We validated a brief and simple instrument and estimated the prevalence of limited health literacy in the literate Portuguese population at roughly three out of four people.

No abstract

Objective To explore the perceptions of the constraining and facilitating factors to patient‐centered communication in clinical encounters of patients with type 2 diabetes and the providers involved in their care. Data Sources/Study Setting Patients (n = 12) and providers (n = 33) involved in diabetes care in northern Portugal. Study Design Seven focus groups. Data Collection/Extraction Methods Grounded theory, using open, axial, and selective coding. Principal Findings Patients focused on the patient‐provider relationship, while providers emphasized the constraining factors when exchanging information and the facilitating factors regarding disease and treatment‐related behavior. Patients and providers both agreed on some constraints (power imbalance, avoidance of criticism, disease minimization, use of jargon, and insufficient competencies and consistency among providers) and facilitators (seeing patients as persons, providing tailored information in plain language, and recognizing the “wake‐up call”). Patients perceived an aggressive attitude as a barrier to communication, but providers perceived it as a facilitator. Patients included issues related to trust, respect, and psychosocial support as important factors to them. Only providers mentioned the influence of macro‐level interventions and patients’ socioeconomic position as essential factors. Conclusions Improvements in patient‐centered communication depend on fostering the patient‐provider relationship, patients’ participation and involvement, and training providers’ communication skills.

No abstract

The 'Patient Activation Measure 13' is now available in European Portuguese and has good psychometric properties.

Resultados: Os sites eram maioritariamente comerciais (49,5%), com parte do site dedicado a enfarte agudo do miocárdio/ acidente vascular cerebral (94,2%), com informações exclusivamente sobre factos médicos (59,5%) e apresentavam imagens, vídeos e animações para além do texto (60,3%). A confiabilidade dos sites foi baixa. Nenhum dos sites exibiu o selo da Health on the Net Foundation. Os sites de enfarte agudo do miocárdio/ acidente vascular cerebral diferiram na cobertura da informação. A validade da informação foi aceitável embora frequentemente incompleta. Conclusão: A qualidade da informação sobre enfarte agudo do miocárdio/ acidente vascular cerebral nos sites portugueses foi aceitável. A confiabilidade foi baixa o que pode comprometer a capacidade dos utilizadores em identificar conteúdos potencialmente mais credíveis. Palavras-chave: Enfarte do Miocárdio; Acidente Vascular Cerebral; Internet, Educação para a Saúde. ABSTRACTIntroduction: The quality of health information in the Internet may be low. This is a concerning issue in cardiovascular diseases which warrant patient self-management. We aimed to assess the quality of Portuguese websites as a source of health information on acute myocardial infarction and stroke. Material and Methods: We used the search terms 'enfarte miocardio' and 'acidente vascular cerebral' (Portuguese terms for myocardial infarction and stroke) on Google ® , on April 5th and 7th 2011, respectively, using Internet Explorer ® . The first 200 URL retrieved in each search were independently visited and Portuguese websites in Portuguese language were selected. We analysed and classified 121 websites for structural characteristics, information coverage and accuracy of the web pages with items defined a priori, trustworthiness in general according to the Health on the Net Foundation and regarding treatments using the DISCERN instrument (48 websites). Results: Websites were most frequently commercial (49.5%), not exclusively dedicated to acute myocardial infarction/ stroke (94.2%), and with information on medical facts (59.5%), using images, video or animation (60.3%). Websites' trustworthiness was low. None of the websites displayed the Health on the Net Foundation seal. Acute myocardial infarction/ stroke websites differed in information coverage but the accuracy of the information was acceptable, although often incomplete. Conclusion:The quality of information on acute myocardial infarction/ stroke in Portuguese websites was acceptable. Trustworthiness was low, impairing users' capability of identifying potentially more reliable content.

suggest that the Portuguese version of the Newest Vital Sign (NVS) should not be used to assess older adults in clinical practice because of a floor effect. We disagree. A floor effect is a problem when the performance on the test does not reflect the true performance in the domain being assessed.1 This is not the case here. We are not classifying older people incorrectly by using the NVS. Another study using a different health literacy instrument, one that asks people questions about their perceived difficulty performing health-related tasks, has also documented a very high proportion of limited health literacy in the older Portuguese population. 2In addition, it is also not the case that the educational level of the population used to validate the instrument was very different from that of the Portuguese population. The subgroup of 101 people from the general population in our study included 30.7% of participants with less than five years of schooling (the oldest of whom was 86 years old). This figure is close to schooling estimates from the Portuguese population near the time the study was conducted.3 Furthermore, when we compared this subgroup with the other more literate groups (physicians, health researchers, engineering researchers) we were not testing divergent validity (i.e. assessing whether constructs that are not supposed to be related are actually unrelated) but known-groups validity, which relies on administering the instrument to different groups that logically should have different levels of the construct to confirm whether the hypothesised difference was reflected in the scores of the groups. 4 We do agree with the authors in that the NVS should not be used as a proxy for poor health outcomes or poor medication self-management capacity. Concerning outcomes, the NVS can and has been used successfully to study the association between health literacy and health outcomes in studies that included older persons, but as a determinant and not as a proxy.5 Moreover, the study by Schillinger et al 6 cited by the authors to illustrate this point used the short version of the TOFHLA, 7 an instrument composed of two short cloze passages (an exercise where key words are deleted from a text and respondents are asked to fill in the blanks) and four very easy numeracy questions, which is quite unlike the NVS, as findings from studies using both the instruments can confirm. 8,9 Regarding self-management capacity, we also agree that it should not be used alone in samples with very low expected health literacy. If it is important to assess the numeracy component of health literacy (to assess skills related to timing, scheduling, and dosing of medications as well as numeric concepts needed to understand and act upon directions and recommendations, such as in the assessment of risk perception of an intervention) 10 in elderly samples, the NVS could be used in combination with another very brief instrument such as the Medical Term Recognition Test (METER), which has not displayed a floor effect.11 Nevertheless we argu...

Searching for health information is one of the most popular activities on the web. In this domain, users often misspell or lack knowledge of the proper medical terms to use in queries. To overcome these difficulties and attempt to retrieve higher-quality content, we developed a query suggestion system that provides alternative queries combining the Portuguese or English language with lay or medico-scientific terminology. Here we evaluate this system's impact on the medical accuracy of the knowledge acquired during the search. Evaluation shows that simply providing these suggestions contributes to reduce the quantity of incorrect content. This indicates that even when suggestions are not clicked, they are useful either for subsequent queries' formulation or for interpreting search results. Clicking on suggestions, regardless of type, leads to answers with more correct content. An analysis by type of suggestion and user characteristics showed that the benefits of certain languages and terminologies are more perceptible in users with certain levels of English proficiency and health literacy. This suggests a personalization of this suggestion system toward these characteristics. Overall, the effect of language is more preponderant than the effect of terminology. Clicks on English suggestions are clearly preferable to clicks on Portuguese ones.