Objectives To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. Data sources We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. Review methods We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. Results We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. Conclusions The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

/pdf/health-literacy-interventions-and-outcomes-an-updated-chswt8nilu.pdf

Health literacy interventions and outcomes: an updated systematic review.

This article is focused on the growing empirical emphasis on connections between narrative and self-development. The authors propose a process model of self-development in which storytelling is at the heart of both stability and change in the self. Specifically, we focus on how situated stories help develop and maintain the self with reciprocal impacts on enduring aspects of self, specifically self-concept and the life story. This article emphasizes the research that has shown how autobiographical stories affect the self and provides a direction for future work to maximize the potential of narrative approaches to studying processes of self-development.

/pdf/selves-creating-stories-creating-selves-a-process-model-of-9x32a4nrnv.pdf

Selves Creating Stories Creating Selves: A Process Model of Self-Development

Initial research on maternal reminiscing style established clear and consistent individual differences that vary along a dimension of maternal elaboration and that are related to children's developing autobiographical skills. More recent research has linked maternal elaborative reminiscing to strategic memory development, language and literacy skills, developing attachment relationships, and understanding of self, other, and mind. In this review, this research is placed in theoretical context by arguing for the critical role of reminiscing in developmental process and outcome.

Elaborating on elaborations: role of maternal reminiscing style in cognitive and socioemotional development.

A language and literacy intervention was implemented in 10 Head Start classrooms. Teachers were trained in specific book reading and conversation strategies. The focus of the intervention was to train teachers how to increase opportunities for language and vocabulary development in young children. At the end of the year, children in the intervention classrooms performed significantly better than children in the control classrooms on the Peabody Picture Vocabulary Test-III and the Expressive One-Word Vocabulary Test (3rd ed.). In addition, teachers in the intervention classrooms used strategies that promoted language development during book reading and other classroom activities. Head Start teachers can be trained to implement strategies that have positive effects on children's language and literacy development.

https://psycnet.apa.org/journals/edu/98/1/63.pdf

The Effects of a Language and Literacy Intervention on Head Start Children and Teachers

Autobiographical memory is a uniquely human system that integrates memories of past experiences into an overarching life narrative. In this review, I extend social-cultural models of autobiographical memory development and present theory and research that demonstrates that (a) autobiographical memory is a gradually developing system across childhood and adolescence that depends on the development of a sense of subjective self as continuous in time; (b) autobiographical memory develops within specific social and cultural contexts that relate to individual, gendered, and cultural differences in adults' autobiographical memories, and, more specifically, (c) mothers who reminisce with their young children in elaborated and evaluative ways have children who develop more detailed, coherent, and evaluative autobiographical memories.

The development of autobiographical memory.

Twenty economically disadvantaged preschoolers (mean age 3;7) were randomly assigned to an intervention or a control group, and their mothers' styles of eliciting narratives from their children were assessed before and after intervention. Mothers of intervention children were encouraged to spend more time in narrative conversation, ask more open-ended and context-eliciting questions, and encourage longer narratives through back-channel responses. Children's narrative and vocabulary skills were assessed before and after the year-long intervention and 14 children participated in a follow-up assessment a year later. Narrative measures included the number and length of narratives as well as how decontextualized and informative they were. Intervention children showed significant vocabulary improvement immediately after intervention terminated, and a year later they showed overall improvements in narrative skill. In particular, intervention children produced more context-setting descriptions about where and especially when the described events took place. Such decontextualized language has been emphasized as important for literacy acquisition.

Encouraging narratives in preschoolers: an intervention study.

Oral language skills in the preschool years are predictive of children's later reading success and literacy acquisition, and among these language skills, vocabulary and narrative ability play important roles. Children from low socioeconomic families face risks to their language development and because of threats to these skills it is important to identify factors that promote their development among high-risk groups. This preliminary study explored two potential factors that may be related to language skills in 56 low SES mother-child dyads (children aged 2; 8-4; 10), namely child temperament and parenting stress. Results showed that child temperament and parenting stress were related to children's oral language skills. Child temperament characteristics that would likely aid social interaction were related to narrative ability and children rated high on emotionality had poorer receptive vocabulary skills. Parenting stress was related to children's receptive and expressive vocabulary skills. Results are interpreted in terms of the possible mediating role of parent-child interactions in children's oral language skill development, and future directions for family intervention are discussed.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0305000908008805

The relationship of parenting stress and child temperament to language development among economically disadvantaged preschoolers

Research indicates that people living in rural and remote areas of Canada face challenges to accessing health services. This article reports on a community-engaged research project conducted by investigators at Memorial University of Newfoundland in collaboration with the Rural Secretariat Regional Councils and Regional Partnership Planners for the Corner Brook–Rocky Harbour and Stephenville–Port aux Basques Rural Secretariat Regions of Newfoundland and Labrador. The aim of this research was to gather information on barriers to accessing health services, to identify solutions to health services’ access issues and to inform policy advice to government on enhancing access to health services. Data was collected through: (1) targeted distribution of a survey to communities throughout the region, and (2) informal ‘kitchen table’ discussions to discuss health services’ access issues. A total of 1049 surveys were collected and 10 kitchen table discussions were held. Overall, the main barriers to care listed in the survey included long wait times, services not available in the area and services not available at time required. Other barriers noted by survey respondents included transportation problems, financial concerns, no medical insurance coverage, distance to travel and weather conditions. Some respondents reported poorer access to maternal/child health and breast and cervical screening services and a lack of access to general practitioners, pharmacy services, dentists and nurse practitioners. Recommendations that emerged from this research included improving the recruitment of rural physicians, exploring the use of nurse practitioners, assisting individuals with travel costs,  developing specialist outreach services, increasing use of telehealth services and initiating additional rural and remote health research. Keywords : rural, remote, healthcare, health services, social determinants of health

/pdf/access-to-health-services-in-western-newfoundland-canada-yrycpg8xop.pdf

Access to health services in Western Newfoundland, Canada: Issues, barriers and recommendations emerging from a community-engaged research project

https://journals.sagepub.com/doi/pdf/10.1177/17151635211004643

Establishing the Medication Therapy Services Clinic: Goals, challenges and future directions:

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Encouraging narratives in preschoolers: an intervention study.

The relationship of parenting stress and child temperament to language development among economically disadvantaged preschoolers

Access to health services in Western Newfoundland, Canada: Issues, barriers and recommendations emerging from a community-engaged research project

Establishing the Medication Therapy Services Clinic: Goals, challenges and future directions: