To examine the impact of effective health information acquisition on hemophilia-related health literacy among adult caregivers of children and adolescents with hemophilia in China, and to provide evidence-based recommendations for improving adult caregivers' hemophilia-related health literacy. Data were derived from the 2024 nationwide multicenter cross-sectional survey, "Health Literacy Survey of Hemophilia Patients in China". A total of 856 adult caregivers of children and adolescents with hemophilia were recruited through convenience sampling. To explore the differences in hemophilia-related health literacy and effective health information acquisition levels among caregivers across different demographic characteristics, univariate ANOVA and independent-samples t test were adopted for statistical analysis. The bootstrap method was employed to test the mediating role of effective health information acquisition in the relationship between hemophilia-related health literacy and its influencing factors. The overall level of hemophilia-related health literacy among caregivers of minor patients with hemophilia was relatively low, with an average score of 11.87±2.92. Only 20.68% of the caregivers for underage patients with hemophilia had acquired hemophilia-related health literacy. Univariate ANOVA analysis indicated that marital status, educational attainment, annual household income, registered residence location, and employment status significantly influenced adult caregivers ' hemophilia-related health literacy (P < 0.05). The utilization rate of various health information channels by caregivers of underage hemophilia patients exceeded 70%. Over 95% of the caregivers reported obtaining hemophilia-related health information from medical staff and hemophilia patient organizations. While, the caregivers demonstrated relatively low overall effective health information acquisition (34.43±16.50). The level of effective health information acquisition was related to educational attainment, place of household registration and employment status. Caregivers with higher educational attainment, urban household registration and full-time employment had a higher level of effective health information acquisition, and the differences were statistically significant (P < 0.05). The mediation analysis showed that the level of effective health information acquisition was positively correlated with hemophilia health literacy (P < 0.01), and effective health information acquisition played a partial mediating role between "education attainment" and "hemophilia health literacy", "employment status" and "hemophilia health literacy", and "place of household registration" and "hemophilia health literacy" (P < 0.05). Higher educational attainment and favorable employment status not only directly improved health literacy, but also indirectly enhanced it by promoting effective information acquisition. Compared with urban household registration, rural household registration had a negative impact on health literacy in patients with hemophilia. Meanwhile, effective information acquisition also exerted a partial mediating effect between registered residence location and health literacy. The hemophilia-related health literacy among caregivers of underage hemophilia patients is relatively low. Enhancing adult caregivers' effective health information acquisition of health information will improve their hemophilia-related health literacy. Tailored strategies to optimize effective health information acquisition for adult caregivers with varying sociodemographic characteristics could indirectly contribute to improved health literacy outcomes. 探讨我国未成年血友病患者照护者的有效健康信息获取水平对其血友病健康素养的影响，为提升照护者健康素养提供建议。 基于2024年全国多中心横断面调查《中国血友病患者健康素养调查》数据，采用方便抽样法纳入856例未成年血友病患者的成年照护者。通过单因素ANOVA分析或独立样本t检验了解不同人口学特征下照护者健康素养和有效健康信息获取水平的差异，并采用Bootstrap法检验有效健康信息获取在健康素养与其影响因素之间的中介作用。 未成年血友病患者照护者的血友病健康素养水平整体较低，平均得分为11.87±2.92。仅有20.68 %的照护者具备血友病健康素养，婚姻状况、受教育程度、家庭年收入、户籍所在地和就业状况是照护者血友病健康素养的影响因素(P＜0.05)。未成年血友病患者照护者对各类健康信息获取渠道的使用率均超过70%，超过95%的照护者报告从医护人员、血友病患者组织获取血友病相关健康信息。未成年血友病患者照护者有效健康信息获取水平整体偏低(34.43±16.50)，有效健康信息获取水平与受教育程度、户籍所在地、就业状况相关，受教育程度越高、户籍所在地为城市及有全职工作的照护者有效健康信息获取水平更高，差异有统计学意义(P＜0.05)。中介效应分析表明，有效健康信息获取水平与血友病健康素养呈正相关(P＜0.01)，且有效健康信息获取在“受教育程度”与“血友病健康素养”、“就业状况”与“血友病健康素养”，以及“户籍所在地”与“血友病健康素养”之间均存在部分中介作用(P＜0.05)。 未成年血友病患者照护者的血友病健康素养水平较低，提升照护者的有效健康信息获取水平有助于改善其血友病健康素养；针对不同社会人口学特征的人群，可通过优化有效健康信息获取路径，间接提升其健康素养水平。
The WHO defines self-care as 'the ability of individuals, families and communities to promote health, prevent disease, maintain health and cope with illness and disability with or without the support of a healthcare provider', while self-care confidence refers to an individual's perceived ability to effectively engage in these activities. The interface between health and care professionals (HCPs) and the public is pivotal in promoting self-care behaviours, yet barriers such as health literacy deficits, professional constraints, misconceptions and disparities in self-care confidence persist. This study aimed to explore how self-care confidence, professional support and health literacy interact to influence self-care behaviours among UK adults. Cross-sectional online survey. Community-based national study of adults across primary care and community care settings in the UK. Community-dwelling UK adults aged 18 years and above, including HCPs, were recruited from June to September 2024 via social media, online research participant recruitment platforms and professional networks. Participants provided demographic information including age, gender, ethnicity, employment, education, disability status and UK region. Data collected from adults aged ≥18 residing in the UK able to complete an online questionnaire in English were included. Incomplete survey responses or duplicate entries were excluded. None (observational study). Primary outcome: self-reported confidence in maintaining a healthy lifestyle and managing common illnesses. accessibility to health information, health literacy (measured using the validated WHO Action Network on Measuring Population and Organizational Health Literacy instrument, HLS19-Q12), self-reported knowledge of National Health Service guidelines and receipt of professional encouragement to self-care. A total of 3255 community-dwelling UK adults (members of the general public) participated in the study. A subset of 227 participants self-identified as HCPs. Most respondents (88.5%) reported confidence in maintaining a healthy lifestyle; 91.9% felt confident managing common illnesses. Locating professional help when ill was perceived as easy (77.4%) but not evaluating treatment options (51.4% difficult/very diffcult) or mental health information accessibility (43.6% difficult/very difficult). Among HCPs, 94.7% endorsed the importance of self-care but cited patient reluctance to engage or take responsibility (64.8%), understanding (59.0%), time constraints (42.7%) and health literacy challenges (45.8%) as key barriers. In the general population, 68.6% found screening information accessible but 28.1% struggled with interpretation. Regression analyses revealed that older adults (65+) were significantly less confident in self-care with professional guidance (adjusted OR (aOR)=0.50 (0.33-0.74), p=0.001), whereas males (aOR=1.41 (1.23-1.62), p<0.001) and black/Asian British individuals (aORs=2.31 (1.66-3.21), 1.98 (1.51-2.61); p<0.001) reported higher confidence levels. This study highlights the complex relationship between professional guidance, self-care confidence and health literacy. While most individuals value and engage in self-care, critical disparities persist, particularly in health literacy and access to digital resources. Targeted interventions and strengthening the public-healthcare professional dialogue and interface will be crucial in advancing self-care as a sustainable pillar of healthcare policy and practice.
Disparities in health outcomes have been associated with inequitable access to health literacy and services. Additionally, reduced health literacy may lead to an unhealthy lifestyle, causing a decrease in quality of life and social inequities. Advancing health literacy is vital in educational organizations to curb gaps in social inequities. Adapting strategies to promote health literacy is essential for advancing equitable and effective educational organizations. Therefore, policies and interventions should aim to address any barriers that threaten inequities in the educational organization. This scoping review aims to explore how advancing health literacy strategies within the school organization can promote health equity. A scoping review of current literature was conducted using Arksey and O'Malley's framework and reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Articles were identified using ERIC (Education Resources Information Center), PUBMED (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature), and ProQuest Education Database. Included articles were restricted to the English language and the last twelve years to capture the most recent literature. Thirty-seven interventions to advance health literacy in educational settings were identified, with most published between 2020 and 2025 (28/37). Twenty-nine targeted elementary to secondary school students, while fewer focused on teachers, counselors, school personnel, or university students. Most were individual-level interventions aimed at improving student health literacy, while organizational approaches emphasized staff development and whole-school practices. Strategies included peer-led programs, curriculum-embedded teacher-led interventions, digital tools, staff-focused training, and whole-school models. Mental health literacy predominated, though oral health, infectious disease, pain, emergency preparedness, and WaSH literacy were also addressed. All studies reported improved health literacy-related outcomes. Evidence indicates that educational institutions may advance health literacy through curriculum-based, digital, peer-led, and whole-organization strategies. Integrating these approaches into policies and practice may promote equity, improve student and staff outcomes, and position schools and universities as important settings for health promotion and future intervention research.
AI technology has had a significant revolutionary impact on the fields of healthcare and education. For the nursing staff population, the lack of artificial intelligence (AI) literacy may not only weaken the construction of their professional self-concept but also constrain the development of evidence-based practice. However, empirical research on the intrinsic correlation mechanism between these three factors is still relatively scarce at present. The purpose of this study was to explore the mediating role of AI literacy in the relationship between nurses' professional self-concept and evidence-based practice. A cross-sectional study was conducted from October 15 to November 1, 2025, using convenience sampling to select 497 nurses from four tertiary public hospitals in Chongqing. The data collection tools include participant demographic characteristics, AI Literacy Scale (AILS), Nurse Self-Concept Questionnaire (NSCQ), and Evidence-Based Practice Questionnaire (EBPQ). The statistical software R (version 4.5.2) was adopted for data analysis, which included data feature description, correlation verification, and structural equation modeling. The overall demographic characteristics of the respondents were characterized by high educational levels, a mix of middle-aged and young people, and extensive work experience. The average scores for professional self-concept, AI literacy, and evidence-based practice were 232.29 ± 42.57, 63.34 ± 10.14, and 143.05 ± 22.45, respectively. It was found that a positive relationship exists between nurse AI literacy and professional self-concept (r = 0.89, p < 0.001), as well as between nurse professional self-concept and evidence-based practice (r = 0.94, p < 0.001). A significant positive correlation has also been found between AI literacy and evidence-based practice (r = 0.92, p < 0.001). AI literacy played a partial mediating role between nurse professional self-concept and evidence-based practice, with a mediation effect value of 0.587 (95% CI: 0.569-0.606), which explained 38.5% of the total effect. The study confirmed that there was a positive relationship between nurse professional self-concept and evidence-based practice, and AI literacy played a partial mediating effect in this relationship chain. It can be seen that AI literacy plays an indispensable and critical role in promoting the shape of nurse professional self-concept and enhancing their evidence-based practice ability. Improving the AI literacy of nurses and conducting precise training are fundamental tasks in promoting the effective empowerment of clinical nursing scenarios with AI technology. To this end, it is necessary to integrate knowledge and skills related to AI into the nursing education system and simultaneously promote the lifelong professional development of nurses to effectively enhance their ability to use AI technology to optimize medical services. At the same time, healthcare institutions and nursing managers should focus on building supportive practice environments, advocating for standardized clinical applications of AI technology, and always adhering to the nursing core values guided by patient needs. Chinese Clinical Trial Registry: ChiCTR2600118905.
This study evaluated the effectiveness of an Educational App for Complementary Therapy in Diabetes Management in improving health literacy, quality of life, and diabetes empowerment through complementary therapy. An assessor- and investigator-blinded randomized controlled trial was conducted. The report of this study adheres to the CONSORT 2025 guideline. Eighty-eight participants with type 2 diabetes who reported complementary therapy use were randomly assigned to either an app-based intervention or a standard-education control group. The eight-session intervention incorporated self-control, cognitive, psychological, and behavioural strategies. Outcomes, including diabetes empowerment, complementary therapy health literacy, and quality of life, were assessed at three time points. Data were analysed using generalized estimating equations. Participants in the intervention group demonstrated statistically significant improvements in CT-related critical health literacy and quality of life compared with the control group, but no statistically significant improvement in diabetes empowerment. Results suggest that the educational app enhances individuals' knowledge and capacity to evaluate the use of complementary therapies. The Educational App for Complementary Therapy in Diabetes Management is a promising digital tool for improving complementary therapy health literacy and quality of life in diabetes care. Although empowerment did not improve, the app's design and alignment with empowerment processes highlight its potential for extended educational and clinical use. Future research should explore longer-term engagement, methods of reinforcement, and broader implementation across diverse populations. Healthcare professionals can utilize the app to enhance patient education on the use of complementary therapies, thereby improving communication, shared decision-making, and the overall quality of diabetes management. What problem did the study address? The use of complementary therapy alongside conventional diabetes care is common, yet individuals often lack adequate knowledge to evaluate its potential benefits, risks, and safety. Disclosure of complementary therapy use to healthcare professionals is frequently low, posing risks of adverse interactions and undermining coordinated care. Knowledge, health literacy, and a supportive environment are critical components of chronic disease management, but they are underexplored in the context of digital interventions focused on the use of complementary therapies. What were the main findings? This study evaluates the Educational App for Complementary Therapy in Diabetes Management for smartphones-a digital educational intervention designed to enhance complementary therapy health literacy and safe decision-making among individuals diagnosed with diabetes. The intervention demonstrated statistically significant improvements in complementary therapy health literacy and quality of life, underscoring its potential clinical utility. While diabetes empowerment did not improve within the study period, the intervention's grounding in the WHO empowerment process framework and interactive features suggest that longer or more reinforced exposure may yield stronger health outcomes. Where and on whom will the research have an impact? The app empowers individuals to make safer and more informed decisions regarding complementary therapy use, improving self-management and quality of life. The findings provide a practical digital tool to support safer CT-related decision-making by helping participants appraise CT information, evaluate benefit-risk, and communicate with healthcare professionals. The research supports the integration of digital health literacy interventions into diabetes management programs, promoting evidence-based and patient-centred practice. This study was reported in accordance with the CONSORT 2025 statement. Professional experts contributed to the co-design of the intervention. The intervention was pilot-tested with patients, whose feedback informed protocol refinements to enhance feasibility and acceptability. ClinicalTrials.gov identifier: NCT06317584.
African, Caribbean, and Black (ACB) populations in high-income countries (HICs) continue to experience long-standing health inequities rooted in structural and anti-Black racism embedded in health systems, policies, and institutional practices. From an ecosocial perspective, these inequities reflect the embodiment of intersecting forms of oppression structured through racialized, gendered, and socioeconomic relations. Critical racial literacy (CRL) has emerged as a promising framework for recognizing and addressing structural racism in ways that foster critical reflection and support justice-oriented action in health contexts. However, evidence on how CRL is conceptualized and operationalized in health research, policy, and practice concerning ACB communities remains fragmented and limited. This scoping review aims to map how CRL is conceptualized and operationalized in HICs and examine its potential to advance health equity for ACB populations. This scoping review will be conducted in accordance with the Joanna Briggs Institute guidance. Comprehensive searches will be conducted in MEDLINE (Ovid), Embase, CINAHL, PsycInfo, ERIC, Scopus, and ProQuest Dissertations and Theses Global from inception to March 31, 2026. Peer-reviewed articles and theses or dissertations will be included, with no restrictions on study design or publication type. At least 2 independent reviewers will conduct screening, charting, and analysis of the data. A 3-phase thematic mapping process guided by critical race theory, intersectionality, and ecosocial theory will be used to analyze and interpret the findings. Searching, screening, data charting, and analysis will be undertaken between April 2026 and July 2026. Manuscript preparation will be completed by July 31, 2026, and dissemination will occur between August 2026 and October 2026. The findings will identify key CRL components, applications, strategies, barriers, and equity pathways across clinical, policy, and community contexts. This scoping review will provide a comprehensive overview of how CRL is conceptualized and applied in health contexts involving ACB populations in HICs. By clarifying current conceptualizations, applications, and gaps in the literature, the review will identify priorities for future theoretical, methodological, and practice-based development. In doing so, the findings will inform more critically grounded, praxis-oriented, and structurally focused antiracism efforts across health systems. Results will be disseminated through open access publications, conference presentations, and stakeholder engagement activities to advance evidence-informed health equity action. PROSPERO CRD42024623132; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623132. PRR1-10.2196/79361.
Chronic, non-communicable diseases accounted for 74% of deaths worldwide in 2024, representing a significant social and economic burden. The WHO identifies reducing preventable risk factors as a primary intervention point. Patient-centered care plays a prominent role in modern healthcare, promoting prevention and increasing the effectiveness of lifestyle therapy by taking into account the individual needs, lifestyle, and motivations of patients. Nutritional guidelines play a crucial role in prevention and medical nutrition therapy. However, the effectiveness of personalized dietary care is greatly influenced by the health literacy of the population. Our research aimed to explore the characteristics that emerge in the interpretation of the OKOSTÁNYÉR® nutritional recommendations based on health literacy. Medical nutrition therapy is an important part of lifestyle management for chronic, non-communicable diseases. However, the effectiveness of such interventions is greatly influenced by patients' health literacy. Our research aimed to explore observable characteristics based on health literacy in the interpretation of the OKOSTÁNYÉR® dietary recommendations, with the goal of increasing the effectiveness of dietetic practice. The research was based on a qualitative methodological approach, using focus group interviews. Four online focus group interviews were conducted with 6 participants each (N = 24). 58% of the participants were women (14 people) and 42% were men (10 people); their average age was 50.1 years. A quantitative survey using the HLS-EU47 questionnaire was conducted prior to the selection of participants, during which groups with low and normal health literacy were formed based on internationally validated cut-off scores. The selection of participants was preceded by a quantitative survey, on the basis of which groups with low and normal health literacy were formed. The audio recordings and transcripts of the discussions were analyzed by group and thematic unit, using multi-coded systematic data processing. Coding, analysis, and data visualization were supported by NVivo14 and SmartDraw softwares. Based on the lifestyles, behaviors, and aspirations of individuals with normal and low health literacy, distinctly different character groups can be identified. Higher health literacy is linked to coping strategies that support health maintenance. Awareness of the OKOSTÁNYÉR® recommendation is moderate (33.3%), particularly among those with low health literacy (16.6%). Navigating the vast amount of health information available can be challenging, especially for individuals with low health literacy. When it comes to ideal nutritional advice, participants highlighted the importance of reliable sources, however, they primarily rely on the internet and social media for answers to their nutritional questions, only seeking professional help when a health issue has already been established. They assess recommendations based on their personal habits and beliefs, often modifying them accordingly. Low health literacy can pose a significant barrier to effective dietary interventions. In the future, it will be essential to improve health communication, for example, by developing targeted nutritional recommendations and providing guided support to groups with low health literacy, such as developing nutritional competencies and increasing the effectiveness of personalized, patient-centered dietary counselling. Orv Hetil. 2026; 167(24): 952-964. Bevezetés: A krónikus, nem fertőző betegségek dietoterápiája az életmódkezelés fontos része. A dietetikai intervenció eredményességét ugyanakkor nagymértékben befolyásolja a páciensek egészségműveltsége. Célkitűzés: Kutatásunk célja az OKOSTÁNYÉR® táplálkozási ajánlás értelmezésében, az egészségműveltség alapján megfigyelhető sajátosságok feltárása volt a dietetikusi tevékenység hatékonyságának növelésére. A krónikus, nem fertőző betegségek társadalmi és gazdasági terheinek csökkentésében a WHO elsődleges beavatkozási pontként a megelőzhető rizikófaktorok csökkentését jelöli meg. A modern egészségügyi szemléletben kiemelt szerepet kap a betegközpontú ellátás, amely a páciensek egyéni szükségleteit, életmódját és motivációit figyelembe véve segíti elő a prevenciót és növeli az életmód-terápia hatékonyságát. Minta és módszer: A kutatás kvalitatív módszertani megközelítésen alapult, fókuszcsoportos interjúk alkalmazásával. Négy, 6 fős (n = 24) online fókuszcsoportos interjú készült. A résztvevők 58%-a nő (14 fő) és 42%-a férfi (10 fő); átlagéletkoruk 50,1 év volt. A résztvevők kiválasztását kvantitatív felmérés előzte meg a HLS-EU47 kérdőív alkalmazásával, amelynek során alacsony, illetve normál egészségműveltségű csoportokat alakítottunk ki a nemzetközileg validált küszöbértékek mentén. A beszélgetések hanganyagait és azok leiratait csoportonként, tematikus egységek szerint elemeztük, multikódolt szisztematikus adatfeldolgozást alkalmazva. A kódolás, elemzés és adatvizualizáció során az NVivo14, valamint a SmartDraw szoftvereket használtuk. Eredmények: A normál és alacsony egészségértésű csoportok életmódja, viselkedése, törekvései alapján eltérő karaktercsoportok különíthetők el. A jobb egészségértés az egészségmegőrzést segítő megküzdési stratégiákkal párosult. Az OKOSTÁNYÉR® ajánlás ismertsége mérsékelt (33,3%), különösen az alacsony egészségértésű csoportokban (16,6%). Nehézséget okoz – alacsony egészségműveltség esetén különösen – a sok egészséginformáció közötti navigáció. Egy ideális táplálkozási tanáccsal kapcsolatban a résztvevők kiemelték a hiteles információforrás fontosságát, azonban táplálkozási kérdésekkel elsősorban az internet, a közösségi média felé fordulnak, csak kialakult betegség esetén kérik szakember segítségét. Az ajánlásokat személyes szokásaik, meggyőződésük alapján ítélik meg, ezek tükrében „korrigálják”. Következtetés: Az alacsony egészségműveltség jelentős akadálya lehet a hatékony dietetikai intervencióknak. A jövőben elkerülhetetlen az egészségügyi kommunikáció, például a táplálkozási ajánlások célzott fejlesztése, az alacsony egészségműveltségű csoportok irányított támogatása, mint a táplálkozási kompetenciák fejlesztése, a személyre szabott, páciensközpontú dietetikai tanácsadás hatékonyságának növelésére. Orv Hetil. 2026; 167(24): 952–964.
Cancer poses a significant global healthcare challenge, and individual health literacy directly impacts screening and the adoption of self-care behaviors. This study aimed to compare health literacy scores for four cancers (colorectal, esophageal, lung, and kidney) among Chinese urban residents and to identify associated factors. A descriptive cross-sectional study recruited 1,226 urban adults via professional networks across China. Participants provided demographic data and completed a validated health literacy questionnaire. Multiple linear regression was used to analyze associations with health literacy scores. Health literacy scores ranked as follows: colorectal (7.50 ± 3.35), esophageal (6.27 ± 3.15), lung (5.88 ± 3.07), and kidney (4.30 ± 2.89). Education and household income emerged as consistent predictors of health literacy across all cancers. Age, sex, employment status, and a family history of cancer were associated with colorectal cancer health literacy scores. Participants who reported higher levels of health literacy scores in esophageal cancer were older and had a previous cancer diagnosis. Participants who reported higher lung cancer health literacy scores were older, female, retired, and had a family history of cancer. Factors contributing to higher kidney cancer health literacy scores included education, annual household income, and non-smoking status. Urban residents demonstrated moderate levels of cancer-related health literacy, and public health strategies should be targeted toward people with lower education and reduced annual household income. Implication for Practice: This research highlights the need for targeted educational interventions in community healthcare settings to identify urban residents at high risk of low health literacy, ultimately strengthening the reach and impact of cancer screening and prevention programs.
Type 2 Diabetes Mellitus (T2DM) presents a major public health challenge globally, disproportionately affecting Indian migrants who are vulnerable to diabetes-related complications due to cultural, linguistic and systemic barriers that can limit access to timely and effective care. Health literacy is a key determinant of T2DM management, yet its association with medication adherence in this population remains underexplored. This study investigates the association between performance-based (objectively assessed) and self-reported (subjectively assessed) health literacy and medication adherence among Indian migrants with T2DM, while accounting for a range of demographic, socioeconomic and health-specific factors. A cross-sectional study design was employed. Participants (n = 309) were recruited through multicultural health services, and hospital diabetes clinics across Greater Western Sydney, a socioeconomically and culturally diverse area of Sydney, NSW, Australia. Eligible participants self-identified as Indian, were aged 18 years or older, had been diagnosed with T2DM for at least one year, and were currently prescribed diabetes medication. Data were collected via a structured survey and analysed using multivariate logistic regression. Low health literacy was prevalent among Indian migrants, with over 67.6% demonstrating low performance-based health literacy and 62.5% reporting low self-reported health literacy. Approximately 68.9% of participants had low medication adherence. Lower medication adherence was significantly and positively associated with lower health literacy, both performance-based (adjOR=9.14, 95%CI: 4.24-19.72; p = <0.001) and self-reported (adjOR=12.45, 95%CI: 4.55-34.10; p = <0.001). Key predictors of medication adherence included health literacy, private health insurance, BMI, glucose level, comorbidities and social support. Models differed slightly depending on the type of health literacy assessed. Health literacy plays an important role in diabetes self-management for Indian migrants. These findings highlight the need for culturally tailored interventions that address both health literacy support - such as improving understanding of medical information and navigating healthcare systems - and social or family support systems that influence health behaviours and decision-making.
Community awareness of swallowing and dysphagia plays a significant role in improving early-referral behavior. Literature reports that community awareness of swallowing and dysphagia in the Western countries to be low. Conversely, India has a diverse cultural, linguistic and healthcare-related factors which may influence the health-seeking behavior and early-referral of dysphagia. Hence, it becomes difficult to generalize the findings of existing literature. The primary objective of this study was to analyze the knowledge, attitudes and practices (KAP) related to swallowing and dysphagia among the community dwelling adults of South India. The secondary objective was to evaluate if age, sex and education levels were associated with these factors. Community dwelling adults were recruited from Mangalore city, India for a cross-sectional survey using a convenience sampling design. A purposive built content validated 27-item questionnaire was distributed using Google Form and/or hard copies to the participants for data collection. Participant's responses were independently analyzed by two Speech Language Pathologists using open content analysis. The responses were summarized as percentages and categories and chi square test was administered to examine the association between age, sex and education levels and KAP enquiries at 0.05 level. A total of 372 participants aged 20-79 years (mean age = 46.26; SD = 15.63) participated in the study. Participants demonstrated limited knowledge of signs, causes, complications and professional management of dysphagia. Aspiration was widely recognized as unsafe, yet only one-tenth correctly identified pneumonia as a complication of dysphagia. Less than one-fifth knew the treatment options for dysphagia. Attitudes reflected fear of choking, discomfort towards nasogastric-tube feeding and moderate willingness to seek help from healthcare professionals. Practices suggested low awareness of Heimlich maneuver, inconsistent food-texture modification and reliance on water to manage dry mouth. Age, sex and education levels were significantly associated with knowledge (saliva is important for chewing, avoid eating in public space to overcome stigma, early intervention helps regain swallowing abilities, age range frequently associated with dysphagia), attitude (fear of choking, preference to non-oral feeds), practices (using internet to find solutions for dysphagia, drinking water before meals or moistening food using water, changing food consistencies, using straw over cup) at p > 0.05 level. Community dwellers demonstrated insufficient knowledge, predominantly negative attitudes and unsafe self-management practices related to swallowing and dysphagia. Strengthened public education, early-referral pathways and inclusion of basic life-support skills are highly warranted to improve community awareness on swallowing and dysphagia. What is already known on this subject Community awareness of dysphagia is low in Western countries. Cultural beliefs, literacy, superstition and access to healthcare influence what people know, how they respond and when they seek help. Understanding knowledge, attitude and practices (KAP) of swallowing and dysphagia in India is critical for reducing self-management risks and improving early-referral behavior. What this study adds to existing knowledge The study provides the first structured KAP analysis on swallowing and dysphagia in an Indian community . Participants recognized aspiration as dangerous, yet lacked awareness of critical signs, causes, treatment options and responsible team members. Fear of choking was high, and most were uncomfortable with tube-based feeding. The public seldom employed safe compensatory strategies and very few were familiar with Heimlich maneuver or food-texture modification. Age, sex and education levels were significantly associated with multiple KAP variables. What are the clinical implications of this work? There is an urgent need to conduct more public awareness programs on prevention, early identification and intervention of dysphagia by healthcare professionals involved in dysphagia care. Efforts must be scaled to provide basic life support (BLS) skills training programs, including training in Heimlich maneuver, to the public.
Healthcare litigation is increasing globally and imposes significant emotional, financial and reputation and trust-related costs. Orthopaedic and spine surgery carry particularly high medico-legal risk because of technical complexity, uncertain outcomes and heightened patient expectations. Alternative dispute resolution (ADR), especially mediation, offers confidential and collaborative means to both prevent and resolve conflict. To (i) examine litigation-prevention strategies and ADR modalities applicable to orthopaedic and spine practice; (ii) synthesise common sources of conflict, the advantages of ADR over litigation and implementation challenges within the Nigerian health system and (iii) propose recommendations for hospital governance, professional regulation and incorporation of ADR training in medical education. A narrative review of English-language literature was conducted across biomedical databases and grey sources using predefined keywords ADR, ADR processes with outcome and barriers in low- and middle-income countries, and patient safety. Eligible studies included empirical research and programme reports. Thematic synthesis focused on conflict drivers, mediation, on medical litigation, orthopaedics, policy and legal analyses, preventive mechanisms and spine surgery. One hundred and fifty-two sources met the inclusion criteria. Major conflict drivers were consent and communication failures, poor documentation, expectation-outcome mismatch, disputes over surgical indication, peri-operative complications, implant and device issues, financial hardship and delayed presentation. ADR consistently showed advantages in cost, timeliness, confidentiality, therapeutic relationship preservation and learning potential. Barriers included weak institutional ADR frameworks, limited mediator clinical literacy, fragmented regulation, low insurance penetration and poor quality-improvement data. ADR provides an effective, confidential approach to reducing litigation in orthopaedic and spine practice by addressing communication failures early and preserving therapeutic relationships. Strengthening consent, documentation, institutional ADR pathways and mediator clinical skills, supported by policy reforms and ADR education, can reduce preventable conflicts and promote safer, more accountable surgical care in Nigeria.
Digital health literacy has become essential for effective clinical practice as healthcare systems increasingly adopt digital technologies. However, many low- and middle-income settings continue to face substantial gaps in digital readiness among the health workforce. Despite growing national initiatives to expand digital health in Ethiopia, evidence on digital health literacy among healthcare professionals in the eastern part remains limited. Therefore, this study aimed to assess the level of digital health literacy and its determinants among healthcare professionals in Eastern Ethiopia. A cross-sectional study was conducted from May 1-30, 2025, among 401 randomly selected healthcare professionals working in three public and private hospitals. Data were collected using a structured questionnaire based on the European Digital Competence framework and analyzed using STATA (V17.0). Multivariable logistic regression was used to identify independent predictors of digital health literacy with significance set at p < 0.05. Out of 401 participants, 50.6% (95% CI: 45.62-55.62) of health professionals had adequate digital health literacy. Internet access (AOR = 3.89, 95% CI: 1.21-12.47), digital technology training (AOR = 6.24, 95% CI: 3.46-11.26), higher perceived usefulness (AOR = 2.87, 95% CI: 1.51-5.46), perceived ease of use (AOR = 1.90, 95% CI: 1.02-3.57), and good computer literacy was significant predictors of adequate digital health literacy (AOR = 3.11, 95% CI: 1.71-5.68). Digital health literacy among healthcare professionals in the Harari region is relatively low compared to global standards. Strengthening digital infrastructures, expanding structured digital trainings, and creating user-friendly digital environment are essential to improve digital health literacy.
Adverse childhood experiences (ACEs), toxic stress, relational insecurity, and structural adversity are major public-health concerns for children and adolescents, but ACE evidence should not be treated as an individual diagnostic score or deterministic prognosis. This Hypothesis and Theory article proposes developmental literacy and epistemic dignity as linked upstream constructs for primary child protection. Developmental literacy is defined as developmentally staged and disability-inclusive neurobiopsychosocial knowledge and skills concerning bodies, emotions, stress, attachment, co-regulation, play, nutrition, safety, rights, boundaries, non-violent care, and help-seeking. Epistemic dignity refers to the supported capacity and right of children-including preverbal, disabled, neurodivergent, and communication-diverse children-to have bodily, emotional, relational, play-based, and communicative signals interpreted with seriousness, humility, and appropriate response. Drawing on research on ACEs and positive childhood experiences (PCEs), nurturing care, relational health, health-promoting schools, social and emotional learning, mental-health literacy, sexuality/safety education, child participation, epistemic injustice, disability studies, implementation science, and critiques of ACE and trauma-informed practice, the article develops a universal, proportionate, relationally safe, anti-bias, and non-coercive public-health framework. It argues that early-childhood services, schools, pediatric/public-health touchpoints, caregiver support, and community systems can provide age-appropriate developmental knowledge without turning schools into clinics, teachers into trauma detectors, or children into individual risk scores. The framework does not recommend routine individual ACE-score screening in schools as a default practice; it supports ethically governed, service-linked pathways for recognizing distress and unmet support needs. Coercive reproductive control is treated only as a rejected comparator because it targets reproductive status rather than modifiable developmental environments, support access, and institutional trust. The article concludes with safeguards and testable hypotheses for evaluating developmental literacy, epistemic dignity, relational safety, accessibility, help-seeking, response quality, caregiver support, referral continuity, and unintended harms.
Tuberculosis (TB) remains a critical public health challenge in India, where sustained patient engagement is essential for its effective management. Despite the pivotal role of health literacy, the ability to access, understand, appraise, and apply health-related information in treatment adherence and outcomes, few tools are TB specific, culturally attuned to India, and psychometrically validated. The Health Literacy Instrument for Adults (HELIA), developed in Iran, is a multidimensional, World Health Organization (WHO)-aligned measure with proven reliability and open access, making it an ideal candidate for adaptation. This study aimed to culturally adapt and validate the HELIA for use among adults receiving TB treatment in India (HELIA-TB). An exploratory sequential mixed-methods design was employed for the cultural adaptation and psychometric validation of the HELIA-TB in Junagadh district, Gujarat, India, between March 2024 and March 2025. The qualitative phase included expert review, forward translation, cognitive interviews with adults with TB and  frontline healthcare workers, back translation, and pilot testing, following international cross-cultural validation guidelines. Findings from the qualitative phase directly informed item modification, simplification of terminology, and contextual adaptation of the HELIA-TB prior to quantitative psychometric validation. The finalized instrument was subsequently administered to 393 adults with TB to assess internal consistency, test-retest reliability, content validity, and construct validity. HELIA-TB retained the original five domains, access, reading, understanding, appraisal, decision-making with TB specific modifications. Internal consistency and test-retest reliability were high (α = 0.82-0.89 across domains; 0.86 overall; ICC = 0.88), and so was content validity (S-CVI/Ave = 0.92). Health literacy scores were significantly associated with treatment adherence (Cohen's d = 0.89, p < 0.001) and self-rated health (Cohen's d = 0.76, p < 0.001). No significant differences were observed by TB type or drug resistance status. The adapted HELIA-TB demonstrated satisfactory psychometric properties and may support assessment of health literacy and development of targeted TB care interventions in the Indian context.
The study aims to analyze the association pathways of factors related to oral health behaviors among older diabetic patients in Shanghai, China, using the COM-B model. A convenience sample of 358 older diabetic patients was enrolled between July 2025 and December 2025 from one tertiary hospital and a community health service center in Shanghai. Information was collected via a general information questionnaire, the Older Oral Health Knowledge, Belief and Behavior Questionnaire, the 14-item Health Literacy in Dentistry Scale, the Perceived Social Support Scale, the Geriatric Self-Efficacy for Oral Health Scale, and the 5-item Geriatric Depression Scale. Descriptive statistics, univariate analysis, correlation analysis, and path analysis were adopted to analyze the relevant factors and pathways of oral health behaviors. The constructed structural equation model showed satisfactory goodness of fit (χ2/df = 2.173, NFI = 0.987, TLI = 0.976, CFI = 0.991, RMSEA = 0.07, and SRMR = 0.0474). Capability factors, including oral health literacy (β = 0.205) and oral health knowledge (β = 0.155), the opportunity factor of social support (β = 0.169), motivational factors covering oral health self-efficacy (β = 0.377), oral health belief (β = 0.225), and depression (β = -0.107), could all be directly associated with oral health behaviors. Oral health self-efficacy mediated the associations of oral health literacy (β = 0.199), oral health knowledge (β = 0.072), social support (β = 0.049), and depression (β = -0.044) with oral health behaviors. Oral health belief mediated the relationships of oral health literacy (β = 0.054) and oral health knowledge (β = 0.135) with oral health behaviors. Depression acted as a mediator between social support (β = -0.056) and oral health behaviors. Capability factors, opportunity factors, and motivational factors are directly or indirectly associated with the oral health behaviors among older diabetic patients. This suggests that clinicians regularly conduct diabetes-related oral health education and cleaning skills training, encourage relatives to provide supervision, improve access to oral healthcare, and provide psychological counseling to improve patients' oral health behaviors in terms of capability, opportunity, and motivation.
Resource extraction poses a substantial environmental justice problem globally. Community-based efforts to increase environmental health literacy have been linked with reducing exposure and increasing positive health outcomes. However, there is a gap in community-based environmental justice work centering around the education and needs of youth in rural communities. Using frameworks of environmental health literacy, an Ecological Model of Health, and Funds of Knowledge, we facilitated the ongoing STEAM in Action project, where we hosted two community-based youth environmental health trainings in environmental justice communities in rural Arizona. Photovoice, poster activities, environmental monitoring, data visualization, participant observation, pre- and post-surveys, focus groups, and follow-up interviews were quantitatively and qualitatively analyzed to understand youth environmental health literacy, concerns, and capacity for action. Survey results indicated that 83% (n = 36) of youth's motivation to take action increased as a result of the training. Environmental health literacy was demonstrated by youth's knowledge and awareness of local environmental issues and solutions, highlighting environmental pollution from littering and industry, health issues like drug use, and a culture of stubbornness. Unique activities like Photovoice, environmental monitoring, and data visualization provided youth hands-on experiences to increase environmental health literacy. Trainings through the "STEAM in Action" project allowed youth to surface taboo issues in their towns, while building the knowledge and skills to understand and address environmental justice issues in their communities. Future work will build out advisory boards, critical consciousness, and environmental justice trainings in service of collective action to affect community change.
My Kidneys & Me (MK&M) is a digital health intervention (DHI) codeveloped to provide specialist health and lifestyle education aimed at enhancing self-management among individuals with chronic kidney disease. The MK&M DHI was shown to improve self-management behaviors in a multicenter randomized controlled trial (SMILE-K), but strategies to support effective integration into routine clinical practice are not known. This study aimed to explore patient perspectives about real-world implementation and sustainability of the MK&M DHI. For this substudy, participants from the SMILE-K trial were invited to take part in a semistructured qualitative interview to explore their perspectives on the implementation and sustainability of the MK&M DHI in routine clinical practice. Barriers and facilitators that could potentially influence the uptake and usage of the program in real-world settings, outside of a clinical trial, were also explored. Topics included accessibility, usability, integration into routine care, and types of support required to sustain engagement over time. Data were analyzed using reflexive thematic analysis. A total of 42 interviews were conducted with 35 individuals (mean age 62.5, SD 9.9, range 38-84 years; 23/35, 66% male; 33/35, 94% White British; estimated glomerular filtration rate: mean 33.5, SD 12.4 mL/min/1.73 m2). Five themes were identified, encompassing a range of critical factors that should be addressed to ensure the successful implementation of MK&M into routine kidney care and its alignment with real-world clinical needs. These include ensuring that information is timely, relevant, and tailored to individual needs. Participants highlighted the importance of promotion through multimodal strategies and approaches, leveraging diverse communication channels to maximize reach and engagement. Equitable access was identified as a priority, with potential barriers, such as digital literacy and digital poverty, requiring attention. Building trust, through reassurance and endorsement from trusted health care professionals, was seen as essential to strengthen confidence in MK&M. Finally, participants stressed the need for continued engagement and sustainability, ensuring that MK&M is successfully integrated into care pathways and supported over time to maintain its impact. The study findings highlight that timely, well-targeted communication using diverse strategies will be critical for the successful uptake of MK&M among people living with chronic kidney disease. The identification of perceived factors that will influence implementation of the program provides actionable insights to guide the development of tailored implementation strategies to ensure that MK&M is relevant, acceptable, and feasible in real-world practice. These findings provide a foundation for designing approaches that are not only patient-centered and inclusive but also adaptable to diverse clinical contexts. By addressing these factors proactively, implementation efforts can promote equitable access, foster sustained engagement, and support the long-term integration of DHIs, such as MK&M, into routine kidney care.
Early childhood offers an important opportunity to lay the foundations for lifelong health literacy. The Little Aussie Bugs (LAB) dialogic book series and online professional development (PD) course were designed to support Early Childhood Education and Care (ECEC) educators to embed health literacy concepts, including hygiene, healthy eating, and oral health, into everyday learning routines. This mixed methods study evaluated the course pilot and examined its contribution through the lens of the Ottawa Charter for Health Promotion-a framework comprising five interrelated action areas: building healthy public policy; creating supportive environments; strengthening community action; developing personal skills; and reorienting health services. Quantitative findings demonstrated statistically significant improvements in educators' overall health literacy scores and confidence using dialogic reading to deliver health messages. Educators reported enhanced capability to support children's understanding of health behaviors. Qualitative findings revealed educators' experiences embedding learning and LAB resources into daily routines, strengthening their confidence, supporting communications with families, and aligning practice with policy and accreditation expectations. Applying the Charter sharpened research insights into how the intervention developed personal skills and created supportive environments, while also illuminating structural gaps in policy alignment, educator training, and equitable implementation. This evaluation demonstrates how applying the Charter can support analysis of digital, early-years health promotion initiatives and help identify system-level supports for their sustainability. It also shows the course is an accessible and scalable approach to embed health literacy across ECEC settings. Implications for early-years PD and health literacy practice are discussed through the lens of the Charter.
To assess public and healthcare professional knowledge, attitudes, perceptions and behaviours regarding spatial computing technologies, virtual reality (fully immersive computer-generated environments), augmented reality (digital overlays on the physical world) and mixed reality (spatially anchored holograms) in healthcare, with a focus on perceived benefits for self-care and barriers to adoption in primary care and community settings. Cross-sectional online survey. UK-wide, web-based survey conducted between January 2025 and August 2025. Community-dwelling adults aged ≥18 years residing in the UK, including healthcare professionals. A total of 405 respondents completed the survey; 41 were healthcare professionals. No intervention was delivered. Participants completed a structured questionnaire assessing familiarity with spatial computing, perceived utility across self-care domains aligned to the Seven Pillars of Self-Care and perceived barriers to adoption. Primary outcomes were self-reported familiarity with spatial computing technologies and perceived benefit across self-care domains. Secondary outcomes included perceived barriers to adoption and associations between demographic characteristics and familiarity. Analyses used descriptive statistics and exploratory inferential tests (χ², Fisher's exact, Friedman and Wilcoxon signed-rank tests with Bonferroni correction). Most respondents (71.4%) reported familiarity with spatial computing technologies, although regular use was uncommon (4.7%). Oculus Quest (57.5%) and Apple Vision Pro (46.9%) were the most recognised platforms. Participants perceived strong potential for supporting health literacy, mental well-being and physical activity, particularly through guided mindfulness, avatar-led exercise and immersive patient education. Perceived benefit was lower for medication management and dietary guidance. Familiarity was statistically associated with gender (p<0.001), age (p=0.002) and ethnicity (p=0.006), with higher awareness among men, younger adults and some minority ethnic groups. The most frequently cited barriers to adoption were high cost (56.5% rating as critical), lack of training (67.4% rating 4-5) and data privacy concerns (63.5%). Spatial computing is viewed positively by the public and healthcare professionals as a tool to support self-care and aspects of healthcare delivery, particularly health literacy, mental well-being and physical activity. However, high cost, training gaps and privacy concerns remain substantial barriers. Targeted investment in evidence generation, workforce training and inclusive governance will be necessary to support equitable and responsible implementation.
Nurses in general hospitals play a critical role in identifying and managing patients with comorbid physical and mental health conditions. However, under current educational and training systems, their professional competence in mental health often faces limitations. This study aims to identify latent profiles of mental health literacy among nurses in tertiary general hospitals in Chongqing, China, using latent profile analysis (LPA), and to explore associated sociodemographic and occupational factors, thereby providing a scientific basis for targeted and stratified intervention strategies. A cross-sectional study was conducted using a multistage stratified cluster sampling method from April to May 2023. Based on the gross domestic product levels of 38 districts and counties in Chongqing, regions were stratified into high-, medium-, and low-economic levels. A total of nine tertiary general hospitals were randomly selected from each stratum. Nurses meeting the inclusion criteria were recruited using department-based cluster sampling. Data were collected using a self-designed demographic questionnaire and the Chinese version of the Mental Health Literacy Scale (MHLS-C). The MHLS-C comprised four dimensions: knowledge of mental disorders ("knowledge"), ability to seek information and help ("ability"), recognition of mental disorders ("recognition"), and acceptance of individuals with mental illness ("acceptance"). LPA was performed to identify latent profiles, with model fit evaluated using entropy and multiple information criteria. Considering the nested structure of participants within hospitals, multivariable generalized estimating equations (GEE) were used to analyze associated factors, with departments treated as clustering units. The latent profiles are identified based on LPA, and considering the Bayesian information criterion (BIC), sample-size adjusted BIC (aBIC), Akaike information criterion (AIC), and clinical interpretability. A total of 1 492 valid participants were included, with a mean MHLS-C score of 92.38±10.04. Based on LPA, and considering the BIC, aBIC, AIC, and clinical interpretability, 3 distinct latent profiles were identified: Profile 1 ("low cognition-moderate acceptance", n=90, 6.03%): very low scores in knowledge, ability, and recognition, but moderate acceptance; Profile 2 ("moderate cognition-low acceptance", n= 886, 59.38%): moderate cognitive scores but the lowest acceptance; Profile 3 ("high cognitive-moderate acceptance", n=516, 34.59%): high cognition levels with moderate acceptance. Using Profile 3 as the reference, multivariable GEE analysis showed that nurses who had received professional psychological interventions (OR=3.742, 95% CI 2.124 to 6.592), had not received mental health training (OR=2.136, 95% CI 1.705 to 2.677), or had an annual income ≤100 000 CNY (OR=2.682, 95% CI 1.284 to 5.605) were more likely to be classified into Profile 1 (all P<0.05). Male sex (OR=2.104, 95% CI 1.309 to 3.382), aged≥30 years (OR=1.476, 95% CI 1.013 to 2.150), being married (OR=1.358, 95% CI 1.069 to 1.725), working in intensive care units (OR=2.286, 95% CI 1.543 to 3.387) or surgical departments (OR=1.499, 95% CI 1.141 to 1.969), lack of mental health training (OR=1.573, 95% CI 1.326 to 1.866), employment in county-level hospitals (OR=1.353, 95% CI 1.043 to 1.754), and annual income ≤100 000 CNY (OR=1.558, 95% CI 1.206 to 2.014) were significantly associated with Profile 2 (all P<0.05). Significant heterogeneity exists in mental health literacy among nurses in tertiary general hospitals in Chongqing. Personal help-seeking experience, lack of professional training, and high-pressure work environments are key determinants of profile membership. Future interventions should move beyond a "one-size-fits-all" approach and adopt stratified strategies: for the "low cognition-moderate acceptance" group, emphasis should be placed on improving knowledge; for the "moderate cognition-low acceptance" group, anti-stigma interventions and cognitive burden reduction are needed; for the "high cognition-moderate acceptance" group, efforts should focus on enhancing humanistic reflection and psychological empowerment. Such tailored approaches may ultimately contribute to the development of a holistic nursing care system. 目的: 综合医院护士是识别和处理躯体-精神共病患者的核心力量，但现行教育培训体系下其精神卫生专业储备常面临瓶颈。本研究旨在通过潜在剖面分析(latent profile analysis，LPA)，精准识别重庆市三级综合医院护士心理健康素养的潜在类别，并探讨不同群体剖面的特征及其社会人口学、职业环境相关因素，从而为制订靶向性、分层精准干预策略提供科学依据。方法: 本研究采用横断面调查设计和多阶段分层整群抽样方法，于2023年4月至5月，基于重庆市38个区县的国内生产总值进行高、中、低经济发展层级分层后，在各层级中随机抽取共9家三级综合医院，然后以科室为单位，对符合纳入与排除标准的在岗护士进行整群调查。研究工具包括自行设计的一般资料问卷及中文版心理健康素养量表(Chinese version of the Mental Health Literacy Scale，MHLS-C);其中，对MHLS-C的分析包括心理障碍知识(以下简称“知识”)、寻求信息和帮助的能力(以下简称“能力”)、心理障碍的识别(以下简称“识别”)及对精神疾病患者的接纳(以下简称“接纳”)4个维度。使用LPA进行模型拟合，评价指标包括信息熵及各类拟合准则;由于存在医院与研究对象的嵌套结构，采用多变量广义估计方程(generalized estimating equations，GEE)分析相关因素，并以科室作为聚类变量。综合考量贝叶斯信息准则(Bayesian information criterion，BIC)、样本量校正的BIC(sample-size adjusted BIC，aBIC)、赤池信息准则(Akaike information criterion，AIC)及临床解释意义的分析结果，以识别潜在剖面。结果: 最终共纳入1 492名研究参与者，MHLS-C总分为92.38±10.04。结合LPA结果，综合考量BIC、aBIC、AIC及临床解释意义的分析结果，最终识别出3个具有显著异质性的潜在类别:剖面1在“知识”“能力”“识别”维度的得分极低，但“接纳”的维度中等，命名为“低认知-中接纳型”(n=90，6.03%);剖面2的各项认知指标得分中等，但“接纳”维度的得分为全样本最低，命名为“中认知-低接纳型”(n=886，59.38%);剖面3的认知水平较高，但“接纳”维度的得分中等，命名为“高认知-中接纳型”(n=516，34.59%)。以“高认知-中接纳型”为参照组的多变量GEE分析结果显示，曾接受专业心理干预(OR=3.742，95% CI 2.124~6.592)、未接受心理知识相关培训(OR=2.136，95% CI 1.705~2.677)及年收入≤10万元(OR=2.682，95% CI 1.284~5.605)的护士更倾向于归入“低认知-中接纳型”(均P<0.05);而男性(OR=2.104，95% CI 1.309~3.382)、年龄≥30岁(OR=1.476，95% CI 1.013~2.150)、已婚(OR=1.358，95% CI 1.069~1.725)、在急危重症医学科(OR=2.286，95% CI 1.543~3.387)或外科(OR=1.499，95% CI 1.141~1.969)工作、未接受心理知识培训(OR=1.573，95% CI 1.326~1.866)、在区县医院工作(OR=1.353，95% CI 1.043~1.754)及年收入≤10万元(OR=1.558，95% CI 1.206~2.014)的护士，归入“中认知-低接纳型”的可能性显著更高(均P<0.05)。结论: 重庆市三级综合医院护士的心理健康素养存在显著的非线性群体异质性。个人心理求助经历、专业培训缺失及高压执业环境是决定剖面归属的关键因素。未来建议摒弃“一刀切”模式，实施分层精准干预:针对“低认知-中接纳型”护士，重在知识补盲;针对“中认知-低接纳型”护士，需推行抗污名化与认知减负策略;针对“高认知-中接纳型”护士，则需强化人文反思与心理赋能，最终构建全人护理生态。.