To examine awareness and self-reported influence of Mexican front-of-package warning labels (FoPWL) on sugar-sweetened beverages (SSB) among Mexican American adults in the USA.

Data were analysed from Mexican Americans in the 2022 and 2023 annual cross-sectional International Food Policy Study surveys. FoPWL awareness (≥sometimes) and reported reductions in buying cola (2022–2023), soda (2022 only) and sweetened fruit drinks (2022 only) due to FoPWL were assessed. Weighted, adjusted negative binomial models tested associations between reported reductions in SSB purchases and past 7-d SSB consumption (2022 only).

Online survey.

Mexican Americans in US aged 18–100 years (2022, n 3329; 2023, n 2972).

Overall, 43 % of participants reported being aware of FoPWL on beverages ≥ ‘sometimes,’ with higher awareness among participants with limited health literacy (v. adequate) (AOR = 1·5, p < 0·001), high (v. low) education (AOR = 1·50, p < 0·001) and more frequent Spanish language use (AOR = 1·59 p < 0·001). Self-reported purchasing less cola due to the FOPWL was also more likely among those with limited literacy (AOR = 1·28, p < 0·05) and high (v. low) education (AOR = 1·21, p < 0·05), while more frequent Spanish use was associated with reported purchasing less of all three drink categories (p < 0·001). In 2022, reported buying less of all three SSB due to the front-of-package nutrient warning labels was associated with lower SSB consumption (p < 0·001).

Mexican American adults – particularly those with lower health literacy, higher education and more frequent Spanish use – reported greater awareness of Mexico’s FoPWL on beverages and purchasing less SSB due to the labels, suggesting FoPWL could be considered for the USA.

To examine parents’ lived experiences of implementing cot-only advice in a contemporary Australian cohort, assess alignment with the international literature on infant sleep and shared sleep practices, and determine whether explicit risk minimization guidelines address information needs identified by parents.

The risk elimination approach to shared sleeping has dominated public health messaging for decades but has been unsuccessful in reducing Sudden Unexpected Deaths in Infancy (SUDI) rates, while bedsharing rates have remained stable. The risk minimization approach offers an alternative, pragmatic framework for reducing controllable risks.

A retrospective, secondary, qualitative directed content analysis of free-text responses related to bed-sharing drawn from the 2017 Infant Care Awareness and Routines Evaluation among Queenslanders (I-CARE Qld Study) cross-sectional survey dataset. 3,341 primary caregivers (97% mothers) of infants aged approximately three months, born in Queensland between April and May 2017. For this secondary analysis, free-text responses related to co-sleeping/bedsharing were extracted and analysed qualitatively in line with study objectives.

Queensland parents expressed a desire for more information and non-judgemental education on improving safety while sharing sleep with their baby. Nearly a third of this cohort reported difficulty following advice to sleep their baby separately citing infant temperament/ needs, breastfeeding and caregiver fatigue or exhaustion as top rationales for this difficulty, aligning with earlier international findings. Some awareness by parents of risk minimization strategies to improve shared sleep safety was evident and in alignment with current Queensland Clinical Guidelines. There is an urgent need for public health messaging on safer infant sleep to better align with the lived experiences of parents and families through the adoption of a universal, proactive risk minimization approach to shared sleep. Co-designing guidance with parents may serve to bridge the gap between idealized and real-world implementation of safer infant sleep strategies.

This study aimed to develop and validate a questionnaire assessing the nutrition knowledge (NK) of Italian adult women regarding the relationship between diet, lifestyle and bone health.

A thirty-item questionnaire in Italian was developed by experts based on a literature review. Participants completed the questionnaire twice, with a 2–4 week gap between the two administrations. During the initial administration, weight and height were recorded using a mechanical scale and a stadiometer, while bone mineral density (BMD) of the lumbar spine (L1-L4), femoral neck and total femur were assessed via dual-energy X-ray absorptiometry (DXA).

Centre for Metabolic Bone Diseases at the Parma University Hospital, from January 2022 to June 2024.

Women aged 45–75 years old, native Italian speakers, undergoing DXA at the Centre participated.

The sample included 295 women with a median age of 63 years (interquartile range 11·5). The questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0·698) and high temporal stability (R = 0·810, P = 0·002), effectively differentiating between individuals with and without a nutritional background. Regression analysis indicated negative associations between NK score and age (β1 = –0·130, P < 0·001) and BMI (β1 = –0·193, P < 0·001).

The NutriBone questionnaire is a valid and reliable tool for evaluating NK related to bone health in Italian adult women undergoing DXA, with potential for future research applications.

Adult children caring for a parent with cancer often assume the role of a “surrogate seeker,” looking online for information regarding their parent’s diagnosis, which they may then discuss with their parent’s clinician. The current study aims to apply the previously developed “Stoplight typology” to explore caregivers’ experiences discussing online health information with their parents’ clinicians and factors associated with each response type within the typology.

We conducted an online survey of adult children caring for a parent with a blood cancer about their experiences communicating with their parent and their parent’s clinicians. We used regression analyses to examine the association between physician responses as categorized according to the stoplight typology with 3 caregiver communication measures assessing eHealth literacy, caregiver communication, and physician–caregiver and patient communication. Second, we examined the experiences participants had with clinician communication about online health information.

A total of 121 caregivers completed the survey. Over half reported clinicians giving green light responses, with fewer reporting yellow or red light responses. Lower eHealth literacy significantly predicted greater likelihood of red light responses, whereas higher self-reported communication skills predicted more green light and fewer red light responses; neither communication measure predicted yellow responses. Thirty-two percent did not discuss their most recent online search with clinicians, most commonly because they saw no need. Seventy-four percent had discussed online information with a clinician, and 56% of these encounters were coded as green light responses. Among caregivers who had been told not to search online, 77% continued to do so despite the clinician’s discouragement.

The study findings provide support for the stoplight typology in a caregiver population. Although most clinician responses were engagement responses, results demonstrate that the rejection response is ineffective. Future research could examine caregivers who reported lower eHealth literacy to target for future intervention.

To tailor an existing Person-Centred Integrated Care (PC-IC) approach to the needs of patients with low socioeconomic status (LSES) and chronic conditions in primary care.

While Disease Management Programs (DMPs) have been introduced to reduce the burden of chronic diseases, their effectiveness for patients with LSES remains uncertain due to insufficient attention to the individual context. A PC-IC approach may enhance patient outcomes by addressing patients’ cultural backgrounds, values, and health literacy needs, because these factors are particularly relevant for patients with LSES.

A qualitative study was conducted using three co-creation sessions with patients with LSES and chronic conditions, along with general practitioners and practice nurses, to adapt, develop, and test specific elements of the PC-IC approach. Participatory learning and action (PLA) techniques incorporating visual materials were employed to ensure meaningful engagement and input by all participants, including those with limited reading and language skills. Following these sessions, we conducted a validation check by patients on the draft materials.

In the co-creation sessions, an existing PC-IC approach was tailored to the needs of LSES patients with chronic conditions in primary care. The adapted PC-IC approach emphasized key elements as trust, being seen as a person in the social context, shared decision-making, and access to clear and easily understandable information. Existing materials needed to be adapted, resulting in a visual conversation tool. This tool covers the physical, social, and mental health domains as well as daily life, each domain with six to eight topics. It helps to get better insight into the patient’s daily life, wishes, and possibilities. It maps medical and psychosocial issues and supports the patient in gaining a better understanding. The adapted PC-IC approach with the conversation tool is being presented in a training for primary care professionals.

Individuals’ COVID-19 protection and awareness could be related to their health literacy levels. This study aims to determine individuals’ COVID-19 awareness and health literacy levels in eastern Turkey and the relationship between them.

This study utilized a descriptive and correlational design. The target population was individuals aged 18-65 years who sought treatment in the emergency department of a state hospital in Turkey. The sample consisted of 762 individuals who visited the health institution where data were collected between July 15, 2021-December 15, 2021 and agreed to participate in the study. Data were collected through the Personal Information Form, the COVID-19 Awareness Scale, and the Health Literacy Scale. Ethics committee approval and institutional permissions were obtained to conduct the study. Data analysis used arithmetic means, standard deviations, skewness and kurtosis coefficients, t test, ANOVA, Welch ANOVA, Bonferroni tests, and correlation analysis.

The participants’ COVID-19 Awareness Scale total mean score was 50.71 ± 14.93, and the Health Literacy Scale total mean score was 45.03 ± 10.57. A moderate positive correlation was detected between the participants’ health literacy levels and the COVID-19 awareness scale sub-scales and total scores (r = 0.350).

The participants’ health literacy level increased with their COVID-19 awareness level. It is recommended that health literacy levels be increased to help individuals increase their awareness of COVID-19 and to protect and improve their health.

The 2018 Common Rule revision intended to improve informed consent by recommending a concise key information (KI) section, yet provided little guidance about how to describe KI. We developed innovative, visual KI templates with attention to health literacy and visual design principles. We explored end users’ attitudes, beliefs, and institutional policies that could affect implementing visual KI pages.

From October 2023 to April 2024, we conducted semi-structured interviews with principal investigators, research staff, and Institutional Review Board (IRB) personnel, including those in oversight/management, and community partners. Forty participants from three academic institutions (in the Midwest, Southeast, and Mountain West) viewed example KI pages and completed interviews. We coded written transcripts inductively and deductively based on the capability, opportunity, and motivation to change behavior (COM-B) framework. Data were analyzed using content analysis and organized thematically.

Participants responded positively to the visual KI examples. They discussed potential benefits, including improving information processing and understanding of study procedures, diversity in research, trust in research, and study workflow. They also described potential challenges to consider before widespread implementation: IRBs’ interpretations of federal guidelines, possible impacts on IRB submission processes, the effort/skill required to develop visuals, and difficulty succinctly communicating study risks. There was no consensus about when to use visual KI during consent, and some wondered if they were feasible for all study types.

Visual KI offers a promising solution to long-standing informed consent challenges. Future work can explore resources and training to address challenges and promote widespread use.

Clinical research trials rely on informed consent forms (ICFs) to explain all aspects of the study to potential participants. Despite efforts to ensure the readability of ICFs, concerns about their complexity and participant understanding persist. There is a noted gap between Institutional Review Board (IRB) standards and the actual readability levels of ICFs, which often exceed the recommended 8th-grade reading level. This study evaluates the readability of over five thousand ICFs from ClinicalTrials.gov in the USA to assess their literacy levels.

We analyzed 5,239 US-based ICFs from ClinicalTrials.gov using readability metrics such as the Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning Fog Index, and the percentage of difficult words. We examined trends in readability levels across studies initiated from 2005 to 2024.

Most ICFs exceeded the recommended 8th-grade reading level, with an average Flesch-Kincaid Grade Level of 10.99. While 91% of the ICFs were written above the 8th-grade level, there was an observable improvement in readability, with fewer studies exceeding a 10th-grade reading level in recent years.

The study reveals a discrepancy between the recommended readability levels and actual ICFs, highlighting a need for simplification. Despite a trend toward improvement in more recent years, ongoing efforts are necessary to ensure ICFs are comprehensible to participants of varied educational backgrounds, reinforcing the ethical integrity of the consent process.

Limited research is available on how motivations to adopt plant-based diets and nutrition literacy influence diet quality. This study assessed diet quality, diet motives and nutrition literacy in vegans, vegetarians and semi-vegetarians and investigated predictors of dietary quality.

Cross-sectional study, participants completed an online survey about diet-related motives and nutrition literacy. Dietary intake was assessed with the Diet History Questionnaire III, and diet quality was calculated with the Healthy Eating Index (HEI)-2015. A one-way ANCOVA was used to compare diet quality, nutrition literacy and diet motives among diets. Hierarchical regression analysis was performed to identify significant predictors of diet quality.

Online survey, participants were recruited through paid targeted social media (Facebook/Instagram) advertising.

Adults following a plant-based diet, including 117 (52·5 %) vegans, 51 (22·9 %) vegetarians and 55 (24·6 %) semi-vegetarians.

Vegans had higher HEI-2015 scores (80·8 (sd 6·5), P < 0·001) compared to vegetarians (75·1 (sd 9·1)) and semi-vegetarians (76·8 (sd 7·5)). Most participants (74 %) had good nutrition literacy scores. Total nutrition literacy did not differ between groups, but vegans had higher vegetarian nutrition literacy than vegetarians and semi-vegetarians (P < 0·001). Ecological welfare, health and sensory appeal were highly important to all participants. Motives accounted for 12·8 % of the variance in diet quality scores. HEI-2015 scores were positively associated with motives of health and natural content, but negatively associated with weight control motivation (all P < 0·05).

Individuals following plant-based dietary patterns have high diet quality and nutrition literacy. Messages valuing intrinsic over extrinsic factors may facilitate healthier dietary adherence in this population.