterChangMs.Fung-LingFeliciaLee1),Dr.Ya-wenChiu1),Dr.KristineSorensen2),Prof.JürgenPelikan3),Prof.StephanBrouker4),Prof.HelmutBrand2),Prof.PeterChang1)1TaipeiMedicalUniversity,Taipei,Taiwan2UniversityofMaastricht,Maastricht,Netherland3LudwigBoltzmannInstituteHealthPromotionResearch,Vienna,Austria4UniversityCatholicLouvain,Louvain,Belgium5TaipeiHospital,MinistryofHealthandWelfare,NewTaipeiCity,TaiwanIntroduction. While a growing interest in healthliteracy researcheshasbeen observed inAsia andseveral assessing tools have been developed indifferent languages. This study examined healthliteracy and its relevant determinants that mayassociate with health literacy in young adults inTaiwan.Methods. Specifically, the study is based on theEuropean Health Literacy Survey [HLS-EU]conducted in 2009-2012 to assess self-perceiveddifficulty in health-related situational decision-making and tasks, using the European HealthLiteracyQuestionnaire:HLS-EU-Q.Withestablishedvalidity and reliability, additional questions

regarding localcultureandsociety forestablishingHealthLiteracySurveyinTaiwan[HLS-EU-Taiwan].A sample of 510 young adults from 9 universitiesacross5citiesinTaiwanwastested.Results. Overall, university students with lowhealth literacy were more likely to self-assessfinanciallydeprivedand reportpoorhealth status,lowersocialstatus,and they tended tohave lowerfrequency of physical exercise. We have alsocategorizedourrespondentsintothreeacademicalsto identify associate significant determinants.Several main predictors: frequency of watchingmedical TV series, previous medical trainingbackground,self-assessedfinancialdeprivationandself-assessedhealthstatus,influencedstudentswithHumanities background the strongest than SocialScienceandScience&Technologymajor.Conclusion.Thisstudywas the firstsurvey touseHLS-EU-Q in young adults in Asia and the resultsdemonstrated a sensitivemeasure,which couldbeconsidered for national level measurement andinternationalcomparison.O-16-UsingNationalHealthLiteracySurveyResultstoImprovePractice,DevelopPolicy,andStrengthentheResearchBaseforPromotingHealthandSelf-CareDianeLevin-ZamirDrDianeLevin-Zamir1,2,4),ProfOrnaBaron-Epel2),ProfAsherElchayani3)1ClalitHealthServices2UniversityofHaifa,SchoolofPublicHealth3ArielUniversity4IUHPEGlobalWorkingGrouponHealthLiteracyIntroduction: A substantial body of scientificliterature indicates the strongassociationbetweenlowhealthliteracyandhealthoutcomes.Lowhealthliteracy is significantly associated with increasedhospitalization, increased use of emergencyservices, infrequentuseofpreventive servicesandpoorer outcomes for chronic disease indicators,poorer health status and greater use of healthresources.TheIsraelNationalHealthInsuranceLawguarantees healthcare to all citizens in Israelaccordingtotheprinciplesofequityandreasonableaccessibility. A National Health Literacy Survey(HLS-ISR)was conducted in Israel in2012,among600 participants in a representative sample,members of Clalit, Israel's largest health serviceorganization.Theobjectivesofwereto:a.Develop and validate a research instrument formeasuringandestimatinghealthliteracyamongthegeneral adult population in Israel, based on theHealthLiteracySurveyofEurope(HLS-EU).

b. To empirically assess health literacy in thegeneral population in Israel and characterize bygender, age, education, ethnicity, religiosity andsocio-economicstatus,thus identifyingpopulationsat risk for low health literacy; c. To study theassociation between health literacy, use ofhealthcare services, health behavior and self-reported health, sources of health information,healthempowerment ;d.Toallow for comparisonofhealthliteracyindicatorsoftheIsraelipopulationwith those ofdifferent regions ofEurope (HLS-EUstudy).Multivariateanalysisshowededucation(=1.8)andincome ( =2.2) were the main significantcontributors to low health literacy. Low healthliteracy was significantly associated (p<0.0001)with greater use of healthcare services, higherprevalence of reported chronic conditions, higherrate of disabilities and hospitalizations, low self-ratedhealth.Contribution to practice, policy and research inIsrael:This study contributes to the growing body ofstudies that seek to interpret evidence regardinghealthdisparitiesinIsrael,andwhatcanbedonetoreduce them. The results of the HLS-ISRsignificantlyinfluenceplanningofhealthpromotionpolicy and practice, primarily in the health caresystem.Thefocusiscurrentlyontwoparallelactionareas: improving the levelofhealth literacy,whilepromoting health care organizations to be morehealth literate friendly, adapting services to thevarious levelsofhealth literacy.Basedon theHLS-ISR study, continued research is planned fordetermining the contribution of health literacy tochronic disease management, as well as toimplement innovative, participatory interventionsbased on the components of the HLS-ISR (EURO)measure.Additional researchwillbe conducted todetermine towhat extent low health literacy as arisk factor is resilient, for example, regardingnavigationinthehealthsystem,andtransformedtoa health asset. Finally, the results of this studyprovideabasisuponwhichthefinancialcostoflowhealth literacy can be estimated, providingnecessary information for policy makers to makeinformed decisions and engage in long-termplanning inreducingdisparities tomeet thehealthneeds of the Israelipopulation.The results of thisstudy significantly contribute to discussionregarding the role of health literacy as a priorityarea in the public health and health policy arena.O-17-Falseself-perceptionoffunctionalhealthliteracyinNorthRhine-Westphalia:

IdentifyingendangeredgroupsusingtheHLS-EUdataMonikaMensingMonikaMensing1)1NRWCentreforHealthIntroduction:WithintheEuropeanHealthLiteracyProject2009-2012(HLS-EU"),asurvey instrumentHLS-EU-Q was compiled, providing data on self-perceived health literacy ("HL") in the fields ofHealthcare, Health Prevention and HealthPromotion, concerning the abilities of finding,understanding, evaluating and applying health-relevant information. The federal Institute forHealthNRWwasoneoutofeightEuropeanprojectpartners.The NRW data helps gauging the problem ofoverestimating one's capability concerningfunctionalHL,sincethesurveywasaccompaniedbytheobjectiveNewest-Vital-Sign-Test.Wewant to identitypossiblecharacteristicsof thisgroupofparticipants,since itcanbeassumed thattheygivethemselvesafalsesenseofsecuritywhendealingwithinformationconcerningtheirhealth.Methods: Within the HLS-EU-Project, CAPI-interviewswith1,057participants (aged15+yrs.)werecarriedoutinJuly2011intheGermanfederalstate of North Rhine-Westphalia (NRW). ThequestionsdealtwithHealthcare,HealthPreventionand Health Promotion, complemented by the"Newest Vital Sign"-test (NVS), measuringfunctional HL via alphanumeric skills based on anutrition label from an imaginary ice creamcontainer. Participants were also asked to assesstheir difficulties of understanding when readingfood label information,and these statementswerecheckedonconsistencywiththeNVS-score.Logisticregression was performed to determine effectingvariables on true and false self-perception inrespectthereof.Results:Atotalof38%oftheNRWsampleshowaNVS-scoreproddingtoprobablyorpossiblylimitedfunctional HL, and 54% acknowledge difficultiesunderstandingfoodlabels.Inthisregard,theNRW-sampleshowsadegreeofcongruityof58%(=trueself-perception).Theremaining42%ofparticipantspresent a false self-perception, and almost 1/3 ofthisgroupoverestimate theirability tounderstandinformationon food labels.Factorspromotingself-overestimation significantly are migrantbackground and older age (64+),whereas genderand education show weaker associations. On theotherhand, factorspromoting true self-estimation,amongst others, are female sex (61% vs. 54% inmales)andyoungage(<30yrs.).Conclusions: Within the NRW sample, firstindicationscouldbeidentifiedthatmay influenceafalse self-perceptionof functionalHL.Furtherdataanalysis will focus on this subgroup of self-

overestimators, whose vulnerability may take theform of false security, as this may lead to anunintended risky behaviour or ignoring of usefulalthoughmissinginformation.O-18-QuickScanHealthLiteracyinhospitals.DevelopmentandimplementationofapracticebasedtoolboxinDutchhospitalsJorienC.H.BakxdrsJanineVervoordeldonk1),MScAnnemiekDorgelo1),irKarlijnTijhuis2),JorienC.H.Bakx1)1CBOBV,Utrecht,Netherlands2internshipCBOBV,Wageningen,WageningenUniversity,dep.HealthandSocietyIntroduction:IntheNetherlandsmorethan25%oftheadultpopulationhas(very)poorhealthliteracyskills(HLS-EU,2010).Thesepeoplearenotabletofind relevant information, tounderstand it,and toapply it forhealth-relateddecisions.By improvingpeople'saccesstohealthinformationandthehealthcaresystemand theircapacity touse iteffectively,hospitals can contribute to the empowerment ofpeoplewith low literacy skills, resulting in betterhealthoutcomesandlowercosts.WiththeToolboxQuick Scan Health Literacy,hospitals are able toscreen their communicationwithpatientswhoarelesshealth literate.TheToolbox includesscreeningtoolsonwritteninformation(e.g.leafletsandforms,digital information(e.g.websites),oral information(consultation by health care professionals), andaccessto/navigationinthehospital(interview).By using the Toolbox, hospitals become aware ofhealth literacyandareable to formulateplans forimprovement.TheToolboxhasbeendevelopedbyCBOinclosecooperationwith6Dutchhospitalsandpeoplewithpoor literacy skills. Itwas tested in 2pilot projects during 2011-2013. Two healthinsurancecompaniescontributedfinancially.Methods: The pilot projects consisted of fourphases.(1) Development of the tools. CBO developed thetools based on (inter)national literature andpracticebasedexperiences.Each tool consistsof aselfevaluation checklist for hospital professionalsand toolswhich can be used by the target groupitself.(2)Pretesting.Sixhospitalspretestedthetools(incl.aqualitativeandprocessevaluation)andexchangedexperiencesinaregionalprojectteam.(3)Adaption.BasedonthepretestCBOadaptedthetools and a user instruction was developed. Theprocess evaluation will be used to improve theimplementationprocesswithinthehospitals.(4) Implementation.Thepilothospitalshave takenfirst steps to embed the tools in general patient

communication policies and activities, qualityassessments,qualitycarepolicy.Results: There is a lot of support for thecontinuation of working on health literacy in theparticipatinghospitals,bothatmanagementlevelaswell as on the level of individual employees. Alldeveloped toolsproved tobeuseful.Especially thetoolsdirectedatthecollaborationwithpeoplewithlow literacy skills and the opinions expressed bythis targetgroupwhereperceivedas inspiringandsupporting. Professionals mentioned for examplethat thewebsite testwas awake up call and theleaflet-test helps to critically look at patientcommunication ingeneral.All toolsprovedeasy touse, fittedwithindailywork routinesand it is feltthey are easy to adapt to different hospitals andhospitaldepartments. In 5of the 6hospitals smallimprovements have already been implemented.Largerimprovementshavebeenincludedinannualplanssuchasarchitecturalimprovementsbasedonthe walking interview. Working with the entireToolboxhasbeenincludedinthegeneralpolicyandwill be executed in specific divisions in at least 2hospitals.Conclusion: Working with the Toolbox increasedthe awareness of the hospitals on the subject ofhealth literacy. The tools are implementedsuccessfully on department level and seem usableforbothprofessionalsasthetargetgroupbasedontheprocessandqualitativeevaluation.They intendto keep using the tools and therefore an validitycheckwouldbeworthwhileforthefuture.O-19-EqualopportunitiesforinformedparticipationincolorectalcancerscreeningMirjamFransenDrMirjamFransen1),DrEllenUiters2),DrsEvaLaan1),ProfDaniëlleTimmermans3),ProfEvelienDekker4),ProfMarie-LouiseEssink-Bot1)1DepartmentofPublicHealth,AcademicMedicalCentre,UniversityofAmsterdam,Amsterdam,TheNetherlands2CentreforNutrition,PreventionandhealthServices,NationalInstituteforPublicHealthandtheEnvironment,Bilthoven,Netherlands3DepartmentofPublicandOccupationalHealthEMGOInstituteforHealthandCareResearch,VUUniversityMedicalCenter4DepartmentofGastroenterologyandHepatology,AcademicMedicalCentre,UniversityofAmsterdam,Amsterdam,TheNetherlandsIntroduction:Colorectalcancer(CRC)isthesecondmost common cause of cancer-related death. CRCscreening aims at detecting CRC in an early orpreclinicalstage, inwhichearly treatment leads tobetterhealthoutcomes.Toensurethatallscreeninginvitees have equal opportunities to make an

informeddecisionregardlessoftheirhealthliteracy(HL) level, effective methods are needed toadequatelyinformthosewithlowHL.Inthisprojectweaimedtooptimizetheinformationmaterialsforthe CRC screening programme that will beimplemented in the Netherlands in 2014. Allindividuals between 55-75 years of age will beinvited for a screeningstest (iFOBT) that they canperform at home. Our research objective was toexplore the accessibility, comprehensibility andrelevanceof thepreliminary informationmaterialsfor screening inviteeswith lowHLan toassess towhat extent the information materials enableinviteeswithlowHLtomakeinformeddecisionsinCRC screening. The findings of this study will beusedtoformulatewhichadaptationsinthewrittenanddigitalinformationmaterialsareneeded intheCRC screening programme to support informeddecision-makingamonginviteeswithlowHL.Methods: We analysed text characteristics anddesign of the information materials (notificationletter, invitation letter, brochure, and test withinstructions for use) and performed qualitativeinterviewsamong30 individualswith lowHLwhowereeligible forCRCscreening.Acomputer-basedsurvey was conducted to test to what extent theinformationmaterialsenable inviteeswith lowHL(n=150) and adequate HL (n=150) to makeinformed decisions in CRC screening. HL wasassessedbytheNewestVitalSigninDutch(NVS-D)and ShortAssessment ofHealthLiteracy inDutch(SAHL-D).Results: The qualitative interviews showed thatindividuals with low HL experienced problems inprocessing theamountof informationgiven in thebrochure.Theyfoundithardtodistinguishbetweenscreening-anddiagnostictestingandhaddifficultyunderstanding some of the instructions for thescreenings test. They did not understand theinformation about costs and insurance and thevisual risk presentations in the brochure. Thecomputer-based survey is still ongoing at themoment, results will be presented at theconference.Conclusion: This research project contributes tothedevelopment of informationmaterials forCRCscreening that optimize informed decision-makinginscreeningparticipationintheNetherlandsandinother countries as well. The results will beimplemented in the Dutch CRC screeningprogramme.O-20-AddressingtheHealthLiteracyskillsmismatchinEngland:movingfromevidencetopolicychangeGillianRowlands

ProfGillianRowlands1,2),DrJoanneProtheroe3),MrJonathanBerry4),1King'sCollege,London,UK2AarhusUniversity,Aarhus,Denmark3KeeleUniversity,Keele,UK4CommunityHealthandLearningFoundation,Leicester,UKIntroduction:Recentresearchinto levelsofhealthliteracy in England show that 43% of England'sworkingagepopulation(aged16 to65years) lackthe literacy skills required to fullyunderstandandusehealth information incommoncirculation.Thispercentage rises to 61% when materials containnumerical information or concepts. These resultsstimulated a project to develop consensus onnational changes inpolicyandpractice to addressthemismatchbetweenpopulationskillsandhealthinformationcomplexity.Methods: A group of key national experts andstakeholders from theareasofpolicy,governmentdepartments for health and education, patientgroups, and senior practitioners in health,education and public safety, met to review theresearch findingsand identify thekeyareaswherechanging national policy and/or practice mightaddress the mismatch between population skillsandhealth information complexity,and to identifypotential policy changes. This was followed by 2roundsofweb-based surveys. Inaddition to thosewho participated in the initial meeting, newparticipants were identified through a snowballtechnique.Inbothrounds,participantswereshowntheemergingprojectoutcomes,andwereaskedforadditionalsuggestionsforpolicyorpracticechange.In thesecondsurvey,participantswerealsoaskedto rate the impactof theproposed changeson theskills:information complexity mismatch. The finalstage of the project was a meeting of keystakeholders,whereprojectfindingswerereviewedand policy areas prioritized. Stakeholders wereasked to consider cost-benefits, potential forbuilding on current initiatives, and potential forworkingacrossprofessionalandpolicyboundaries.Results:Fifty-one stakeholdersparticipated in theproject, representing a range of keypublic,healthand education perspectives. Suggested policychange fell into three broad areas; health,education/lifelong learning, and the non-statutorysector (i.e. non-governmental, charity andcommercial organisations). Suggestions includedbothbuildinghealth literacyawareness and skills,andincreasingtheclarity,andaccessibilityofhealthinformation. The suggestions prioritized forimplementationwere(1)toraisethestandardandaccessibilityofhealthinformation,(2) to develop the health literacy skills of healthcareworkers,

(3)todevelopanationalopen-accessrepositoryofhigh quality health information from health,educationandnon-statutorysectors,(4) to incorporate health literacy into local healthstrategies,(5) to work with employers to integrate healthliteracyskillsintoapprenticeshipprogrammes,and(6) to develop the health literacy skills ofindividuals, families and communities throughCommunityLearningTrusts.Conclusions: This project enabled stakeholdersfrom a wide range of key public, health andeducationperspectivestoworktogethertoidentify,andthenprioritise,changesinpracticeandpolicytoaddresstheissuesofhealthliteracyinEngland.Theareas chosen for implementation balance buildingcitizens' skills with improving the clarity andaccessibilityofcommunicationofhealthmessages,andemphasise thebenefits tobe realized throughco-operationandinter-disciplinaryworking.O-21-Framinghealthliteracyintotheworkplace-meansandperspectiveofapreventiveinterventionAnneKonringLarsenMrsAnneKonringLarsen1),MrsJanniBach1),MsHeleneHøjbergJohansen1),DrMortenHulvejRod2),DrMarieBirkJørgensen1),1TheNationalResearchCenterfortheWorkingEnvironment2NationalInstituteofPublicHealth,UniversityofSouthernDenmarkBackground:Musculoskeletaldisorders(MSD)isaconsiderableproblem amongnursing assistants inDenmark, causing e.g. reduced wellbeing at workandqualityof life, increased sicknessabsenceandearly retirement. Numerous environmental,societal,personal and situational factorsaffect theincidence, recurrence and persistence of MSD.Additionally, interpersonal factors suchas supportfrommanagementandcolleaguesandemployeejobcontrolcanaffectdevelopmentandconsequencesofMSD.Interventions designed to improve Health literacyandmanaging chronic disease, indicate that theseinterventions positively affect prevalence andseverity of MSD. Health literacy contains anindividuals'opportunity forprevention(definedastheindividual'sopportunitiestoaccess,understand,appraise and use health information).Organizationalandinterpersonalfactorspotentiallyinfluence(supportsorimpair)thesecapabilities.Inthe current study, we aim to create workplacehealth literacy" entailing optimal organizational,interpersonal and individual premises for goodhealthliteracy.

Method:Thisworkplaceinterventionaimstobuildworkplacehealth literacy foremployees innursinghomes through 1) Courses (2 x 3 hours) foremployeesandsupervisorsseparately.Thecoursesare based on cognitive behavioral training andgenerate a common base of knowledge aboutprevention,handlingofMSDandtoolsforimprovedcommunication between employees andsupervisors about these issues 2) Structureddialogue: Implementationof a3-weeklystructureddialogue between each employee and his/hersupervisor to ensure a knowledge flow, and tofacilitate the finding of the best solution for eachemployee. Furthermore, efforts are continuouslymade to maintain the organizational preventioncompetences through e.g. half yearly boostercourses,roll-upsandthemedaysattheworkplace.Seven workplaces participate in the project withapproximately600employeesenrolled.Wewillusequasi-experimental design with a stepped-wedgeenrolment of clusters and several pre- and postmeasurements of MSD and workplace healthliteracy.Theeffectisevaluatedafter6monthswithfurther evaluation of sustainability, up to 2 yearsafter the intervention start.The evaluationwillbebased on questionnaires (monthly using textmessages) and register data ( -yearly).Workplacehealth literacy ismeasured by a newly developedandvalidatedquestionnaire inspiredby theHealthLiteracyquestionnaire(HLQ).Discussion: Individual health literacy is highlydependent on the environment around theindividual.Theworkplaceconstitutesan importantsetting for health promotion and preventioninitiatives.However knowledge about the effect ofinterventions tobuildworkplacehealth literacy islimited.Theindividuals'opportunityforpreventingand handling health issues within the workplaceorganizational framework, affect the employeehealth and well-being. Therefore, it is highlyrelevanttoevaluate ifthecurrent intervention isafeasible method to improve the organizational,interpersonal and individual premises forworkplacehealthliteracy.O-22-Canweassumethatnursesarealwayssufficientlypreparedtosupportpatientsintheirhealthliteracydevelopment?TheresultsoftheWarsawcross-sectionalstudyZofiaSlonskaAssist.ProfessorZofiaSlonska1),1TheCardinalStefanWyszynskiInstituteofCardiologyWarsaw,PolandIntroduction. The question of the quality of themedical staff contribution to the patient's health

literacydevelopmentisofgreatimportance.Usuallyis silently assumed that the medical staff issufficiently prepared to support patients in theireffortstoraisethelevelofhealthliteracy.Thereforeprobably researchers mainly focus on healthliteracyofpatients forgettingaboutphysiciansandnurses'readiness tocooperatewithpatients in thehealth literacy domain. Some empirical dataindicate the existence of significant gaps in themedicalstaffknowledgeandskillsnecessary intheprocess of patient health literacy building. Thepurpose of this presentation is to assess selectedcomponentsofnurses'knowledge,theadequacyofnurses' perception of their own competency, thefrequencyofprovidingcounseling innutritionandphysical activity, and furthermore to identify therelationshipsbetweenthenurses'knowledge,self-assessed competency and providing counseling innutrition and physical activity.Methods. The datacome from the cross-sectional study which wascarried out at the turn of2005/2006 years in therandomly selected sample of 500 PHC nursesemployed in Warsaw (response rate 71,1%). Thedata were collected in face-to-face interviews.Results. The data analysis confirmed insufficientPHC nurses' knowledge of nutrition and physicalactivity.Only4.2%nursescorrectlyanswered4and49% nurses only 2 of 5 questions of basicimportance for nutrition counseling. Nurses whoanswered correctly 3 essential questionsconcerning definition and interpretation of BodyMassIndex,accountedforonly32,2%ofthestudiedgroup. The minimum dose of physical exercisenecessary for the prevention of cardiovasculardisease correctly identified only 50.3% nurses.49,2%nurses overestimated their own abilities innutrition counseling, and 26.2% of themoverestimated own abilities in physical activitycounseling.Thosenurseswhorecognizedtheirowncompetencyassufficient,independentlyontherealone, more often gave advice in nutrition andphysical activity. Conclusions. Interventionprogramsplannedinhealthserviceunitsandaimedat raising the level of health literacy of patientsshouldbeprecededbyanevaluationandthenfillingthe gaps in knowledge and skills of medicalpersonnel,includingnurses.Key words: health literacy, nurses, real andperceived competency, counseling, behavioral riskfactorsO-23-Healthliteracyinmigrants:anintegrativereviewoftheliteratureEnriqueCastro-SánchezMrEnriqueCastro-Sánchez1)1CentreforInfectionPreventionandManagement,ImperialCollegeLondon,London,UK

Introduction: Health literacy has gainedrecognition as a crucial determinant of optimalhealth. It is suggested that certain populationgroupssuchasmigrantsareparticularlyvulnerabletoavarietyofacuteandchronicclinicalandpsycho-social problems. Increasingly, they also face legalhurdles to access and navigate health and socialcare services.Additionally, the financial crisis andits after effects has encouraged novel migratorypatterns, with potential challenges for healthservices.For these reasons, a systematic reviewofhealth literacystudies inmigrants iscarriedouttodeterminegapsinevidenceandtoinformpolicy.Methods: Electronic databases (AMED, BritishNursing Index, CINAHL, HMIC, Medline, PsycInfo,Embase)wereinterrogatedusingthehealthliteracysearch stringavailable inPubmed togetherwith abroad definition of migrant individuals(documented, undocumented, political, economic,etc). Qualitative and quantitative research studiespublished between 01/01/2000 and 31/12/2012,inEnglishorSpanish language,reportingonhealthliteracyscreeningorinterventionsinadultmigrantsonanyhealthcaresettingorcountrywereselected.The ICROMS quality appraisal tool was used toevaluatethestudies.Results: 55 research papers were selected, all inEnglish language.Geographically,39(70%)studiestookplace intheUS,9(16%) inCanada,1(2%) inthe UK and 6 (11%) elsewhere. There exists amarkedcontrastbetweenstudiescarriedoutintheUS,with17/39(43%)ofstudiesfocusedmajorlyonlatino/Hispanic and trans-border populations, andthe rest of the world. Studies focusedpredominantly on the impact ofhealth literacy onclinicaloutcomes.9/55(16%)studiesreportedonHL and screening and management of cancer,followed by development of HL screeningquestionnaires (7/55, %), education and supportprogrammes (6/55, 11%) and structuralcharacteristicsofnationalhealthcare systems suchasprovisionofinterpreters(6/55,11%).Conclusions:Overall,currentevidenceaboutHLinmigrantindividualsismodestandpolarised,withamajority of studies carried out in the US andthereforeofrelativeusefulnesstoinforminitiativeselsewhere. The lack of European studies appearssurprising, considering longstanding external andrecent internal migratory flows Amongst thepathologiesnot explored, the absence ofHIV/Aidsor post-traumatic stress are noteworthy, andsuggest areas for further studies. There are otherissues to resolve, including the validation ofscreeningscalesinmigrantindividuals.P01-HealthLiteracyonthePublicAgenda:ExploringtheRiseofaSocialIssuethroughaPublicPolicyApproach

GatiendeBrouckerMr.GatiendeBroucker1)1UniversityofOttawa,Ottawa,CanadaIntroduction: Developing our understanding ofhealth literacy is becoming a growing concern forclinicians, managers of health programmes, andresearchers. What was a new concept tooperationalize one's capacity in accessing,managing, and using information to pursue goodhealth soon became a public health issue on aninternational scale.Health literacy - as a researchfieldandas apublichealthconcern - is finding itsplaceinpublicpolicyagendas.Thishasonlybecomea reality thanks to the mobilization and work ofvariousgroupsofactorsinteractingwithinthefieldofpublichealthandmedicine.Duetotheinterdisciplinarynatureofthisconcept,anumber of definitions of health literacy haveemerged, bringing with them very differentperspectivesonhealthliteracyand,furthermore,onhealth systems. Many studies in the variousdisciplinesstudyinghealthliteracyhavefocusedonbuilding a consensus around its definition andconceptualization,tryingtoshapeacommonideaofthis notion.However, a limited number of studiesdiscuss thegroupsofactors'perspectives inawaythathighlightboththeirelementsofconsensusandofdivergence.Exploringthedifferencesinhoweachgroup considers individuals who navigatehealthcare and the individuals' social context canenrich our comprehension of health literacy. Theopposing views on health literacy may, then,promote adapted applications of research findingsinvariouspolicyandsocialsettings.Methods:Toadvanceoursenseof thesituationofhealthliteracyonthepublicagendainternationally,theobjectiveof thisstudy is todevelop amappingof the different conceptions of health literacy,organizedpergeopoliticalregionandperacademicdiscipline. A literature review is conducted inEnglishand inFrenchthroughoutmajordatabases,then analyzed under the lenses of sociology andpublic policy studies. The study draws fromtheoriesemployedbysocialscientiststoinvestigatehowasocialissueisdraftedontothepublicagendaandhowtheviewsofgroupsofactorscontributetoshaping their contribution to the definition andadvancementofhealthliteracy.Goals:Upuntiltoday,socialdeterminantsofhealthremain difficult to integrate accurately ingovernment policies. More knowledge about thedynamics of the groups of actors surroundinghealth literacy should help policy-makers andhealthcaremanagers to take a better hold of thisrelatively new concept, the issues and socialconcerns that accompany it, and its evolution intimeandacrossdifferentacademicdisciplines.

P02-ValidatingtheNorwegianversionoftheHLS-EUQ47andthe3levelHL-scaleHanneSøbergFinbråtenPhDstudentHanneSøbergFinbråten1,2),AssociateprofessorØysteinGuttersrud3),ProfessorBodilWilde-Larson1,2),ProfessorGunNordström1,2),AssociateprofessorAnneTrollvik1),AssociateprofessorKjellSverrePettersen4)1HedmarkUniversityCollege,Elverum,Norway2KarlstadUniversity,Karlstad,Sweden3UniversityofOslo,Oslo,Norway4OsloandAkershusUniversityCollegeIntroduction: Health literacy (HL) is defined invarious ways and has been measured by severalscales.The47-itemsEUhealthliteracysurveyHLS-EUQ47,whichwasdevelopedbyanEU-consortium,was recently applied in eight EU countries. The3levelHLscaleisthemostfrequentusedinstrumenttomeasure HL among personswith diabetes andwasdevelopedby Ishikawa,Takeuchi &Yano.TheHLS-EUQ47 questionnaire and the Japanese3levelHL-scale have now been translated andadaptedintoNorwegian.The two instruments rely on different theoreticalperspectives of HL, but may be somewhatoverlapping.WhenvalidatingHL-scales, traditionaltest theory is most frequently used. However,traditional test theory may have limitations inconfirming the validity of scales. The aim of thisstudywasa) to translate the two instruments intoNorwegian and 2) to validate the scales amongpersons with type 2 diabetes and in the generalNorwegian population by applying modern testtheory.Methods: After performing standard forward andbackward translations and analyzing a first field-survey, the instrumentswere further validatedbycognitiveinterviewsandsubsequentRasch-analysisof data from a second field-survey. The frame ofreference was first year bachelor students at auniversitycollege,personswithtype2diabetesandemployeesinthreemunicipalitiesinNorway.Results: Preliminary results of the Rasch-analysisrevealed that the items and the scales work asintended, and that the items are invariant acrossgenderandsubgroups.Thedimensionalityofhealthliteracyand the targeting of the instrumentswerealsoexplored.Resultsof theRasch-analysiswillbepresentedattheconference.Conclusions: Rasch-analysis is an importantmethod tovalidate thedata fromnewlydevelopedHLscales.P03-The'HealthPromotionHealthLiteracyIndex'inthe'GermanHealth

InterviewandExaminationSurveyforChildrenandAdolescents'Wave2(KiGGSWave2)-FirstpretestresultsSusanneJordanSusanneJordan1),PetraRattay1),ElviraMauz1),PanagiotisKamtsiuris1)1RobertKochInstituteIntroduction: For prevention and healthpromotion, it is verypromising topromotehealthliteracy at young age. To gain knowledge of thehealth literacy levels in young people is the firststep.However, inGermany, there isnopopulationsurvey for health literacy in adolescents, yet.Therefore, the Robert Koch Institute plans tointegrateahealthliteracyindexintheKiGGS-study.KiGGS is a long-term population survey andincludes interviews, examinations and tests. ForKiGGS Wave 2 starting in 2014, a pretest wascarried out to test various data collectioninstrumentsaswellasproceduresof the study. Inthefieldofhealthliteracy,theKiGGSwave2pretestinvestigatedwhetherthe 'HealthPromotionHealthLiteracy Index' (HP-HLI) of the 'European HealthLiteracySurveyQuestionnaire'(HLS-EU-Q)(HLS-EUConsortium2012)consistingof16 itemswith fouransweroptions in aLikert-scale is suitable for theagegroup14-17years.Anotherquestioniswhetherdatecollectionmethods(modeeffect)influencetheanswer choices, because so far the HLS-EU-Q hasonlybeenusedinpopulationsaged15orolderandin personal assisted paper interviews (PPI). InKiGGSwave 2pretestpaperandpencil interviews(PAPI) and (CAWI) computer assisted webinterviewswereused.Methods: First data of the KiGGSwave 2 pretestsample was randomly collected from August toDecember2013 in four federal states ofGermany.Response rate is now around 40%. The pretestanalyseswillcomparetheratesofmissingvaluesinthe16 itemsof theHP-HLIasan indicator foragespecificunderstandingoftheitemquestions(mean,range). The sample size of the first half of thepretest comprises 313 adolescents aged 14-17years. A comparison is also carried out betweengirls and boys and with the missing values of astudy onhealth literacy of15-year-olds inAustria(Röthlin,Pelikan,Ganahl2013), alsobased on theHP-HLI.Results: The number of adolescents in each agecohort (14, 15, 16, 17 years) was nearly similarbetween 71 and 86 persons, as well as theproportionofgirlsandboys (n=121/117),but thestudymodeswerenot(PAPI:n=189,CAWI:n=49).Themeanofmissingvaluesofadolescentsaged14years (10.9%, range 10.7%-12.0%) was twice ashighthanthatoftheolder ineveryofthe16 itemsof the HP-HLI. The 15 year olds had a range ofmissing values from 1.4%-4.2% (mean=3.4%), the

16yearoldsof from1.2%-7.0%(mean=4.0%)andthe17yearsoldsfrom1.2%-3.7%(mean=2.2%).IntheAustrianstudy,themeanofadolescentsaged15yearswas3.5%.Themeanofboysaged15-17yearswastwiceashighasthegirls'onesofthesameage(4.1%vs.2.4%).ThemeanofthePAPImode(2.8%)showed a lower rate than theCAWImode (4.6%).Conclusions:Thepreliminaryresultsconcerningthemissing values indicate that the HP-HLI ismaybetoo difficult to understand for some adolescentsunder the age of 15 years. The other age cohortsshow no noticeable missing value rates. Thedifference between boys and girls might beexplainedbythefactthatgirls/womentendtohavehigher health literacy levels than boys/men. Tounderstand the differences between the surveymodes,weneed thecompletepretestsample.Thatand further detailed and updated pretests resultswill presented at the conference. Overall, for themomenttheHP-HLIappearstobeasuitabletooltomeasurehealthliteracyinadolescentpopulationsinthefieldofhealthpromotion.P05-ApproachinghealthliteracyinCataloniaintheframeworkofself-promotingAssumpcióGonzálezMestre,PalomaAmilBujan,OriolGarciaCodinaAssumpcióGonzálezMestre1),PalomaAmilBujan1),OriolGarciaCodina2),AntoniaMedinaBustos2),DolorsJuvinyàCanals3),AlbertLedesmaCastelltort1),EsteveSaltóCerezuela2)1Programaprevencióiatencióalacronicitat.DepartamentdeSalut.GeneralitatdeCatalunya.Barcelona(Spain)2ServeidelPladeSalut.DireccióGeneraldePlanificacióiRecercaenSalut.DepartamentdeSalut.GeneralitatdeCatalunya.Barcelona(Spain)3CàtedradePromociódelaSalut.Departamentd’infermeria.UniversitatdeGirona.Girona(Spain)TheHealthPlan forCatalonia (HPC)2011-2015 isthe indicative instrument and framework for allpublic performances in the field of the HealthMinistryoftheGovernmentofCatalonia.NinelinesofactionpointingoftheHPC,3cometogetheratthesame time to identify the health literacy as a keyelementtofacethechallengesofcommunityhealthin the21stcentury.Theseare the linesofaction1(objectives and health programmes), 2 (moreorientedsystemtochronicpatients)and5(greaterfocusingtopatientsandrelatives).TocomplywiththeHPC2011-2015withregardtothe area of self-responsibility of patients andcaretakers and forms of self-care, one of thestrategicprojects is theExpertPatientProgrammeof Catalonia®, which is included in the line ofprevention and attention to the chronicity of

Catalonia. The EPPC® is a multidisciplinaryinitiative based on patient-healthcare professionalcollaborationand teamwork. In theEPPC it is theExpert Patient (EP) who leads the process andtransmits knowledge about his or her disease toother patients who suffer from the same healthproblem. The healthcare professional becomes anobserver, and only intervenes if it becomesnecessary.Thedesignofspecificactionsforthepromotionandimprovement of the level of health literacy ofcitizensofCataloniamustbebasedon theanalysisof the characteristics of this phenomenon.AccordingtothedataoftheHealthLiteracyProject2009-2012,theresultsarenotsatisfactorylevelsinSpain.Duringtheyear2014thehealthsurveyofCatalonia(ESCA-HealthsurveyforCataloniaHSC)includedinaspecificmoduleversioninCatalanandSpanishinthe short version of the EuropeanHealthLiteracySurvey Questionnaire (HLS-EU-Q16). Thisquestionnaire,with16items,isashortenedversionof questionnaire HLS-EU-Q47 elaborated by theEuropean Health Literacy project of HLS, 2009-2012andcurrentlyworkingonthevalidationofthequestionnaireintheCatalanpopulation.TheESCA is an official statistical activityprovidesinformation relevant to population on the healthstatus,lifestylesandtheuseofhealthservices,andinthiswaytoevaluatetheobjectivesofhealthandreduction of risk and the effectiveness of healthinterventions.Since2010 theESCAhascontinuouscharacter, that is to say, the collection ofinformation is uninterrupted, with semi annualsamples semi independents of about 2,400individualswho allow the accumulation of results.Thesampleuniverseof theESCA is thepopulationof Catalonia who do not live in collectiveestablishments,without age limit, and the sampleunit is the individual.Since thequestionnaireHLS-EUadministeredpopulation15yearsandover,therealshowwillbemorethan3,000cases.Theanalysisoftheresultsofhealthliteracy,startingin2015,willbe thestartingpoint to identifyareasof improvement, and allow you to designinterventions aimed at different segments of thepopulation,adapted to theneedsandexpectationsofhealthservicesofeachofthem.Theultimategoalof designing these actions for the promotion ofhealth literacy is, inaccordancewith thedefinitionof theWHO toachieve acognitiveandsocialskillsbestdeterminedbythemotivationandtheabilityofpeople to access, understand and use theinformationappropriately,inordertopromoteandmaintainagoodstateofhealthofthecitizens.

P06-PortugueseculturaladaptationandvalidationoftheEuropeanHealthLiteracySurvey(HLS-EU-PT)LuisSaboga-NunesprofessorLuisSaboga-Nunes1),Dr.KristineSorensen2)1NewUniversityofLisbon-NationalSchoolofPublicHealth,Lisbon,Portugal2Dt.InternationalHealth,MaastrichtUnversityIntroduction: A trans-cultural adaptation andvalidation of the HLS-EU to portuguese (HLS-EU-PT)will supply policymakers, experts and healthprofessionals with information that can promotehealthier communities while fighting healthdisparitiesinportuguesespeakingindividuals.Thisfollows themodel tomeasureHealth literacy(HL)proposed in the context of the European projectHealthLiteracySurvey(HLS-EU).Methods: After permissionwas granted from theHL European Consortium, the TRAPD model wasusedwith theHaccoun technique.After a paralleltranslation a focusgroupconsidered the firstHLS-EU-PT version and submitted it to two backtranslations. After comparing them adjudicationwasdoneandanassessmentandpretestingofHLS-EU-PTwasdonewith54subjects.ThefinalversionoftheHLS-EU-PTprotocol includedtheoriginal86questions of the HLS-EU-Q86. Documentation ontheuseofthesurveyaccompaniedthefinalversionof theHLS-EU-PT thatkeptalloriginaldimensionsanditemsofHLS-EU.Results:Aquantitativeandqualitativeexplanatorycross-correlated study with a sample of 480individualsfromPortugal(mainland)wascollectedfor the validation process. A variety of measureswere obtained including social support, personaldisposition, health-related lifestyle behaviors, andoutcomes including health. Age as well as socialstrata or sex were considered as confoundingelements. For evaluation of the psychometricproperties of theHLS-EU-PT itwaspredicted thattheHLS-EU-PTscalewoulddemonstratereliability,satisfactory internal consistency and test-retestreliability. On the validity level focus was forcontent, face and consensual, before consideringconvergent and discriminant validity, knowngroups validity and criterion validity. Exploratoryfactor analytic procedures to examine the factorstructure of the scalewas done.Results indicatedinternal consistence reliability with a highCronbach's alpha coefficient (between 0.92 forHealthCare,0.92forDiseasePreventionand0.93toHealthPromotion)and0.96 to theglobalHLS-EU-PTinstrument.ThecorrelationbetweenHLS-EU-PT,and the NVS suggest the external validity of thescale. Test-retest reliability provided highcorrelations (r = 0.88) between groups.Discriminant validity suggests that the scale is

correlatedwithsocialnetwork,socialstratahealthperception and health behaviours. Principalcomponents analysis with a Varimax rotationsequenceproducedasolutionoffactors,suggestingthat the HLS-EU-PT is a dimensional instrumentthat follows the original pattern. Inadequate HL(16%)andproblematicHL(38%)show thatabout51% of respondents have limited HL. One of themany related issues to HL that have a definitiveinfluence on health, are health behaviors. Thisresearch shows that when performing bivariateexamination of HL with health behaviors, likephysical activity (r= -.23), there is an associationbetweenHLandanhealthylifestyle.Conclusions: Results enhance the reliability,validity, internal validity, statistical validitylongitudinalandlinguisticvalidity,aslandmarksofthetranslationandvalidationprocesstoportugueseoftheHLS-EUsurvey.TheusefulnessoftheHLS-EU-PT instrument can be further discussed whileplanningpublichealthpolicystrategiesfromtheHLstandpoint. The validated HLS-EU-PT portugueseversion of the HLS-EU survey, with the user'smanualcanbeaccessedatwww.literacia-saude.infoP07-Developingamethodtoderiveindicativehealthliteracyfromroutinesocio-economicdataKarinRosenkildeLaursen,GillianRowlandsBach.scient.san.publ.KarinRosenkildeLaursen1),ClinicalseniorLecturerGillianRowlands1),SeniorLecturerinGeneralPracticeJoanneProtheroe2),PhDMichaelS.Wolf3)1DepartmentofPrimaryCare&PublicHealthSciences,SchoolofMedicine,King'sCollegeLondon,London,England2ResearchinstituteforPrimaryHealthCare&HealthSciences,KeeleUniversity,England3InstituteforHealthcareStudiesandDivisionofGeneralInternalMedicine,FeinbergSchoolofMedicine,NorthwesternUniversity,Chicago,Illinois,USAIntroduction: Research has shown that lowfunctionalhealthliteracyisassociatedbothdirectlyandindirectlywitharangeofpoorhealthoutcomes.Despite concern about the prevalence andconsequences of inadequate functional healthliteracy, there isanabsenceof tools for efficientlycollecting functional health literacy data in largepopulations. Direct measures of health literacyrequire in-personevaluation,which isnotdone inmostnationalandregionalhealthsurveys.Multiplereportshavefoundhighcorrelationsbetweentest-based health literacy measures and demographicindicators such as age, ethnicity, and years ofschooling. Imputed measures based oncombinations of these indicators have beenproposed.

Theobjectiveof thisongoingstudy is todevelop amethod of deriving indicative functional healthliteracy levels from routinely collected socio-economic data (such as age, sex, employment,income, education etc). The method will bedeveloped using English data, but can then bereplicated in any country undertaking national orregional surveys on health that includes suitabledataonsocio-economiccharacteristicsoncitizens.Methods: Using data from respectively The Skillsfor Life 2011 Survey" and the identified healthliteracycompetencythresholdsfrom"Defininganddescribingthemismatchbetweenpopulationhealthliteracy and numeracy and health systemcomplexity"wewill investigatewhichsetofsocio-demographicvariableswillbestdepictwhetheranindividual is being above or below the functionalhealth literacy competency threshold. We aredeveloping and testing a series of models to seewhichcombinationsofsocio-demographicvariablesgives us the largest area under the ReceivingOperator Characteristics curve. We will estimatemeasuresofagreement(sensitivity,specificity)anddiscrimination(areaundertheROC)asdescriptorsof each model's ability to predict an individual'shealthliteracylevel.Results: The project is currently ongoing, andemerging findings will be presented at theconference. The outcome of the project will be anew tool toenable indicativehealth literacy levelsto be derived from routinely collected socio-demographic data and applied to regional andnational-level survey data. The models will bedevelopedusingEnglishdatabutcanbereplicatedin any country where routine socio-demographicdataarecollected.Conclusion: Currently, few population surveysmeasurehealthliteracy.Ourformulaemaybeusefulfor researchers to estimate functional healthliteracy levels in populations from routinelycollected socio-demographicdata.Thiswill enableexploration of the associationsbetween functionalhealthliteracyandhealthandhealthbehaviors,andfacilitateboth researchanddevelopmentofhealthandeducationservicestoimprovehealth.P08-UsingtheHealthLiteracySurveytoMeasureHealthLiteracyinKazakhstanAltynAringazinaMed.Sci.D.,Ph.D.AltynAringazina1)1)DepartmentofPopulationHealthandSocialSciences,KazakhstanSchoolofPublicHealth,Almaty,KazakhstanIntroduction:Healthliteracyhascontinuedtogainattention in research and everyday practice overthepastdecades.According to internationalhealth

literacy experts, the subject is linked to educationand entails people’s knowledge, motivation andcompetenceswithregardstoaccess,understanding,appraisal and application of health information tomake judgements and decisions in everyday lifeconcerning general healthcare, protection fromdisease, and promotion of preventativemeasures.Quantifyinghealth literacy studies isan importantissue,whichiswhyitisnecessarytorecognizeandintegrate the activity done throughout Europeanand Asian countries. As for the current status ofhealth literacy study in Kazakhstan, there is norepresentative data on the national or populationlevel, thus making it crucial to develop such asurvey.Aims:The overall aim of this study is tomeasurehealth literacy and to create an overview of itsstatusinKazakhstan.Theobjectivesaretopresentawork plan and preliminary results of a healthliteracy survey in Kazakhstan in order to explorecore issuesand their implications forhealthcare inthefuture.Results: At the time of submission of the presentabstract,wehavedevelopedquestionnaires in twolanguages (Kazakh and Russian) for study inKazakhstan.Thesequestionnairesarebasedontheconceptualmodel of theEuropeanHealthLiteracyStudy consortium (HLS-EU). In addition to theexisting87questions,another18havebeenaddedin order to reflect local diversity and specificinterests of the country, as well as having beensuggested by the Health Literacy Study project inAsia.Wewillconductascalepilotstudyinordertotest the validity and feasibility of the HLS-Asia-Qpriorto itsuseonthenational level.Afterthepilottesting, we plan to train interviewers on studyprotocolsanddata collection tools (thenumberofwhich will depend on the duration of the study,givenasamplesizeof1000participants).Conclusions: The project is a work in progress.However, there is already growing interest in thispromising venture, including among politicians,stakeholdersand researchers.The implementationof this study will require cooperation betweenmany partners. Furthermore, addressing healthliteracy requires great capacity within the publichealthsector.P09-HealthLiteracyinChildhoodandAdolescence(HLCA)asaTargetforHealthPromotionandPrimaryPrevention-TheGermanHLCAconsortiumPauloPinheiro,UllrichBauerPauloPinheiro1),Eva-MariaBitzer2),UweH.Bittlingmayer3),UllrichBauer1)

1FacultyofEducationalSciences,UniversityDuisburg-Essen,Germany2InstituteofPublicHealthandHealthEducation,UniversityofEducationFreiburg,Germany3InstituteofSociology,UniversityofEducationFreiburg,GermanyHealth literacy has widened from individualfunctional skills inmedicalword recognition, textcomprehension, and numeracy to other skillsrequired to access, appraise and use healthinformation.Integrativehealthliteracyconceptsputa stronger focus on underlying competences andmotivationandencompass socialand life skills. Inaddition, the widened understanding of healthliteracyhasalsobeen recognized for itsquality toshift the focusfrom individual-levelskills tosocial,economic, or environmental forces that impact onhealth atpopulation- and system-level.The recentconceptual developments make health literacy apromisingtargetforhealthpromotionandprimaryprevention because they a) allow for integratingbehavioralandcontextual factors,b)canbe linkedtorelatedapproachesfrome.g.socialepidemiologyor socialization research, and c) serve for thedevelopment of measurement tools to assessdimensionsother than those thatareusuallyusedtoinformonhealthliteracylevelsinpopulations.Screening of scientific literature however revealsthat children and adolescents have poorly beenincluded into health literacy research. Gapsencompass e.g. prevalence data, definitions,concepts and models refined for different agegroups,theformulationofneedsofanddemandsonhealth literacy for childrenandadolescents,or foradult people who impact on child health. Thiscontrastswiththeimportancegiventochildrenandadolescents for health promotion and primaryprevention. The available body of literaturehighlightstheimportancetofocusonthisagegroupaswell as on adults and systemswith impact onchildhealth(parents;educators;teachers;providerofhealthservices).Here, we present the German Health Literacy inChildhood and Adolescence - HLCA" consortiumlaunched tomeet theneedsasoutlinedabove.Theconsortium aims at developing, adjusting,implementing, and evaluating theoretical,conceptual, and methodological health literacyapproaches linkedtochildrenandadolescents.Theconsortiumaims to targetalsoadultsand systemswith impact on child development. It takes amultidisciplinaryapproach involvingpartnersfromacademia, stakeholder in Public Health andEducationandotherwhowork insettingsrelevantfor children and adolescents in- and outsidehealthcare. We will focus on the theoretical andconceptual development of a health literacyunderstanding that is adjusted to children andadolescents and focuses on health literacy and

primarypreventionaswellasonapplied researchwithfocionmentalhealthande-HealthliteracyP11-Aparticipatoryapproachtoasthmaeducationmayimprovechildren'shealthliteracytomeetdemandsineverydaylifeAnneTrollvikPhDAnneTrollvik1,2),PhDKarinC.Ringsberg2),PhDCharlotteSilén3)1HedmarkUniversityCollege,Norway2NordicschoolofPublicHealth,NHV,Sweden3KarolinskaInstitutet,SwedenIntroduction:Programswherechildrenparticipatein the development of educational materials orprograms are lacking. Traditionally, asthmaeducation programs (AEP) are developed byprofessionals. In this study children'sperspectiveswereincorporatedintoaneducationalprogramandthese children were involved in the developmentandimplementationofthisprogram.Methods:Developmentoftheprogram:Theasthmaeducationalmaterialsincludedastorybookthatwaswrittenforchildrenwithasthma.Thismaterialwaspreviouslydevelopedby an interdisciplinary teamtogetherwith children and parents. The AEPwasdevelopedlocallybasedontheeducationalmaterialandaco-operative inquiryprocess,wherechildrenwith asthma, parents and health care personnel(HCP)participated.Implementation of the program: The pedagogicapproach used for this AEP, was theories ofmeaningful learning; the new knowledgemust berelated to the learner's current knowledge, thecontentmustberelevanttoandwithinthecontextof the learner's knowledge, the learner must beactive inthe learningprocess,peerdiscussionsarecentral, reflection integrates knowledge in ameaningfulway,andthelearners'questionsarethedrivingforce.Themainpedagogictoolswerestoriesandpictures.TheAEPwasgroupbasedandatotalof 21 children divided into 6 groups, with 3-4childrenineachgroupparticipatedintheAEP.Evaluationoftheprogram:OneofthesixAEPs,thethird one conducted, was observed for a total ofthree hours. ThisAEPwas selected after theHCPtested the program and were satisfied with itsfunction.IntheobservedAEPthreeparticipants(8-10 years old), two girls and one boy participated.Thesechildrenhadmoderateorsevereasthmathatwas treated daily with asthma medications. TwoHCPs participated in the study, a nurse whospecialisedinasthmaandaphysiotherapistwholedtheAEPsession.Results: The significance of the asthma educationprogramme emerged in four themes: Children are

learning from each other: In a positive learningclimate,thechildrenwereabletoexpressemotionalthemes that they may not have communicatedbefore.Childrenarelearningthroughaninteractionwith the educational material: The childrendiscussedstoriesandpicturesinafellowinterplay:whenonechildexpressedsomething,anotherchildwouldrecogniseitandcontinuethestory.Childrenarelearningfromtheirinteractionwithhealthcarepersonnelandviceversa:Adjustingthevocabularyaccording to the children's experiences, theyweremet on their level of understanding. Children canexpressanddiscusstheirunderstandingofasthma.When the children expressed their thoughts, theHCPwoulddirect theirattention towhat theyhadexpressed.Conclusions:Theuniqueaspectaboutthisprogramisthatitemanatefromchildren'sperspectives.Thechildren were actively involved and learnt fromeach other's shared knowledge and experiences,which develop their health literacy and increasetheirknowledgeandcompetencetomeetdemandsineverydaylife.Relevance to clinical practice. Future educationalapproachesshouldusechildren'sperspectives in amannerinwhichtheirquestions,thoughtsanddailychallengesareemphasised.P12-Investigatingchildren'shealthliteracyrelatedtophysicalactivity-Resultsfromamixed-methodsstudyofhealtheducationwithpedometersintegratedinmathematiclessonsAneHøstgaardBondeMD,MPHAneHøstgaardBonde1),PhD.MScMariaBruselius-Jensen1)1StenoDiabetesCenter,HealthPromotionIntroduction: Most research on pedometers andchildren has focused onmeasuring steps per day,assessing the relation between steps, physicalactivity and health, and how pedometers can beused in interventions topromotephysicalactivity.However, little attention has been given topedometers as an educational tool for promotingchildren's own learning about their movementpatternsineverydaylife.Therefore,”TheImoveApproach”wasdevelopedasa school-based health educational approach withpedometerstobeintegratedinmathematiclessonsin Danish schools. The objective of Imove is topromote children's leaning and reflection aboutmovement and physical activity based on theirinvestigation of theirmovementwith pedometersduring aschoolweekandsubsequentlyprocessingthestepdataandreflectingon thepatternsduringmathematicslessonsinthefollowingweek.Theaim

andtheoutcomeofthishealtheducationallearningprocessphysicalactivityrelatedhealthliteracy.Theobjective of this paper is to explore children'sphysicalactivity-relatedhealthliteracyastheirself-reportedconceptionsofphysicalactivityinrelationtohealthandtheirattitudestomovementandbeingactive.Methods: During winter 2013-2014, the ImoveApproachwasimplementedinfourDanishprimaryschools in grade 5th, 6th and 7th . A total of 12classes with approximately 300 children and 10mathematic teachers participated. For researchpurposes, we asked the children to answer a 10itemquestionnaireoneweekbeforeandoneweekaftertheImoveperiod.Thequestionnairecontainedopenquestionswhere theanswerwas anarrative,as well as closed, multiple choice questions. Inaddition, we observed and audio-recorded themathematiclessons,andweconductedfocusgroupinterviewswith all the children in one class fromeachgrade.Finally,we conducted short individualinterviewswith the teachersand aworkshopwithalltheinvolvedteacherswhenallthetwelveclasseshadcompletedtheImoveperiod.The questionnaire covers three components ofphysical activity-related health literacy: children'stheoretical knowledge, practical experience andattitudes/preferences.Mixedmethodsanalyseswillbeconducted.Results:This studywillproduceknowledgeaboutchildren'sphysicalactivity-relatedhealthliteracytobe used for measuring effect in larger healtheducationinterventioninthefuture.Further,itwillassess the feasibility of using pedometers forpromotingchildren'sreflection,and itwillpointatpotentials and difficultieswhen integrating healtheducationinmathematicslessons.P13-Healthliteracyandthesalutogenicparadigmasapathwaytotacklethehealthgradient:thecaseofsmokingcessationLuisSaboga-NunesprofessorLuisSaboga-Nunes1)1NewUniversityofLisbon-NationalSchoolofPublicHealth,Lisbon,PortugalIntroduction: In Portugal the prevalence ofsmokers over fifteen years of age within thepopulation stood at 20.9% (30.9% for men and11.8% forwomen)by2005.Thenationalgoalwasto decrease this to half by 2010 (National HealthPlan (NHP) of Portugal (2004-2010). While thestrategyofhelpingpeopletoquitsmokinghasbeenemphasisedatNationalHealthService(NHS) level,theuptakeofcessationassistancehasexceededthecapacity of the service. A problem of health

provision emerged withwaiting lists for smokingcessationprogrammes.Theaveragewaitingperiodfor health units with waiting lists was 132 days.Have waiting lists, determines restriction toprogrammes (OR=3.98; p=0.02). This induced thesearch of new theoretical and practical venues tooffer alternative options to stop smoking, besidesthe pathogenic paradigm. Salutogenesis is hereproposed as a new paradigm to contribute toincreasehealthliteracy(HL)andempowersmokerstoconsidersmokingcessation.eHealthandtheuseof information technologies in smoking cessationare researched has operational salutogenicstrategiesfocusingthesenseofcoherence.Methods&Results:AnanalysisofpublicopinionandreceptivitytoInternetuseinsmokingcessationto increase health literacy, as a secondaryprevention intervention examining screening forthe presence of tobacco-related by-products (suchas Carbon Monoxide - CO) in a sample group of10,824 (58.3% were males) was implemented.Smokers and non-smokers were canvassed abouttheuseof the Internet to increaseHL for smokingcessation. Results show that there were 37.0%smokers, smoking daily a mean of 15 cigarettes.These participants have a mean of 18.4 ppm ofcarbonmonoxide (SD12.9ppm)and43%ofnon-smokers had carbon monoxide levels ≥ 4 ppm.Higher carbon monoxide levels are associated tomotivation to make behaviour changes (IBC) (2=0.120;p<0.01).Asignificantnumberofsmokers(59.4%)would like to stopand60%want tohavehelp.Morewomen thanmen acceptassistance forsmokingcessation(2=4.48;p=0.03).Evenif24.4%do not have Internet access, 57% say a webplatform could help a lot ( 2=18.66; p=0.01). Forthosehaving Internetaccess thewebopinionsaremore favourable to the contributionof theweb tohelpquit (2=377.07;p<0.001).Ahighpercentageof smokers (67%) tried previously to quit andreveal high motivation for attempting smokingcessation ( 2=0.326; p<0.01). Among theparticipants, 43.5%were motivated for not usingtobacco insixmonths (2=0.790;p<0.01)andmenweremoremotivated thanwomen to go throughwithaquittinghelpprogramme(2=10.60;p=0.01).Conclusions: Implementing such initiativesfocusing on health literacy about second handsmoking(SHS)andcarbonmonoxideisfeasibleandhave good receptivity by the public. Internetsupport with emphasis on HL about the benefitsandstrategiestostopsmokingisrecommendedhasa strategy to help, particularlywhenwaiting listsmake it difficult for smokers to get appropriatesupportinduetime.

P15-ThecontributionofhealthliteracytoeducationalinequalitiesincardiovasculardiseaseriskMirjamFransenDrMirjamFransen1),ProfRonPeters2),ProfMarie-LouiseEssink-Bot1)1DepartmentofPublicHealth,AcademicMedicalCentre,UniversityofAmsterdam,Amsterdam,TheNetherlands2DepartmentofCardiology,AcademicMedicalCentre,UniversityofAmsterdam,Amsterdam,TheNetherlands.Introduction: Educational inequalities incardiovascular disease (CVD) risk are wellestablished, but underlying mechanisms arerelativelyunexplored.Theaimofthisstudywastoassess to what extent educational inequalities inCVD riskcanbeexplainedbydifferences inhealthliteracy(HL).Methods: Data were collected in a multi-ethniccohort study (HELIUS) by questionnaire and aphysical examination. CVD risk factors included:age; total cholesterol; HDL cholesterol; systolicblood pressure; diabetes; smoking. General CVDriskwasestimatedfromamultivariableriskfactoralgorithm (Framingham). Objective HL wasmeasuredbytheRapidEstimateofAdultLiteracyinMedicine (REALM), subjectiveHLwasassessedbythe Set of Brief Screening Questions (SBSQ). Weperformedstepwiselinearregressionanalyseswithgeneral CVD risk as independent and educationallevel, HL and ethnic background as dependentvariables.Results: We used data from 6442 participants(meanage46years,57%female,26%Dutchethnicbackground, 57% (medium-) high educationallevel).81%hadanadequateREALMscore,92%hadadequate subjective HL. Educational level wassignificantly associated with objective andsubjective HL. Lower educational level and lowerHLweresignificantlyassociatedwithahigherCVDrisk. In the full regressionmodel,botheducationallevelandHLweresignificantpredictorsofCVDrisk.Conclusions: HL, as measured with REALM orSBSQ, is a contributing factor, but cannot explaineducationalinequalitiesinCVD.FurtherresearchontheroleofHLinsocioeconomicinequalitiesinCVDriskrequirescontext-basedobjectiveHLmeasures.P16-AssessingAdherenceandHealthLiteracyinaHIVCohortinGuineaBissauCharlotteDyrehaveRN,MSACharlotteDyrehave1,2),MDDlamaRasmussen3),MDFaustinoCorreia4),MDDelfimMendes4,5),MD,PhDChristianWejse2,4),RN,PhDLotteRodkjaer2)1BandimHealthProject,StatensSerumInstitut,Guinea

Bissau2DepartmentofInfectiousDiseases,AarhusUniversityHospital,Denmark3DepartmentofInfectiousDiseases,OdenseUniversityHospital,Denmark4BissauHIVclinic,SimaoMendesNationalHospital,Bissau,GuineaBissau5GloHAU,CenterforGlobalHealth,SchoolofPublicHealth,AarhusUniversity,DenmarkBackground:Poortreatmentadherenceisthemainbarriertotheeffectivenessofantiretroviraltherapy(ART) globally. We have previously found in aqualitative study that HIV-infected in Bissau haveinsufficient knowledge about HIV and ART. Wefound that facilitatorswereexperienced treatmentbenefits and complementing social networks. Thebarriers were treatment-related costs andcompeting livelihood needs; poor clinicinfrastructure; perceived stigma; and traditionalpractices.Method: From October 2012 to April 2013, wetested a questionnaire designed for assessment ofadherence and description of barriers andfacilitators to adherence based on our previousfindings. HIV-infected in the Bissau HIV-cohort attheHIV clinic,HospitalNational SimaoMendes inBissau,GuineaBissauwereenrolledinthestudy.Results:A totalof494HIV-infectedwere includedin the study.Twenty-fivepercentweremen,41%were illiterate. 25% did not take the medicineduring the last 4 days and 23% skipped theirmedicineduringweekends.ThemainbarrierswerelackofknowledgeaboutART/HIVanddisclosure-related difficulties. Themost frequent reasons fornot taking medicine were side-effects, simplyforgetting, too ill to attend the clinic and lack offood.Conclusion: Our findings indicate that greaterefforts are needed to educate HIV-infectedsufficientlyaboutHIV,ARTand lifelong treatment,andthereseemtobeanurgentneedforimprovinggeneralHIV-knowledge(e.g.health literacy)andtostrengthen inventions to improve this in clinicalpractice.P18-Testinghealthliteracyinpatientswithchronicobstructivepulmonarydisease(COPD)usingaDanishversionoftheTestofFunctionalHealthLiteracyinAdults(TOFHLA)LisaKorsbakkeEmtekærHæsumPhDstudentLisaKorsbakkeEmtekærHæsum1),ProfessorLarsEhlers2),ProfessorOleHejlesen1,3)1DepartmentofHealthScienceandTechnology,FacultyofMedicine,AalborgUniversity,Denmark2CentreofImprovementinHealthCare,FacultyofSocialSciencesandFacultyofMedicine,AalborgUniversity,

Denmark3DepartmentofComputerScience,UniversityofTromsø,Tromsø,NorwayIntroduction: The lack of consensus about thedefinition of health literacy causes disagreementabouthowitshouldbemeasured.Todateoneoftheinstruments most widely used to measure healthliteracy is theTestofFunctionalHealthLiteracy inAdults (TOFHLA). Functional Health literacy, asmeasured in the TOFHLA, is defined as basicreading,writing, and numeracy skills applied in ahealthcaresetting.TheTOFHLA isonlyavailable inanAmerican and Spanish version, and there isnostandardised way to measure health literacy inmostEuropean countries.As a result the researchinto functional health literacy among the Danishpopulationisalsoinaninfantstage.Elderly people with a chronic disease like forinstance chronic obstructive pulmonary disease(COPD)are at risk ofhaving a low level ofhealthliteracyandnotreceivingthehealthcaretheyneed.COPDpatientsundergocomplex,life-longtreatmentcourses, have multiple encounters with thehealthcare system and most are faced with asituation where their quality of life deterioratesslowly and steadily due to growing physical andcognitive impairment obstructing their ability toperformeverydayactivities.Theactiveinvolvementofthesepatients intheirowncare isakeyprioritythat hinges on effective communication; yet, onlyfewstudieshaveexaminedCOPDpatients'abilitytoaccess, understand and evaluate health-relatedinformation,i.e.theirhealthliteracy.Theobjectiveofthestudywastoassesstheleveloffunctional health literacy among COPD patientsusing a Danish version of the American TOFHLA,and relate this to gender, age, civil status andeducation. The American TOFHLA has beentranslated, adapted and validated for use in aDanishsettingandculture.The totalscores for theDanish TOFHLA test are divided into three levels:inadequate (lowest), marginal and adequate(highest).Methods:42COPDpatients completed theDanishTOFHLAandparticipatedinaface-to-faceinterviewconcerning their basic demographics. Descriptivestatisticswere used to explore the general healthliteracyscorebydemographiccharacteristics, levelof education, and response time to the DanishTOFHLA.Multiple linear regression analyseswereconducted to explore the association betweenfunctional health literacy and gender, age, civilstatusandeducation.Results:DistributionofhealthliteracylevelamongtheCOPDpatients:23hadanadequatelevel,8hadamarginal level, and 11 had an inadequate level.Basedonunadjustedmean,aslightlyhigherhealthliteracyscorewasobservedamongthemalepartoftheCOPDpatientsandalsoamongthoselivingwith

a partner. Themean response time to theDanishTOFHLAbecamelowerwithahigherlevelofhealthliteracy; those with an adequate level had thelowestresponsetime.The level of education was found to be slightlycorrelatedwith health literacy score among thosewith an inadequate level of health literacy (whenadjustedforgenderandage).Agewasalsofoundtobecorrelatedwithhealthliteracyscore.Conclusions:Morethan50%oftheCOPDpatientshadanadequate levelofhealth literacy,which isasomewhatsurprisingresultaselderlypeoplewithachronicdiseaselikeCOPDareathighriskofhavinglowhealthliteracy.Thecorrelationsbetweenhealthliteracy score and education and age were notstrong, but nevertheless in accordance withpreviousfindingsintheliterature.P19-Warfarinmanagementbynon-medicalhealthcareprofessionals:aquestionoftrust?LauraJSahmMrGavinPinington1),DrSuzanneMcCarthy1),DrLauraJSahm1)1SchoolofPharmacyUniversityCollegeCork,Cork,IrelandObjective: To examine patient's views regardingwarfarin management by non-medical healthcareprofessionalsanddeterminewhetherarelationshipexists between health literacy status and patientperceptions.Method: Apreviouslyvalidatedquestionnairewasdistributed to patients attending theanticoagulation clinic at Cork University Hospital(CUH). Socio-demographic information wasrecordedand theRapidEstimateofAdultLiteracyin Medicine (REALM) Health Literacy tool wasadministered.DatawereanalysedusingSPSSv21.Results: A total of 183 patients completed thesurvey (39.3% female, average age 62, standarddeviation 11.75),with a response rate of 68.28%.Theprevalenceoflimitedhealthliteracywas19.7%and negatively correlated with age (r=-0.429,p<0.0005), age of leaving education (r=-0.72,p<0.0005)andthuseducationlevelobtained.Whilst100% of patients agreed or strongly agreed thatpharmacists or nurses were qualified enough tomanage their anticoagulation, nonetheless 48.2%expressedapreferenceforconsultingaphysician,ifthisoptionwasavailable.Therewasasmallpositivecorrelation between adequate health literacy andpatientperceptionsofnon-medicalanticoagulationmanagement regarding trust in the pharmacist ornurse (r=0.159, p<0.05), and in their ability toanswerquestionscorrectly(r=0.175,p<0.05).Conclusions:Ourstudy indicatesthatthemajorityof patients are open to non-medical professionals

managing theirwarfarindoses.The role ofnursesandpharmacists isoftenseenassupplementary tophysicians, and most patients prefer medicalmanagement of treatment,when given the choice.The correlationbetweenhealth literacy statusandpatient opinions was, with two exceptions, notstatisticallysignificant.Duetothesmallsamplesizefurther studies are required to generalise theresultstotheIrishpopulation.ThehighprevalenceoflimitedhealthliteracyamongstIrishadultsneedsto be addressed with national strategies to easecomprehensionofhealthrelatedtexts.Keywords:health literacy,anticoagulation,patientperceptions,warfarin,REALM.P21-Measuringpeoples'understandingoftheeffectsoftreatments:areviewofoutcomemeasuresAstridAustvoll-DahlgrenPhDAstridAustvoll-Dahlgren1),MsAllenNsangi2),DrAndyOxman1)1NoregianKnowledgecenterforthehealthServices2MakerereUniversity,UgandaBackground: Being able to critically appraiseclaims about treatment effects is crucial forinformed decision making. Studies mapping orevaluatingpeople'sunderstandingof theeffectsoftreatments have not been measured consistently,andarecharacterisedbydifferencesinterminologyandparalleldiscourses.Such inconsistenciesaretosomeextentattributabletodifferentresearchareasand disciplines being responsible for studies thathaveoftenfocusedonaspecificconcept,suchastheunderstandingofnumeracy.Aim: The aim of this project is to provide asystematic overview of outcomes and outcomemeasurements used in studies evaluating ormapping peoples' understanding of the effects oftreatments, which will inform future research inthisarea.Methods: We conducted a systematic search inCochrane Library (CDSR, DARE, HTA, CENTRAL,Methodstudies)MEDLINEIn-Process&OtherNon-Indexed Citations, and MEDLINE 1946 to Present(Ovid), ERIC 1966 to present (ProQuest). Wereviewed the available evidence to identifyoutcomes and outcome measures used in studiesevaluatingpeoples'understandingof theeffectsoftreatments. In order to identify unpublishedstudies,wealsocontactedkeyresearchersworkinginrelatedresearchareassuchashealthliteracyandtraining of patients and consumers in evidence-basedmedicine,includingmembersoftheCochraneConsumer group and the Nordic Health Literacy

Network. We included all relevant systematicreviews,trialsandobservationalstudiesevaluatingormappingpeoplesunderstandingoftheeffectsoftreatments.Theleadauthorinadditiontoonemoreresearcher reviewed all references independently,extractedalloutcomes in the included studiesandenteredtheseinamatrixtopresentanoverviewofthe outcomes, to explore overlaps, inconsistenciesandlackofevidence.Results: We identified 2961 references, of whichnearly 70 were systematic reviews of studiesmapping or evaluating specific concepts. Alloutcome measures evaluating the identifiedoutcomeswaspresented in a table, anddescribedaccording to the following criteria:whichdomainsare captured, for which target population is theoutcome measure intended, and are the outcomemeasures dichotomous or continuous, andsubjective or objective. The indentified studiesincluded outcomes and outcomemeasures belongto several overlapping research fields including;health literacy,decisionaids,educationinevidencebased practice, numeracy, science education andinformedconsent.Conclusion: This review provides a systematicoverviewofoutcomesandoutcomemeasurementsused in studies evaluating or mapping peoples'understanding of the effects of treatments,whichwillinformfutureresearchinthisarea.P22-Satisfactionwithcancer-relatedinformation:Associationswithinformation-seekingstyleanddecisionself-efficacyBeritKjærsideNielsenPhDBeritKjærsideNielsen1),PhDMimiMehlsen2),ProfessorAndersBonde3),ProfessorRobertZachariae2)1Health,dep.ofClinicalmedicin,UniversityofAarhus,Aarhus,Denmark2UnitforPsychooncologyandHealthPsychology,Dept.ofOncology,AarhusUniversityHospitalandDept.ofPsychology,AarhusUniversity,Aarhus,Denmark3Dept.ofOncology,AarhusUniversityHospital,AarhusDenmarkBackground:Duringthecourseofcancer,patientsare repeatedly challenged with complexinformation and may be involved in difficultdecisions concerning their treatment and care.Information is often regarded as unambiguouslybeneficial.However, itmaybe thatnotallpatientswant all available information about their diseaseandtreatment.Aim: To explore individual differences in cancerpatients' information needs, information-seekingbehaviors,satisfactionandperceivedhelpfulnessoftheinformationreceived.

Methods: Patientswith various cancers attendingan oncology outpatient clinic completedquestionnaires including items measuring theirinformation-seeking behaviors, the EORTCinformationquestionnaire,theHospitalAnxietyandDepression Scale, and the Decision Self-EfficacyScale, measuring confidence in one's ability toparticipateindecision-making.Results: Of the 494 eligible patients, 272 (56%)(Mean age: 61 yrs, 40% males) completed thequestionnaires. Patients exhibiting an activeinformation-seeking style (60%) reported higherlevels of anxiety (M=6.7; SE=4.1) compared topatientswith apassive style (M=5.2; SE=4.0) (p <0.05). Multiple linear regression revealed thatpatientswhowerelesssatisfiedwiththeamountofinformation received, tended to be in curativetreatment (=0.14;p=0.02;95%CI:1.12-13.17), tohaveanactive information-seeking style ( = -0.14;p=0.03;95%CI:-13.44to-0.57),andtobelowerindecisionself-efficacy(=0.20;p<0.01;95%CI:0.21-1.07).Theonlypredictorofperceivedhelpfulnessoftheinformationreceivedwasdecisionself-efficacy(=0.19;p=0.01;95%CI:0.13-0.94).Conclusion: Patients with an active information-seekingstyleweremoreanxiousthanpatientswithapassivestyleandlesssatisfiedwiththeamountofinformation received throughout their cancercourse.Patientswhowerelessefficaciousregardingdecision-making were also less satisfied with theamountof information receivedandperceived theinformation as less helpful.Implications: Attempts to improve information incancer care should take the role of information-seeking style and decision self-efficacy intoconsideration.P23-Informationneedsandhealthliteracyoffirst-timebreastcancerpatients-intentionsofthePIATstudyandinitialresultsAnnaSchmidtDr.AnnaSchmidt1),Dr.ChristophKowalski1),Prof.HolgerPfaff1),Prof.NicoleErnstmann1),1)InstitueforMedicalSociology,HealthServicesResearchandRehabilitationScience,UniversityofCologne,GermanyBackground: Breast cancer is the most commoncancer in women throughout Germany. The PIATstudy sets out to ascertain the information needsand health literacy aspects of first-time breastcancerpatients.Method:Thedataweretakenfromthepreliminaryqualitative study and the quantitativemain study.On the basis of focus group discussions andstandardizedpostalquestionnairesthe information

needs andhealth literacy ofpatients are collectedduring the postoperative hospitalization (T1), 10(T2)and40(T3)weeksafterdiagnosis.Inaddition,breast cancer centres were asked to fill outstructureandprocesscharacteristicsofthecentres.Results: The study results shows that first-timebreast cancerpatientsareoverstrained,at least inpart,bythe information loaddirectlyaftersurgery,and that some information needs are not beingfulfilled.The informationneedswere linked to theage and health literacy of the study participants.Employees from breast cancer centres havereportedwideranginguseofinformationmaterials,forthemostpartnotsubjecttothehealthliteracyofpatients.Summary: The results indicate that the use ofindividualized information at different treatmenttimes seems desirable. The targeted use ofinformation steps could contribute to increase thehealth literacy of breast cancer patients. Theongoingmain studywill providemore indicationsthankstoitsfollowupstudydesign.P24-Theroleofhealthliteracyinthedecisionmakingprocessregardingcolorectalcancerscreening:asystematicreviewIrisvanderHeideMAIrisvanderHeide1),PhDEllenUiters1),PhDJanyRademakers2),PhDJantineSchuit1),PhDMirjamFransen3)1NationalInstituteforPublicHealthandtheEnvironment(RIVM),Bilthoven,TheNetherlands2NetherlandsInstituteforHealthServicesResearch(NIVEL),Utrecht,TheNetherlands3AcademicMedicalCenter,UniversityofAmsterdam,Amsterdam,TheNetherlandsIntroduction. Colorectal cancer (CRC) is animportant cause of cancer-related deathsthroughout theworld.Uptake of CRC screening islower among those with lower SES. Poor healthliteracyiscommonamongthosewithlowerSESandpossibly influences the decision making processwith respect to CRC screening participation. Theaimofthissystematicreviewistoexaminewhetherdecision making regarding participation in CRCscreening differs according to people's healthliteracyskills.Methods.Fourdatabaseswere searched forpeer-reviewed English language articles publishedbetween1950andMay2013thatmeasuredhealthliteracyand(aspectsof)decisionmakingregardingparticipationinCRCscreening.Articlesmeetingtheinclusion criteriawere independently reviewedbytwo investigators,whoassessed thequality of thestudiesbytheuseofastandardizedform.

Results.Resultsindicateinthefirstplacethatthosewith lower health literacy skills have lessknowledgeconcerningCRCandCRCscreeningthanpeople with higher health literacy skills.Subsequently, studies concerning the associationbetweenhealth literacyandCRCscreeningattitudeshow varying results; some find that those withlower health literacy are more likely to havenegative attitudes and perceive more barriersregarding CRC screening than participants withadequatehealthliteracy,whereotherstudiesreportnoeffectofhealthliteracy.Furthermore,thosewithlowerhealth literacy seem tohavemoredifficultywithunderstandingtheconceptofinformedchoiceinthecontextofscreening.Conclusions. Our findings suggest that certainaspects of the decision making process regardingparticipation in CRC screening, differ according tohealth literacy level. However, there is limitedknowledgeavailabletodrawunivocalconclusions.P25-MentalhealthliteracyandsocialsupportforolderpeopleinWaleslivingwithdepressionAelwynWilliamsMrAelwynWilliams1),DrMichelleEdwards1)1Centreforinnovativeageing,SwanseaUniversity,Swansea,Wales,UkBackground: Mental health literacy involves anunderstanding ofmental disorders, knowledge anbeliefs about risk factors, the recognition ofsymptoms, knowledge of sources ofmentalhealthinformation, support and self-help interventions.Studieshave shown that older adultshavepoorermental health literacy and also less likely torecognise symptoms of mental health disorderssuch as anxiety depression than younger adults.This study aims to explore experiences ofmentalhealth literacy in the context of older people inWales livingwithdepressionandexplainhowtheyuse their social network for support withunderstandingandmanagingdepression.Method:A longitudinalqualitative interviewstudyincluding 28 participants (aged 65+) living withdepressionrecruitedfroma largepopulationstudyof the health and well-being of older people inNorth and South Wales (CFAS Wales II). Thetranscripts were analyzed using the 'Framework'approach.Results: Participants had a limited understandingofdepression,howtomanageit,sourcesofsupportand treatment options. Most participants did notengagewith informationaboutdepressionor seekhelp from services other than their GP. Mostparticipants were taking prescribedantidepressants and only a few had been offeredpsychological therapies. Help seeking from family

andfriendswaslimitedbecauseof'non-disclosure',areluctanceto 'burden'othersortoavoid 'stigma'.Differencesare identified inexperiencesofmentalhealth literacy around depression based ondifferent typesofsocialnetworks,ruralandurbanlocation,ageandgender.Conclusion: Identifying differences in mentalhealthliteracyinolderpeoplecanhelpindesigningand targeting appropriate community levelinterventions aimed at providing information,improving symptom recognition, promoting help-seekingbehavioursandsupportingolderpeople inmaking informed decisions about treating andmanagingdepression.P26-Thedistributionofhealthliteracyinthesocialnetworksofolderpeoplewithalong-termconditionMichelleEdwards,AelwynWilliamsDrMichelleEdwards1),MrAelwynWilliams1)1Centreforinnovativeageing,SwanseaUniversity,Swansea,Wales,UkIntroduction: Older people tend to have poorerhealth literacy and consequently they experiencemoreadversehealthoutcomes intermsofphysicaland mental health functioning. Health literacy ispart-cognitiveskillandpart-socialskillandcanbedistributed amongst family, friendship and othersocial networks. This study aims to explain the'distributed' nature of health literacy and identifyhowolderpeople livingwitha longtermconditiondraw on their social network for support withhealthliteracyrelatedtasks.Method:A longitudinalqualitative interviewstudyincluding 67 participants (aged 65+)with a long-term health condition (diabetes or depression)recruited from a large population study of thehealthandwell-beingofolderpeople inWales,UK(CFAS Wales II). The transcripts were analysedusingthe'Framework'approach.Results:Theevidenceforhealthliteracywasmixedin the diabetes group of participants. Some had agood knowledge of diabetes and engaged withinformation and health care services and talkedabout active self-management. Some had littleknowledge andunderstanding ofdiabetes,didnotengagewithinformationorfollowself-managementadvice. Participants with depression had a poorunderstanding and most were not motivated toengage with information. Participants who had apoor understanding and were not motivated tolearnabouttheirconditionoftenreliedonprimarycare services as theirmain source of informationand support. The distribution of health literacywithinsomesocialnetworkswaslimitedwithmostparticipants with depression and some with

diabetes due to a reluctance of seeking socialsupport from family and friends. Differences areidentified in experiences of seeking social supportfor health literacy based on physical and mentalillness,differenttypesofsocialnetworks,ruralandurbanlocation,ageandgender.Conclusion: Support from friends and family canmediate the health literacy demands placed onolder people in managing a long term condition.However, some olderpeople arenotmotivated tobecome health literate and there are barriers toseeking social support. Identifying age-relatedmotivational barriers to health literacy andaccessing social support with health literacy indifferent social network types may help indesigning and targeting appropriate communitylevelhealthliteracyinterventions.P28-HealthyAgeinginIreland:TheRoleofHealthLiteracySarahGibneyDrSarahGibney1),MrJamesFullam2),DrGerardineDoyle1)1UCDLochlannQuinnBusinessSchool2UCDSchoolofPublicHealth,PhysiotherapyandPopulationScienceIntroduction: This study investigates therelationship between health literacy, health statusand behaviour among older people (aged 50+) inIreland.InIrelandtheproportionofthepopulationaged65andolder issetto increaseby44percentin thenext tenyearsanddoubleover thenext30years(Normandetal.,2011).ResultsfromtheIrishLongitudinal Study of Ageing (2011) haveillustrated high rates of current smoking (one infive), overweight and obesity (three-quarters) andlow levels of physical activity among those aged50+.Considerabledisparitieswerealsoobservedinboth health outcomes and behaviour associatedwith education and income. In 2013 the IrishGovernment adopted a 'social determinants ofhealth' framework to reducedisparities related toeducation, social inclusion, and health andwellbeing status at an individual and communitylevel.ForthefirsttimeinIrishhealthpolicy,healthliteracywasreferredtointwoactionpoints,bothinthecontextofempoweringpeopleandcommunitiesto reduced health disparities. In Irish policiesrelating to older people there continues to be astrongemphasisonolderpeopleremainingintheirhomes with support from family carers and localvoluntary and community organisations (Cross,2009).Intrinsictothisemphasisonageinginplaceis the ability for individuals to self-manage andadapt to age related decreases in health andfunction. Continued participation in social andcommunitylifeisalsopromoted.Healthliteracycan

be considered as central to realising the policyobjectivesofhealthyageinginplacewhilereducinghealthdisparitiesinoldage.Methods: This study adopts the 'socialdeterminantsofhealth'asa theoreticalframeworkfor analysing the relationship between healthliteracy, health behaviour and health outcomes ofpeople aged 50 + and older in Ireland. Theanalytical sample (n= 251) is drawn from thoseaged 50 and older who participated in the 2011European Health Literacy Survey in Ireland (n=1005).Giventhesmallsamplesize,non-parametricbivariateanalysiswillbeperformedtoillustratetheextentandnatureof the relationshipbetweenkeydemographicandsocio-economiccharacteristicsofolder people in Ireland and health literacy indiffering domains (cure and care, diseasepreventionandhealthpromotion).RobustOrdinaryLeastSquaresregressionwillbeutilisedtoidentifytheextent towhichhealth literacyperformance inthehealthpromotiondomain(managingresourcesforhealthandwellbeing)predicts1)health statusand2)healthbehaviours (smoking,excessalcoholconsumption,overweightandobesityandphysicalexercise) among older Irish people. Standarddemographic and socio-economics factors (age,gender, educational attainment, income andethnicity)willbe controlled for,which are knowncorrelatesofhealthliteracyattheindividuallevel.Results and Conclusions: The objective of thestudy is to provide an empirical overview of therelationshipbetween1)health literacy andhealthstatus and 2) between health literacy and healthbehaviour among older people in Ireland. Thisinformationwill provide an evidence base for thepromotion of health literacy as a keystone inrealising policy objectives in relation to olderpeople ageing in place and reducing healthdisparities by empowering people andcommunities.P29-Healthyageinginthecity:PromotionofhealthliteracyinoldageinthecontextofbiographiesandtheenvironmentNadineKonopikProfessorDr.FrankOswald1),Dr.InesHimmelsbach1),Dipl.-Päd.NadineKonopik1),ReginaRösel1)1Goethe-UniversityFrankfurtamMain,Germany,FacultyofEducationalSciences,InterdisciplinaryAgeingStudiesThis paper presents preliminary findings from aGerman studyonhealth literacyofolderadults inthree districts in the city of Frankfurt. The studybuildsupon aprojecton themeaningofageing inplace in theneighborhood forhealthyageingwithdatafromN=454communitydwellingolderadults

(70-89yearsold).Thedatarevealeddifferentlevelsofhealth literacy indifferentdistrictsaswellasanexpected statistically significant relationshipbetweenhealth literacyandautonomy indaily lifeofolderpeoplewithdecliningphysicalcompetence.The recent study aims to maintain and promotehealthliteracyaspeopleageinplace.Theaimofthestudyisthreefold:(1) Using a person-environment interactionperspective to better understand how and whyolder people maintain and practice healthpromotionwithinthecontextofageinginplace.(2) Exploring how the experience of one's ownhealth and health literacy develops over the life-span as well as how these perspectives areintegratedintoone'sbiographicalnarratives.(3) Identifying implications to be consideredwithrespect to better health literacy programs andservices.Furthermore,resultsshallservetospecifythe concept of health literacy for older adults ingeneral.The study design incorporates a mixed-methodsapproachutilizingbothqualitativeandquantitativedatacollection techniques.Biographicalqualitativeinterviews were conducted with a sample of 12people stratified for age (range: 70-89 years old),gender,health, socio-economic status andplace ofresidence. In thequantitative section of the study,100persons(matchedpairsof50participantsfromhealth education programs versus 50 non-participants)wereaskedtofilloutaquestionnairefocusing on health literacy (HLS-EU-Q-S andNVS)and items addressing subjective perception (e.g.satisfaction with life), social participation andhealth behaviour. Preliminary findings showconnectionsofhealthattitudesamongolderadultswith former biographical experiences and healthsocializationinthefamily.Furthermore,findingsincontext with the use of health services by olderadults shall be presented. These results help tohighlight the pivotal role health literary plays inprovision of age- and setting-specific services thatfosterhealthyageing.P30-Effectivenessofinterventionstoimproveadherenceinolderadultswithlowhealthliteracy:asystematicmeta-reviewBasGeboersMScBasGeboers1),Dr./MBBSMDYoonLoke2),Dr./PhDJuliiBrainard2),Dr./PhDCharlotteSalter2),Prof.Dr./MDPhDSijmenA.Reijneveld1),Dr./PhDAndreaF.deWinter1)1DepartmentofHealthSciences,UniversityMedicalCenterGroningen,UniversityofGroningen,Groningen,TheNetherlands2NorwichMedicalSchool,FacultyofMedicine&Health

Sciences,UniversityofEastAnglia,Norwich,UnitedKingdomObjectives:Olderadultsfrequentlysufferfromlowhealthliteracy.Increasingadherenceratesmaybeaproductivestrategytoimprovethehealthoutcomesofolderadults,sincedifficultyinadheringtoadvicefrom healthcare professionals may be one of thepotential pathways that exert a detrimental effectonthosewithlowhealthliteracy.Ourfirstobjectivewas to systematically review the availablesystematic reviews on the effectiveness ofadherence interventions in older adults with lowhealth literacy. Our second objective was toevaluatetheassociationbetweenhealthliteracyandadherence in older adults. Also, to get a morecompletepicture of the evidence,we explored theassociation between educational level andadherenceinolderadults.Methods: We conducted a systematic search ofsystematic reviews andmeta-analyses.The searchwas conducted in eight electronic databases:MEDLINE, EMBASE, Education ResourcesInformation Center (ERIC), PsycINFO, CumulativeIndex to Nursing and Allied Health Literature(CINAHL), DARE, Web of Knowledge, and TheCochrane Library. All steps in the selectionprocedure and data-extractionwere conducted bytwoindependentreviewers.Results:Afterscreening1330citations,atotalof12reviewswere included.A totalof7reviewson theeffectiveness of adherence interventions in olderadults with low health literacy were found, 6 ofwhich reported improvements due to adherenceinterventions. Interventions on adherence that areeffective for older adultswith high health literacyare also effective for older adultswith low healthliteracy.Educatingpatients andproviding supportto change ormaintain adherence behaviours (e.g.telephone counselling) are potentially productiveinterventionstrategiestoimproveadherencerates.Another 7 reviews showed inconsistent resultsregarding the association between health literacyand adherence. Similarly, 6 reviews showedinconsistent results regarding the associationbetweeneducationallevelandadherence.Conclusions: Adherence interventions could beeffective for older adultswith low health literacy.Insufficientevidencewasavailabletoprovidesolidconclusionsonwhichtypeofinterventionwouldbemost suitable for this population, although ourresults indicate that interventions that aim toeducate patients and give additional support tochange or maintain adherence behaviour arepromising. No consistent associations betweenhealth literacy and adherence and betweeneducational level and adherence in older adultswerefound.Adherenceinterventionscouldbeusedtoimprovethehealthoutcomesofolderadultswith

low health literacy. However, as the evidence islimited,moreresearchisrequired.P32-ExploringEuropeanimmigranthealthliteracy:acriticalreviewMarkiaGoossensMarkiaGoossens1),Dr.KristineSorensen1)1MaastrichtUniversity,Maastricht,NetherlandsBackground:Healthliteracy(HL)isanincreasinglyimportant topic in public health and health caresystems,andreferstoone'sabilitytogainaccessto,understand and use information in ways whichpromote and maintain good health and meet thedemandsofhealthsystems.Immigrantpopulationsare particularly vulnerable to poor or inadequatehealth literacy and health disparities. Currenteffortsresponding to immigranthealth literacyarelacking.Littleresearchhasbeendone inEuropetoassess best practices related to health literacy inunder-representedimmigrantpopulations.Objectives: The main objective of this literaturereview is to evaluate the effects of low healthliteracy in immigrant populations. Additionalobjectives will be explored including: improvingimmigranthealth literacythroughbestpractices inEurope,investigatingtherelationshipbetweenpoorhealth literacyandhealth careutilizationand costand examining the current state of health literacyresearchinEurope.Methods:A literaturesearchwasperformedusingPubMed.The study inclusioncriteria isas follows:literature must be written in English, publishedfrom Canada, Europe or the United States, andgeneralizabletoimmigrantpopulations.Results: The literature search resulted in 698articleseligibleforscreening,ofthosetwentywereidentifiedaspotential sourcesand finally fourteenwere included. Immigrants often have significanthealthliteracydifficultiesthatarefurtherenhancedby communication barriers when accessing careand making sense of relevant health information.Immigrants are often unaware or misinformedabout available health care services, healthpromotion activities, early detection guidelines,correctuseofmedicationsandtreatmentstrategies,which can cause harmful effects. This vulnerablepopulation is faced with additional challengesincluding language and communication barriers.Immigrants are more likely to experiencemedication and treatment errors when accessingcare and the combination of poorer outcomes,increasedhealthcareutilizationandmedicalerrorscanbeveryburdensome to thehealthcaresystemimpactinghealthcarecostsonthewholesocietyLimitations: Potentiallymissed articles publishedinother languages.Theterm 'health literacy'isnot

as commonly used in Europe thereby missingpublications that failed to identify themselves ashealth literacyarticles.The conceptanddefinitionofhealthliteracyvarythroughouttheworld.Lastly,there isvery limitedresearch in the fieldofhealthliteracy in Europewhich is further reducedwhenresearching the health literacy of under-representedimmigrantpopulations.Implications: As Europe becomes increasinglydiverse the importance of focusing on the healthliteracy of immigrants has become more evident.Little research has been done to assess bestpractices related to immigrant health literacy,interventions for health promotion strategies orevaluation of their effectiveness in immigrantpopulations. Health care professionals, policy-makers and researchers must join forces toconcentrateonthehealth literacyof immigrants inEurope.Evidence-basedpracticesmustbeused tostandardize the quality of care provided toimmigrant populations. Increasing the healthliteracy of immigrants will allow for greaterautonomy with health care decisions, personalempowerment, improved quality of life, anddecreasedhealthcarecosts.P35-IshealthliteracyaddressedinthemedicaleducationofGeneralPractitioners?OanaR.GroeneMrs.OanaR.Groene1),ProfessorJaneWills1),ProfessorNicolaCrichton1),Dr.GillianRowlands2),Dr.RimaE.Rudd3)1LondonSouthBankUniversity,FacultyofHealthandSocialCare2King’sCollegeLondon3HarvardSchoolofPublicHealthIntroduction: A largeproportion ofpatientshavedifficultynavigatingthehealthsystemandstruggleunderstanding the complicated jargon used byhealth professionals both in oral and writtencommunication.Healthliteracystudieshavelargelyfocused on patients' individual skills but haveplaced little emphasis on the role of healthprofessionals in facilitating access to informationandultimately tohealthcare.GeneralPractitioners(GPs) play an important role as gatekeepers ofhealth care: 90% of medical encounters are withGPsandmorethan50%ofmedicalstudentschoosegeneralpracticewhenleavingmedicalschools.Thisresearch, part of a larger project to assess GPregistrars' self rated health literacy competencies,explores current approaches to health literacy inthe undergraduate and postgraduate medicaleducationcurriculumofGPsinLondon.Methods: Fourteen semi structured interviewswere conducted with stakeholders in generalpractice medical education. Data collection took

place between May and September 2012.Stakeholderswere identifiedusingpurposeful andsnowball sampling techniques based on theirinvolvement and experience in elaborating andimplementing key official curriculum documents.They included representatives of professionalassociations setting standards for undergraduateandGPpostgraduatemedicaleducationcurriculum,heads of curricula implementation in medicalschools, heads of communication skills modules,and GP program directors. The frameworkapproachwasused toanalyze theirunderstandingand awareness of health literacy and how it isaddressedinpractice.Results: The ability to access, process and filterinformation" was identified as one of the maindeterminants ofhealthalongwith socio-economic,environmental and cultural factors. Stakeholderswerealsoawareofthehealthliteracydemandsofacomplex healthcare system that is difficult tonavigate for people with low literacy skills. Yet,stakeholdersinmedicaleducationwerenotfamiliarwith the conceptof "health literacy"assuch.Theyunderlined the importance of the use of clearcommunicationtechniquesandstressedtheneedtoenhance medical students' positive attitudestowardspatient-centeredness.Mostofstakeholdersbelievedthatliteracyandhealthliteracymightonlybeindirectlyaddressedinthecurriculumundertheumbrellaof"clinicalcommunicationskills","holisticcare", and "patient-centred" care. Moreover, theywereunawareofanytoolstoassesspatients'healthliteracyorhealthliteracydemands.Conclusions:AsGPeducatorsarenotfamiliarwiththe concept of health literacy, it may not getaddressed in the curriculum.Whereas future GPsare trained in the use of certain clearcommunicationtechniques,it is likelythattheyareunawareof the impactofhealth literacyonhealthoutcomes. Conceptualizing some of the clearcommunication techniques and patient-centredapproaches under the concept of health literacycould increase both GPs' and GP educators'awareness and understanding of health literacyrelated barriers to care and potentially improvetheirskillsinaddressingtheminpractice.P36-TheVaccineLiteracyofHealthCareWorkersinTyrol,AustriaandAlberta,Canada:AComparisonandExchangeofKnowledgeLarynMcLernonMALarynMcLernon1),MADr.JuliaBernardi1)1ManagementCenterInnsbruck,InnsbruckAustriaBackground:Enhancingthepublic'sunderstandingofhealthinformationiscrucialinordertoimprove

vaccination coverage and disease prevention.Health careworkers (HCWs) can function as rolemodelsbyprovidingclearandaccurateinformationabout vaccines to their patients and communities.Research across the globehas revealed significantgaps in the vaccine-related knowledge of HCWs.Vaccine literacy extends beyond mere knowledgeaboutvaccines;italsoconcernsthedevelopmentofa system that minimizes the barriers associatedwith communicating about and accessingvaccination. In Alberta, Canada, concerted effortshavebeenmade in thepastdecade toenhance theimmunizationcompetenciesandvaccinationuptakeof HCWs. Since 2012 the Austrian Ministry ofHealth's strategies highlight the need to improvethe availability of information on thebenefits andrisks associated with vaccines and to raise theawareness about the importance of vaccines forHCWs. These strategies are in line with nationalhealth goals to provide health-promotingworkingconditions and enhance health literacy in thepopulation. However, due to insufficientimmunizationprograms coupledwith a significantnumber of vaccine critics, improving vaccinationcoverageinAustriaremainsachallenge.Thisstudycompares interventions in the regions of AlbertaandTyroldesigned to improve thevaccine-relatedknowledge of HCWs. Additionally, the researcherscollaboratedwiththePublicHealthAgencyofTyrolto create a survey to evaluate the knowledge,attitudesandpracticesofHCWstowardsvaccines.Methods:AdocumentanalysisofpoliciesaswellashealthinformationbrochuresrelatedtovaccinationforHCWswasperformedusingapre-definedsetofcriteria.Expertinterviewswereconductedinorderto obtain information about how the documentshavebeenputintopracticeandtorevealinnovativestrategies for increasing the vaccine literacy andimmunization uptake among HCWs. Thisinformationwas also used to design a survey foreachregion.Results: There is a broader range of well-established policies and customized educationaldocuments in Alberta than in Tyrol. The Albertagovernment has integrated a nationalmultidisciplinary framework for training HCWsabout vaccines along with a social marketingcampaign that utilizes twitter, interactive blogs aswell as intranet forums to connectHCWs and thegeneral public with vaccine experts and easy tounderstand information.Access to vaccines is freeforHCWsandhasbeen improvedbypeer topeerclinics and the introduction of pharmacists asvaccinators. In Tyrol, recent national policiesrelatedto increasingtheawarenessofHCWsaboutvaccineshaveyettobeputintopractice.Ashortageof educational brochures specifically targeted toHCWswasrevealed.Aconflictofinterestandlackoftrust has arisen asmost brochures are sponsored

by vaccine manufacturers. Accessing vaccines iscomplicatedandcostlyforHCWsinTyrol.Conclusion: This study provided a basis forknowledge exchange between decision makers inTyrol,Austria andAlberta, Canada. Findingswereused to inform the provincial and federalgovernments in Austria about improving vaccine-related communication forHCWs.The researcherscontinue to collaborate with the governments inboth regions to integrate a survey as a tool forassessment of HCWs' beliefs and behaviorsregarding vaccination as well as for evaluatingcurrentinterventions.P37-Comprehensibilityofhealthrelateddocumentsforolderadultswithdifferentlevelsofhealthliteracy:asystematicreviewRuthKoopsvan'tJagtMARuthKoopsvan'tJagt1),dr.JohnHoeks1),prof.dr.CarelJansen1),dr.AndreaF.deWinter2),prof.dr.MennoReijneveld2)1DepartmentofCommunicationandInformationSciences,FacultyofArts,UniversityofGroningen,Groningen,TheNetherlands.2DepartmentofHealthSciences,UniversityMedicalCenterGroningen,UniversityofGroningen,TheNetherlands.Introduction:Themainobjectiveofthisstudyistosystematically review the evidence on theeffectivenessofinterventionsaimingtoimprovethecomprehensibility of health related documents inolderadults,bymanipulatingfeaturesand formatsofthesedocuments.Methods: A systematic review was conducted.Seven databases (MEDLINE (1996 - ), PsycINFO(1887-),CINAHL,1982-),WebofKnowledge,TheCochrane Library, ERIC, 1966 - ) and theComprehensible Language and EffectiveCommunication (CLEC) database) were searched(time period: 01-01-2005 until 03-25-2013) andreferences in relevant reviews were checked.Search terms consisted of terms related to healthliteracy, to health related documents and tocomprehensibility. The selection procedure wasconducted by two independent reviewers. Dataextraction and quality assessment of 60 selectedstudies were conducted by one reviewer andcheckedforaccuracybyasecondreviewer.Results:37studiesofthe60selectedstudieshadastudypopulationofolderadultsormadeanexplicitcomparison between a younger and older studygroup.Theremaining23studies includedageas acovariate.Inthisarticle,wefocusonthe37studiesthat report specific results for (the subgroup of)older adults and thereby provide the most directevidence for our objective. Inconsistent evidencewas found about the importance of formats and

design features to enhance comprehensibility ofhealthrelateddocumentsforolderreaders.Onlyforhealthnarrativesandmultiple-featurerevisions,theincluded studies (n=2 and n=4, respectively)provide moderate evidence that they may beeffective in enhancing comprehensibility in olderadultswith limited levelsofhealth literacy.Healthnarratives refer to health related documents thatinclude narratives or apply narrative formats intheirmessages.Multiple-featurerevisionsarebasedon both textual design principles and linguisticfeatures(e.g.aiming tosimplify linguisticcontent).Studies on all other interventions in our reviewprovided inconsistent evidence of effectiveness.While all of these interventions may containelements that contribute to enhancedcomprehensibility in older adults, the largeheterogeneity of the studies, in terms of subjectmatter, research design, outcome measures andstudyparticipants,preventsconsistentconclusions.Conclusions: Using health narratives and/ ormultiple-feature revisions of health relateddocuments seems apromising strategy toenhancecomprehensibility of health related documents forolder adults. Overall, there is limited andinconsistent evidence about the effectiveness ofinterventions aiming to improve thecomprehensibility of health related documents inolderadults.Thisreviewshows that isessential togathermoredataonfeaturesandformatsofhealthrelated documents to increase theircomprehensibility in the targetpopulationofolderadults.P40-DevelopementoftheDutchTalkingTouchScreenQuestionnaireMarliesWelbieMSc.P.T.MarliesWelbie1),PhDAnitaCremers2),professor,PhD,MD,DTMHWalterDevillé3),PhDP.T.HarrietWittink1)1ResearchGroupLifestyleandHealth,FacultyofHealthcare,UtrechtUniversityofAppliedSciences,Utrecht,TheNetherlands2ResearchGroupCo-Design,FacultyofLifeSciencesandTechnology,UtrechtUniversityofAppliedSciences,Utrecht,TheNetherlands3UniversityofAmsterdam,AISSR(AmsterdamInstituteofSocialSciencesResearch),Amsterdam,theNetherlands&InternationalandMigrantHealth,NIVEL(NetherlandsInstituteforHealthServicesResearch),Utrecht,theNetherlandsIntroduction/context: In theNetherlands there isa strong call for transparency in health care.Therefore physical therapists are encouraged tomonitortheircareprocessesbyaskingtheirclientsto fillouthealthrelatedquestionnairesbeforeandaftertreatment.Aconsiderablegroupofclientsareunable to fill out such a questionnaire

independently. The main underlying problem ofDutchnativeaswellas immigrantclientsseems tobe their level of (health) literacy. American andChinese research shows that the use of a TalkingTouch Screen (TTS) increases the ability of low(health) literate clients to fill out questionnaires,eveniftheyhave limitedornocomputerskills.Forthis reason a Dutch/Turkish TTS Questionnaire(DTTSQ)wasdeveloped.Description of policy or practice innovation:Different from the development process of theAmericanandChineseTTS, aUserCentredDesignmethod was used. This involved an iterativedevelopment process inwhich (future) users andresearchers collaborated as equals. Tools andtechniques for co-creation/co-designhave enabledusers to take on the role of 'expert of theirexperiences'andbecomepartofthedesignteam.Inco-designing, the researchers took on the role offacilitators. User needs were discovered throughfocus groups. A prototypewas developed throughgenerativeprototypingandscenariobuilding.Evaluation/impact: Usability of the DTTSQ(n=102) was compared to the usability of aquestionnaire on paper with similar content(n=121).ThroughoutallliteracylevelsclientsweresignificantlybetterabletoindependentlyfillouttheDTTSQ.Additionalqualitative research shows thatclientsaresatisfiedwiththeusabilityoftheDTTSQandphysical therapistsare inclined to incorporatethisinnovationintotheirdailypractice.Discussion/implications: The prototype of theDTTSQ enhances the ability ofDutch and Turkishphysical therapy clientsacrossall (health) literacylevels to independently fill out a health relatedquestionnaire.P41-UsabilityandvalidityoftheDutchTalkingTouchScreenQuestionnaire;aqualitativestudyMarliesWelbieMSc.P.T.MarliesWelbie1),PhDP.T.HarrietWittink1),PhD,MD,DTMHWalterDevillé2)1ResearchGroupLifestyleandHealth,FacultyofHealthcare,UtrechtUniversityofAppliedSciences,Utrecht,TheNetherlands2UniversityofAmsterdam,AISSR(AmsterdamInstituteofSocialSciencesResearch),Amsterdam,theNetherlands&InternationalandMigrantHealth,NIVEL(NetherlandsInstituteforHealthServicesResearch),Utrecht,theNetherlandsIntroduction:The aim of the investigationwas toidentify potential problems with usability andvalidity of the Dutch Talking Touch ScreenQuestionnaire(DTTSQ),whichisbeingdevelopedinorder to enable low (health) literate clients tocomplete it independently. It comprises pain

intensity, pain location and limitations in dailyactivities. Neither reading or writing skills, norcomputer skills are needed to fill out thisquestionnaire.Asnogoldstandardwasavailabletoaddress the issue of validation, we used aqualitativeapproach.Methods: The Three Step Test Interview (TSTI)method containing think aloud and cognitivedebriefing techniqueswas used. Thirty-two DutchphysicaltherapyclientswithvariouseducationandliteracylevelsfilledouttheDTTSQ.Results: Almost all respondents were able tocomplete the questionnaire independently. A fewlow educated respondentshad trouble finding theright button to navigate through the application.The introduction and instruction videos are toolong,buttheconceptofinstructionvideosishighlyappreciated as was the use of a touch screen.Overall respondents were positive about theusability of this questionnaire. Prioritizing dailyactivitieswasdifficultand ledto invalidresponses.TherespondentsstatedtheywereabletoreflectontheirhealthproblemsthroughtheDTTSQ.Conclusions: The usability of the DTTSQ iscurrently sufficient. It could be even better byenhancing the user interface by shortening andsimplifying the instruction videos, improving thevisibility of the navigation buttons, showing allselectable daily activities in one screen andimproving the instruction concerning prioritizingdaily activities. Enhanced user interfacemay alsosolvetheproblemswithvalidity.P47-Identifyingbarriersandfacilitatorstopeople'sabilitytoobtainhealthinformation,andthedevelopmentandevaluationofawebportaltoimprovehealthliteracyAstridAustvoll-DahlgrenDrAstridAustvoll-Dahlgren1),ProfSølviHelseth2),ProfArildBjørndal3)1NorwegianKnowledgeCenterfortheHealthServices2OsloandAkershusUniversityCollege3RBUPBackground:Contemporaryhealthcareiscomplex.For users, participation in decisionmaking is notonlydependentonaccess tovalid information,butalsoon theability to interpret,understandandactupon such information. These arewhat are oftenreferredtoashealth literacyskills.Presently,mostinterventionshavebeendeveloped to improve thefunctional literacyofpatients.Butadvicebasedonreviewsofthehealthliteracyliteratureandstudiesofconceptualdevelopmenthaveextendedthisfocusto include recommendations about the

development of initiatives that target critical andinteractiveskills.Aim: To improve people's health literacy skillsrelated toobtaininghealth information throughanintervention to target key identified barriers andfacilitators,andtoevaluatethiseffortMethods: The project used a mixed methodsapproach including qualitative focus groups, aquestionnairestudyandsystematicsearchesoftheresearch literature for identifying barriers andfacilitators to obtaininghealth information. Awebportalwasdeveloped in the contextual frameworkof evidence based practice and shared decisionmaking,targetingspecificdomainsofhealthliteracybasedonthemodelbyZarcadoolasandcolleagues.Thefinalphaseoftheprojectincludedanevaluationof the web portal in a pragmatic randomizedcontrolledtrial.Thepurposeofthiswastoevaluatetheeffectsofthewebportalinterventioncomparedtonointerventioninareallifesetting.Results: Three main barriers to obtaining healthinformation was identified; 1. the inability tounderstand and critically appraise healthinformation; 2. the inability to exchangeinformationinconsultations,3.notknowingwhereto find reliableand relevant information.Ourwebportal was therefore tailored to address thesebarriers. The contentwas presented inways thatencourageduserstoadoptanactiveroleindecisionmakingandencouraged them tosee thatdecisionsabout healthcare should be informed by the bestavailable, current, valid, and relevant evidence.Central to the design of the structure of thewebportalwerethreesetsoftools,eachpresentedinaneasilyaccessibleandlogicallystructuredway.Conclusion: Theweb portal is freely available tothe public at no cost and provides access toevidence based practical tools for enablinginformeddecisionmaking.P48-NewEuropeanChallenges:HealthLiteracyInterventioninDiverseCommunitiesPilarBasprofessorPilarBas1),professorMartinaFernandez1),PhDstudentMiriamPoza1),PhDstudentNoeliaPelicano1),PatriciaRuiz2)1FacultyofNursing.UniversityofCádiz.Spain2SpanishRedCrossInmigrantShelterIntroduction: Immigration in the EU is central tothepublicandpoliticaldebate inEurope,receivingmoreattentioninrecentyears,especiallyinrelationto immigration from the southern border. Thethirty-ninemillionregisteredimmigrantsrepresentabouteightpercentof theEUpopulation towhichmust be added the irregular influx. The Strait ofGibraltar represents the gateway of immigration

fromAfrica to Europe and thus represents a geo-strategiclocationtoconsider.Thelackofnationalresponsestoaddresstheneedsofhealthservicedeliverytothegrowingdiversityofpopulation, communityculturalcompetencedeficitand difficulties inherent in the immigrant status(the way the migration process itself develops,languagebarrier,socio-culturalexclusionsituationsand low health literacy) influencing thedeterioration of their welfare and act asdeterminantsofhealthfactors.In this regard, theHealthLiteracy is abasic socialdeterminant ofhealth to enhance anddevelop theempowerment of disadvantaged populations. Itinfluences, among others, the availability and theabilitytomanagehealthinformationeffectively,thelevelandqualityofself-care,therapeuticadherenceand, ultimately, the general health status.Under the European Equi-Health project (whichaimstostrengthenthecapacityofgovernmentsandpublic sector actors to provide quality services inhealth and social care), the National PROCOMDIproject (aimed at designing learning paths andaction to improve the competence of providers ofpublic services) and in line with the priority inhealth (Health Literacy) by the EuropeanCommission, thisstudyaims todevelop aprogramof community intervention on Health Literacy,culturally competent, based on scientific evidenceand identified needs, to improve access andutilization of health services in the Strait ofGibraltar. This project has-been funded by theAndalusianRegionalMinistryofImmigrationPolicy.Design. Methods: Mixed design investigationconfigured in threephases: firstand secondphaseofqualitativedesignusingfocusgroupsandexpertconsensus, respectively, and third phase of quasi-experimental designwith one group and pre andposttestmeasures.Preliminary results of first andsecondphasearepresented.Conclusions: The analysis of discourse denotes alimited Health Literacy in all participating groups(wherethelengthofstayinthecountryisadecisivefactor) and highlights the multidimensionality oftheconcept.Themaindifficultiesof the immigrantpopulationinaccesstoservicesare:misinformationabouttheirrights,languageandculturaldifficulties,inadequate health system to their socioeconomicconditions and the use of different ways ofaddressing the symptom.Theeffectivenessofnewmethodological strategies for the development ofproposals for intervention based on action-participationisshown.Keywordsd:HealthLiteracy,Intervention,MigrantPopulation, Empowerment, Health Promotion,SocialDeterminantofHealth,PublicHealth.

P49-HealthliteracyanalysisincitizensseekinghealtheducationinGalicia(Spain)MariaFalconMariaFalcon1),ElisaBorrego2),MercedesCarrera3),CeciliaPenacoba4),MaCarmenEcija4),MariaRuiz4),AurelioLuna-Ruizcabello1),CarmenGallardo4)1UniversityofMurcia2MSDSpain3ServicioGallegoDeSaludAffiliation4UniversidadReyJuanCarlosIIntroduction: The Galician Health School forCitizens, is a public institution focused on healtheducation initiatives to help patients, families andcitizens tomake soundhealthdecisions.Analyzinghealthliteracyintheirpopulationisakeypointformeasuring theeffectivenessof theirprograms.TheEuropean Health Literacy questionnaire is a newtool designed to assess health literacy in a broadway, integrating perceived difficultieswith healthinformation in thedomainsofhealth care,diseaseprevention and health promotion, in terms ofaccessing, understanding, appraising and applyingrelevanthealth information.Theaimsof thisstudywere to analyze health literacy in a sample of apopulation seeking health education in Galicia(Spain).Hopefully,thiswillcontributetodesigningmore effective health education initiatives that fitthepopulation'sneedsandexpectations.Methods: The HLS-E-47 questionnaire wasadministered face-to-face in a sample of 257Spanishadultsseekinghealtheducationworkshopsin Galicia in July 2013. Additionally,sociodemographicdataandperceivedimprovementin addressing health problems after attending theworkshopswerecollected.Results:Healthliteracylevelsinthispopulationaresimilar to those reported in thenational (Spanish)results from theEuropeanHealthLiteracy Survey,although they vary according to the competenceand health domain addressed. Women and thosewith lower levels of formal education show thepoorest levels of health literacy but, surprisingly,we found no relationship between age and healthliteracyscores.Ofnotewasthefactthatthesamplescored higher in the health care and diseasepreventiondomains,andintheirunderstandingandapplicationofhealth information than thenationalaverageobtained inSpain for theEuropeanHealthLiteracySurvey.Thiswasespeciallytrueinthecaseof those citizenswhohadparticipated inpreviousworkshops. Most of the participants enrolled onthese courses because they have chronic diseasesandmainlywish to improve their knowledge andskills tomanage their problem.When the samplewas asked if they thought that theworkshop hadimproved their skills and capabilities to managetheirhealthstatus,75%oftheanswered"yes".This

confirms the validity and successful nature of theprograms directed at patients, although there isroom for improvement in the health promotionarea,whichhadthelowestscores.Conclusions: Most of the participants concludedthat theyhad improved theirknowledgeandskillsto manage their problem. The results of HealthLiteracyanalysesmustbetaken intoaccountwhenformulatinghealth literacypolicies. It isnecessarytoaddressagivenpopulation'sneedstodesignandimplementhealth educationprograms to focus onremoving the gaps that prevent people fromimproving their health. This studywas funded byMSDSpain.P50-Effectivecommunicationwithpatientswithlimitedhealthliteracyandmigrantbackground.HealthcareprofessionalsneedtoadjusttheircommunicationandusemorevisualmaterialsMariekeStopelMariekeStopel1)1Pharos,Utrecht,NetherlandsIntroduction:Patientswith limitedhealth literacyandmanyfirstgenerationmigrantshavedifficultiesinobtaininghealth informationandunderstandingand applying it correctly. They have problemsunderstanding healthcare professionals and tocorrectly followup theiradviceor instructions fortreatment.Thereforetheyareatgreaterriskofpoorhealth outcomes. To tackle this communicationproblem, healthcare professionals should adjusttheir communication and are encouraged to usevisualmaterialssupportingtheconsult.Methods: At Pharos, we develop and conducttraining programs for healthcare professionals ineffectivecommunicationwithpatientswith limitedhealth literacy andmigrantswho have difficultiesunderstandingDutch.Theylearntoavoidjargon,touse"teachback"methods,toencouragepatientstoask questions, to pay attention to culturaldifferencesandtousevisualmaterials.Inaddition,Pharosdevelopsunderstandablevisualhealth informationmaterials in participationwiththetargetgroups.First, we analyze among healthcare professionalswhich information is essential to communicate topatients. Second, we ask patients with limitedhealth literacy andmigrant background how theyperceivetheexistingmaterials;theillustrationsandtext. Based on these analyses we adjust existingmaterials or develop new simplified illustrationssupportedbyafewwrittensentences.Theadjustedandnewmaterialsareextensivelypretestedamongthetargetgroupsandhealthcareprofessionals.

Results: The use of these newly developed visualmaterials and elaborated competencies of theprofessional lead to better understanding amongpatientsoftheirdiagnosisandsuggestedtreatmentbytheirdoctor.Professionalsnotethatbyusingthesimplifiedinformation,patientsaskmorequestions,showmoreunderstanding,andaremoreinterestedin their disease and cure.P51-Individualizedhealthcommunicationatthedentalclinic-ArandomizedcontrolledtrialLindaSteinLindaStein1),MaudBergdahl1),KjellSverrePettersen2),JanBergdahl1)1DepartmentofClinicalDentistry,FacultyofHealthSciences,UiTTheArcticUniversityofNorway,Tromsø,Norway2DepartmentofHealth,NutritionandManagement,OsloandAkershusUniversityCollegeofAppliedSciences,Lillestrøm,NorwayIntroduction: The encounter with a dentist or adental hygienist is an opportunity for patients toreceive individualized oral health information,guidance, and learn skills for oralhealth self-care.However, lowhealth literacy inpatientsmaybe abarrier to successful communication betweenpatientsanddentalhealthprofessionals.Theaimofthe study was to investigate if communicationadapted to patients’ health literacy levels mayimprove patients’ oral hygiene, inspired byNutbeams(2008)modelofhealth literacyasariskfactor.Methods:130adults(meanage48years)fromthewaiting listattheUniversityDentalClinic,Tromsø,Norway participated in the study. Health literacylevel was assessed by using the Adult HealthLiteracy Instrument for Dentistry (AHLID). Oralhygiene was measured clinically by utilizingstandardized international indexes for dentalplaque and gingival bleeding. Demographicvariableswere collected using a self-administeredquestionnaire.Participantswererandomlyassignedto intervention or control group.The interventiongroupgotindividualizedcommunicationadaptedtotheir health literacy levels. The control group gotstandardinformationaccordingtowhatiscommonin generaldentalpractice today.Afterminimum 6months patients’ oral hygiene was measuredclinically once again. The person doing the allclinicalmeasurementswasblindtopatients’healthliteracy levels.Paired-sample t-testwasapplied todeterminedifferencesindentalplaqueandgingivalbleeding from clinical measurements at baselineandrecall.Results:Therewasasignificantdecrease indentalplaque from baseline to recall after 6months for

both patients in the intervention group (p<0.001)and in the control group (p<0.05). A significantdecrease in gingival bleeding (p<0.001) was alsoseen in the intervention group, and aminor non-significantdecreaseinthecontrolgroup.Conclusion: Individualized health communicationadapted topatients’health literacy levelsseems topositivelyaffectoralhygieneinpatientsovertime.

Author’sindex(Firstauthorsprintedinbold)AmilBujan,Paloma....................................................P05Aringazina,Altyn.........................................................P08Austvoll-Dahlgren,Astrid...............................P21,P47Bach,Janni....................................................................O-21Bakx,JorienC.H..........................................................O-18Baron-Epel,Orna........................................................O-16Bas,Pilar.........................................................................P48Bauer,Ullrich................................................................P09Bergdahl,Jan..................................................................P51Bergdahl,Maud.............................................................P51Bernardi,Julia................................................................P36Berry,Jonathan...........................................................O-20Bittlingmayer,UweH......................................O-09,P09Bitzer,Eva-Maria..............................................O-09,P09Bjørndal,Arild...............................................................P47Bo,Anne........................................................................O-02Bonde,Anders...............................................................P22Bonde,AneHøstgaard...............................................P12Borrego,Elisa.................................................................P49Brabers,Anne..............................................................O-01Brainard,Julii.................................................................P30Brand,Helmut..............................................................O-15Brouker,Stephan........................................................O-15Bruselius-Jensen,Maria..............................................P12Carrera,Mercedes........................................................P49Castro-Sánchez,Enrique.........................................O-23Chang,Peter................................................................O-15Chiu,Ya-wen.................................................................O-15Correia,Faustino..........................................................P16Cremers,Anita...............................................................P40Crichton,Nicola.............................................................P35Csizmadia,Peter..........................................................O-07Dalma,Archontoula...................................................O-07deBroucker,Gatien....................................................P01deJong,Judith..............................................................O-01deWinter,AndreaF...................O-07,O-08,P30,P37deWit,Liesbeth.........................................................O-07Dekker,Evelien...........................................................O-19Devillé,Walter.....................................................P40,P41Dorgelo,Annemiek.....................................................O-18Doyle,Gerardine...............................................O-03,P28Droomers,Mariël........................................................O-04Dyrehave,Charlotte....................................................P16Ecija,MaCarmen..........................................................P49Edwards,Michelle.............................................P25,P26Ehlers,Lars.....................................................................P18Elchayani,Asher..........................................................O-16Ernstmann,Nicole........................................................P23Essink-Bot,Marie-Louise...............................O-19,P15Falcon,Maria.................................................................P49Fernandez,Martina......................................................P48Finbråten,HanneSøberg..........................................P02Fransen,Mirjam.....................................O-19,P15,P24Friis,Karina..................................................................O-02Fullam,James.....................................................O-03,P28Gallardo,Carmen..........................................................P49

GarciaCodina,Oriol....................................................P05Geboers,Bas..................................................................P30Gibney,Sarah....................................................O-03,P28GonzálezMestre,Assumpció..................................P05Goossens,Markia.........................................................P32Groene,OanaR.............................................................P35Guttersrud,Øystein......................................................P02HOsborne,Richard....................................................O-02Hejlesen,Ole...................................................................P18Helseth,Sølvi..................................................................P47Hendriks,Michelle......................................................O-01Himmelsbach,Ines.......................................................P29Hoeks,John.....................................................................P37HulvejRod,Morten...................................................O-21Hutter,Inge...................................................................O-07Hæsum,LisaKorsbakkeEmtekær.........................P18HøjbergJohansen,Helene........................................O-21Jansen,Carel.......................................................O-08,P37Jordan,Susanne............................................................P03JuvinyàCanals,Dolors.................................................P05Jørgensen,MarieBirk................................................O-21Kamtsiuris,Panagiotis................................................P03Karnaki,Pania..............................................................O-07Kobayashi,Lindsay...................................................O-14Konopik,Nadine...........................................................P29Koopsvan'tJagt,Ruth................................................P37Koot,Jaap.......................................................................O-08Kowalski,Christoph.....................................................P23Kragballe,Knud..........................................................O-10Landsman,Jeanet........................................................O-08Larsen,AnneKonring..............................................O-21LedesmaCastelltort,Albert.......................................P05Lee,Fung-LingFelicia................................................O-15Levin-Zamir,Diane....................................................O-16Loke,Yoon.......................................................................P30Lomborg,Kirsten........................................................O-10Luna-Ruizcabello,Aurelio..........................................P49Lytsy,Per.......................................................................O-12Laan,Eva........................................................................O-19Mauz,Elvira....................................................................P03McCarthy,Suzanne.......................................................P19McLernon,Laryn..........................................................P36MedinaBustos,Antonia..............................................P05Mehlsen,Mimi................................................................P22Meijering,Louise.........................................................O-07Mendes,Delfim..............................................................P16Mensing,Monika........................................................O-17Messer,Melanie...........................................................O-13Mårtensson,Lena........................................................O-12Nielsen,BeritKjærside.............................................P22Nijman,Jessica.............................................................O-01Nordström,Gun.............................................................P02Novoszath,Agnes........................................................O-07Nsangi,Allen...................................................................P21Oswald,Frank................................................................P29Oxman,Andy..................................................................P21Pelicano,Noelia.............................................................P48Pelikan,Jürgen.............................................................O-15Penacoba,Cecilia...........................................................P49

Peters,Ron......................................................................P15Pettersen,KjellSverre..........................O-05,P02,P51Pfaff,Holger....................................................................P23Pinheiro,Paulo.............................................................P09Pinington,Gavin............................................................P19Poza,Miriam...................................................................P48Protheroe,Joanne.............................................O-20,P07Quenzel,Gudrun........................................................O-13Rademakers,Jany.................................O-01,O-04,P24Rasmussen,Dlama.......................................................P16Rasmussen,GitteSusanne......................................O-10Rattay,Petra...................................................................P03Reijneveld,Menno........................................................P37Reijneveld,SijmenA.......................................O-08,P30Ringsberg,KarinC........................................................P11Rodkjaer,Lotte..............................................................P16RosenkildeLaursen,Karin.......................................P07Rowlands,Gillian...................................O-20,P07,P35Rudd,RimaE..................................................................P35Ruiz,Maria......................................................................P49Ruiz,Patricia..................................................................P48Rösel,Regina..................................................................P29S.Wolf,Michael.............................................................P07Saboga-Nunes,Luis...........................................P06,P13Sahm,LauraJ................................................................P19Salter,Charlotte................................................O-07,P30SaltóCerezuela,Esteve...............................................P05Schaeffer,Doris...........................................................O-13Schmidt,Anna..............................................................P23Schuit,Jantine................................................................P24Silén,Charlotte..............................................................P11Slonska,Zofia..............................................................O-22Sorensen,Kristine..................................O-15,P06,P32Spreeuwenberg,Peter..............................................O-04Stein,Linda....................................................................P51Stopel,Marieke.............................................................P50Sykes,Susie..................................................................O-11Terkildsen,Helle.............................................O-02,O-10Tijhuis,Karlijn.............................................................O-18Timmermans,Daniëlle..............................................O-19Trollvik,Anne.....................................................P02,P11Uiters,Ellen............................................O-04,O-19,P24vanderHeide,Iris...........................................O-04,P24Vervoordeldonk,Janine............................................O-18Vogt,Dominique.........................................................O-13vonWagner,Christian..............................................O-14Wang,Jen.......................................................................O-04Wardle,Jane.................................................................O-14Wejse,Christian............................................................P16Welbie,Marlies...................................................P40,P41Westerling,Ragnar.....................................................O-12Wilde-Larson,Bodil.....................................................P02Williams,Aelwyn...............................................P25,P26Wills,Jane........................................................................P35Wittink,Harriet...................................................P40,P41Wångdahl,Josefin......................................................O-12Zachariae,Robert.........................................................P22