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      The role of primary care in informing and supporting people with limited health literacy in the Netherlands during the COVID-19 pandemic: a qualitative interview study

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          Abstract

          Background

          During the coronavirus disease 2019 (COVID-19) pandemic, people have been confronted with a large amount of information about the virus and the governmental measures against its spreading. However, more than a quarter of individuals have limited health literacy (HL), meaning that they have difficulty finding, understanding, and applying health information. The purpose of this interview study was to investigate how individuals with limited HL acquire information about COVID-19 and governmental measures, what difficulties they experience in understanding and applying it, and what may be needed to overcome these difficulties. We also addressed other problems that they might face as a result of the pandemic. Using our findings, we aimed to make recommendations on the possible role of primary care in informing and supporting patients with limited HL during the pandemic.

          Methods

          Between June and October 2020, 28 individuals with limited HL were interviewed by phone (age range 20–84). The interviews were semi-structured and focused on the first months of the pandemic in the Netherlands (March/April/May 2020).

          Results

          The participants generally found COVID-19-related information abundant and complicated, and sometimes contradictory. Information provision by their own health care professionals was highly appreciated, especially in the context of chronic illnesses. General health care problems resulting from COVID-19 measures were postponement of regular care and difficulty with digital contacts.

          Conclusions

          Individuals with limited HL may benefit from provision of COVID-19-related information and support by their own health care providers. This applies in particular to patients with chronic illnesses. Primary care professionals are in the ideal position to take this role.

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          Most cited references25

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          The Discovery of Grounded Theory

          <p>Most writing on sociological method has been concerned with how accurate facts can be obtained and how theory can thereby be more rigorously tested. In The Discovery of Grounded Theory, Barney Glaser and Anselm Strauss address the equally Important enterprise of how the discovery of theory from data--systematically obtained and analyzed in social research--can be furthered. The discovery of theory from data--grounded theory--is a major task confronting sociology, for such a theory fits empirical situations, and is understandable to sociologists and laymen alike. Most important, it provides relevant predictions, explanations, interpretations, and applications.</p><p>In Part I of the book, Generation Theory by Comparative Analysis, the authors present a strategy whereby sociologists can facilitate the discovery of grounded theory, both substantive and formal. This strategy involves the systematic choice and study of several comparison groups. In Part II, The Flexible Use of Data, the generation of theory from qualitative, especially documentary, and quantitative data Is considered. In Part III, Implications of Grounded Theory, Glaser and Strauss examine the credibility of grounded theory.</p><p>The Discovery of Grounded Theory is directed toward improving social scientists' capacity for generating theory that will be relevant to their research. While aimed primarily at sociologists, it will be useful to anyone Interested In studying social phenomena--political, educational, economic, industrial-- especially If their studies are based on qualitative data.</p></p>
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            Health literacy and public health: A systematic review and integration of definitions and models

            Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.
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              How to fight an infodemic

              WHO's newly launched platform aims to combat misinformation around COVID-19. John Zarocostas reports from Geneva. WHO is leading the effort to slow the spread of the 2019 coronavirus disease (COVID-19) outbreak. But a global epidemic of misinformation—spreading rapidly through social media platforms and other outlets—poses a serious problem for public health. “We’re not just fighting an epidemic; we’re fighting an infodemic”, said WHO Director-General Tedros Adhanom Ghebreyesus at the Munich Security Conference on Feb 15. Immediately after COVID-19 was declared a Public Health Emergency of International Concern, WHO's risk communication team launched a new information platform called WHO Information Network for Epidemics (EPI-WIN), with the aim of using a series of amplifiers to share tailored information with specific target groups. Sylvie Briand, director of Infectious Hazards Management at WHO's Health Emergencies Programme and architect of WHO's strategy to counter the infodemic risk, told The Lancet, “We know that every outbreak will be accompanied by a kind of tsunami of information, but also within this information you always have misinformation, rumours, etc. We know that even in the Middle Ages there was this phenomenon”. “But the difference now with social media is that this phenomenon is amplified, it goes faster and further, like the viruses that travel with people and go faster and further. So it is a new challenge, and the challenge is the [timing] because you need to be faster if you want to fill the void…What is at stake during an outbreak is making sure people will do the right thing to control the disease or to mitigate its impact. So it is not only information to make sure people are informed; it is also making sure people are informed to act appropriately.” About 20 staff and some consultants are involved in WHO's communications teams globally, at any given time. This includes social media personnel at each of WHO's six regional offices, risk communications consultants, and WHO communications officers. Aleksandra Kuzmanovic, social media manager with WHO's department of communications, told The Lancet that “fighting infodemics and misinformation is a joint effort between our technical risk communications [team] and colleagues who are working on the EPI-WIN platform, where they communicate with different…professionals providing them with advice and guidelines and also receiving information”. Kuzmanovic said, “In my role, I am in touch with Facebook, Twitter, Tencent, Pinterest, TikTok, and also my colleagues in the China office who are working closely with Chinese social media platforms…So when we see some questions or rumours spreading, we write it down, we go back to our risk communications colleagues and then they help us find evidence-based answers”. “Another thing we are doing with social media platforms, and that is something we are putting our strongest efforts in, is to ensure no matter where people live….when they’re on Facebook, Twitter, or Google, when they search for ‘coronavirus’ or ‘COVID-19’ or [a] related term, they have a box that…directs them to a reliable source: either to [the] WHO website to their ministry of health or public health institute or centre for disease control”, she said. Google, Kuzmanovic noted, has created an SOS Alert on COVID-19 for the six official UN languages, and is also expanding in some other languages. The idea is to make the first information that the public receive be from the WHO website and the social media accounts of WHO and Dr Tedros. WHO also uses social media for real-time updates. WHO is also working closely with UNICEF and other international agencies that have extensive experience in risk communications, such as the International Federation of Red Cross and Red Crescent Societies. Carlos Navarro, head of Public Health Emergencies at UNICEF, the children's agency, told The Lancet that while a lot of incorrect information is spreading through social media, a lot is also coming from traditional mass media. “Often, they pick the most extreme pictures they can find…There is overkill on the use of [personal protective equipment] and that tends to be the photos that are published everywhere, in all major newspapers and TV…that is, in fact, sending the wrong message”, Navarro said. David Heymann, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, told The Lancet that the traditional media has a key role in providing evidence-based information to the general public, which will then hopefully be picked up on social media. He also observed that for both social and conventional media, it is important that the public health community help the media to “better understand what they should be looking for, because the media sometimes gets ahead of the evidence”.
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                Author and article information

                Contributors
                b.knottnerus@nivel.nl
                Journal
                BMC Prim Care
                BMC Prim Care
                BMC Primary Care
                BioMed Central (London )
                2731-4553
                11 May 2022
                11 May 2022
                2022
                : 23
                : 115
                Affiliations
                [1 ]GRID grid.416005.6, ISNI 0000 0001 0681 4687, Netherlands Institute for Health Services Research (Nivel), ; Utrecht, The Netherlands
                [2 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, CAPHRI (Care and Public Health Research Institute), Department of Family Medicine, , Maastricht University, ; Maastricht, The Netherlands
                Article
                1723
                10.1186/s12875-022-01723-w
                9091153
                35546226
                000280e6-3274-4aef-b32d-7d55917cd7fb
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 30 June 2021
                : 25 April 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                covid-19,health literacy,health communication,primary health care,professional-patient relations,qualitative research

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