OBJECTIVE -Health literacy (HL), the capacity of individuals to access, understand, and use health information to make informed and appropriate health-related decisions, has been recognized as an important concept in patient education and disease management. This study examined the psychometric properties of newly developed scales for measuring three different levels of HL (i.e., functional, communicative, and critical) in patients with diabetes.RESEARCH DESIGN AND METHODS -The reliability and validity of the three HL scales were evaluated in a sample of 138 outpatients with type 2 diabetes. In addition, sociodemographic and clinical characteristics, knowledge of diabetes, information-seeking behaviors, and self-efficacy were assessed for each patient through a self-report questionnaire and review of electronic medical records.RESULTS -Scale items were constructed to directly reflect the definition of HL. Internal consistency of functional, communicative, and critical HL scales was adequately high (␣ ϭ 0.84, ␣ ϭ 0.77, and ␣ ϭ 0.65, respectively). Three interpretable factors were identified in exploratory factor analysis. Correlations between HL scales and other measures supported the construct validity of the scales. The three HL scales were only moderately correlated with each other, suggesting that each represents a different domain of HL abilities and skills.CONCLUSIONS -Our newly developed HL scales are reliable and valid measures of three types of HL in diabetic patients. Exploring a patient's HL levels may provide a better understanding of the patient's potential barriers to self-management of disease and health-promoting behaviors. Diabetes Care 31:874-879, 2008O ver the past few decades, patient participation in the health care process has been recognized as a critical determinant of successful disease management. This is especially true for diabetes, which requires extensive, ongoing patient self-care. Health information is an important resource for helping patients understand and engage in the management of a health condition. Although physicians have historically been the primary source of health and medical information, other sources are becoming more available to the general public with the increase in media reports and rapid diffusion of information via the Internet (1-4). Thus, a patient's skills in understanding and applying information about health issues may have a substantial impact on his/ her behavior and health (5). These skills have recently been conceptualized as health literacy (HL).The National Library of Medicine refers to HL as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (6). Similarly, the World Health Organization defines HL as "the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health" (7). Based on this premise, Nutbeam (8) propos...

With the increase in media reports and rapid diffusion of the Internet, the skills in finding and utilizing health information (health literacy; HL) are becoming important in maintaining and promoting health. This study aimed to examine the psychometric properties of a brief measure to assess major components of communicative and critical HL among Japanese office workers, in order to consider its applicability to health promotion at workplace. The participants were 190 male office workers at a Japanese company. A self-administered questionnaire was distributed at the annual health checkup, in which HL, health-related behaviors and coping with job stress were asked. Also, the number of somatic symptoms reported by the worker was counted out of the eight symptoms in the health checkup questionnaire. The higher HL group was more likely to have regular eating patterns and exercise weekly, and tended to be a never smoker. In coping with job stress, those with higher HL were more likely to actively solve the problems or seek support from others, whereas those with lower HL were more likely to be resigned to the situation. Further, lower HL group reported significantly greater number of somatic symptoms than higher HL group. These findings were generally as hypothesized, supporting the validity of the HL scale among office workers. Further research on HL is needed to explore the extent and impact of HL on health outcomes.

Objectives Health information is an important resource for patients to understand and engage in the management of their health conditions. We discuss the role of health literacy (HL) in improving patient participation and propose future research in this field.Methods Literature searches were conducted to review existing definitions and measures of HL and identify empirical findings of its impact on patient health ⁄ illness-related behaviours. We searched MEDLINE using Ôhealth literacyÕ as a keyword and retrieved 371 articles published in English between 1985 and 2006. We also handsearched publications of leading researchers and related institutes and followed the reference lists of relevant articles.Results The World Health Organization has defined HL as Ôthe cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.Õ Based on this definition, three levels of HL have been described: functional, communicative and critical. Studies of HL have increased dramatically over the past few years, but there is a gap between the conceptual definition of HL and its application. Thus, empirical evidence of its impact on patient health ⁄ illness-related behaviours is still limited.Conclusions The prevalence and consequence of inadequate HL as fully defined have not been determined. Further research is needed to develop measures of HL beyond the functional level and that consider the interaction of the individual patient HL with the health and social contexts in which the patient lives.

Objective To assess the effects on self rated health of individual income and income distribution in Japan. Design Cross sectional analysis. Data collected on household income, self rated health, and other sociodemographic characteristics at the individual level from comprehensive survey of the living conditions of people on health and welfare in a nationally representative sample from each prefecture. Setting Prefectures in Japan. Participants 80 899 people aged > 15 years with full records in survey. Main outcome measures Dichotomous variable for self rated health of each respondent (0 if excellent, very good or good; 1 if fair or poor). Results Inequality in income at the prefecture level measured by the Gini coefficient was comparable with that in other industrialised countries. Unadjusted odds ratios show a 14% increased risk (odds ratio 1.14, 95% confidence interval 1.02 to 1.27) in reporting poor or fair health for individuals living in prefectures with higher inequality in income. After adjustment, individual income was more strongly associated with self rated health than income inequality. Additional inclusion of regional effects showed that median income at the prefecture level was inversely related to self rated health. Conclusions Individual income, probably relative to the median prefecture income, has a stronger association with self rated health than income inequality at the prefecture level.

Recently, the adverse effects of long working hours on the cardiovascular systems of workers in Japan, including "Karoshi" (death from overwork), have been the focus of social concern. However, conventional methods of health checkups are often unable to detect the early signs of such adverse effects. To evaluate the influence of overtime work on the cardiovascular system, we compared 24-hour blood pressure measurements among several groups of male white-collar workers. As a result, for those with normal blood pressure and those with mild hypertension, the 24-hour average blood pressure of the overtime groups was higher than that of the control groups; for those who periodically did overtime work, the 24-hour average blood pressure and heart rate during the busy period increased. These results indicate that the burden on the cardiovascular system of white-collar workers increases with overtime work.