BACKGROUND: Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. DATA SOURCES: Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peerreviewed original research articles published until 31 March 2018. METHODS: Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. RESULTS: The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. DISCUSSION: Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance-vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy. . formulated the research questions and defined the search terms. L.M. carried out the electronic searches. L.M. and A.L.C. carried out the search process, the methodological assessment, and the extraction of studies information. L.M. carried out the meta-analysis. All authors were involved in writing and reviewing the final manuscript. Compliance with Ethical Standards:Not applicable.

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The Covid-19 physical distancing measures had a detrimental effect on adolescents' mental health. Adolescents worldwide alleviated the negative experiences of social distancing by spending more time on digital devices. Through a systematic literature search in eight academic databases (including Eric, Proquest Sociology, Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, Pubmed, and Web of Science), the present systematic review and meta-analysis first summarized the existing evidence from 30 studies, published up to September 2021, on the link between mental health and digital media use in adolescents during Covid-19. Digital media use measures included social media, screen time, and digital media addiction. Mental health measures were grouped into conceptually similar dimensions, such as well-being, ill-being, social well-being, lifestyle habits, and Covid-19-related stress. Results showed that, although most studies reported a positive association between ill-being and social media use (r = 0.171, p = 0.011) and ill-being and media addiction (r = 0.434, p = 0.024), not all types of digital media use had adverse consequences on adolescents' mental health. In particular, one-to-one communication, self-disclosure in the context of mutual online friendship, as well as positive and funny online experiences mitigated feelings of loneliness and stress. Hence, these positive aspects of online activities should be promoted. At the same time, awareness of the detrimental effects of addictive digital media use should be raised: That would include making adolescents more aware of adverse mechanisms such as social comparison, fear of missing out, and exposure to negative contents, which were more likely to happen during social isolation and confinement due to the pandemic.

When the antecedents of health-promoting behavior are explored, the concept of health literacy is deemed a factor of major influence. Originally defined as reading, writing and numeracy skills in the health domain, health literacy is now considered a multidimensional concept. The ongoing discussion on health literacy reveals that no agreement exists about which dimensions to include in the concept. To contribute to the development of a consistent and parsimonious concept of health literacy, we conducted a critical review of concepts in other literacy domains. Our review was guided by two research questions: (i) Which dimensions are included in the concepts of other literacy domains? (ii) How can health literacy research profit from other literacy domains? Based on articles collected from PubMed, PsycINFO, Communication & Mass Media Complete, CINAHL, SAGE Full-Text Collection, Cochrane Library and Google Scholar as well as selected monographs and editions, we identified seven distinct dimensions. Some of the dimensions recur across all reviewed literacy domains and first attempts have been made to operationalize the dimensions. Expanding upon these dimensions, the paper discusses how they can prove useful for elaborating a consistent and parsimonious concept of health literacy and foster the development of a more holistic measure.

BackgroundChronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective.ObjectiveThis study aims to assess the impact of interactive sections of an Internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes.MethodsA total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the Internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden.ResultsAll patients completed the study. Overall, the intervention had a moderate effect (F 1.52=2.83, P=.03, η2=0.30, d=0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment: mean difference=+1.2, P=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=−1.5, P=.04, d=0.28; final assessment: mean difference=−1.6, P=.03, d=−0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups.ConclusionsResults suggest that interactive sections as part of Internet-based interventions can positively alter patients’ feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed.Trial RegistrationClinicalTrials.gov: NCT02114788; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR).