BMJ Public Health最新文献

{"title":"The process of developing a joint theory of change across three global entities: can this help to make their efforts to strengthen capacity for implementation research more effective?","authors":"G. Aslanyan, Kabir Sheikh, Marta Feletto, P. Launois, Mahnaz Vahedi, Vanessa Brizuela, Anna Thorson, Sara Begg, Susie Crossman, Imelda Bates","doi":"10.1136/bmjph-2023-000029","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000029","url":null,"abstract":"A theory of change is a visual representation of the pathway by which a programme anticipates it will achieve its goal. It usually starts with discussions around the goal and works backwards through outcomes and outputs to activities.We used a theory of change to improve coherence across three research entities at the WHO. Part of the remit of all three entities is to strengthen capacity in low-income and middle-income countries for implementation research.Representatives from the three entities were able to formulate a joint goal for strengthening capacity in implementation research. They identified three pathways by which this could be achieved: (a) conducting implementation research, (b) strengthening implementation research systems and (c) using implementation research for public health priorities.The process of developing the theory of change and the logic framework it created, provided a means to track progress towards the goal and to guide improvements in programmes within their lifetime. The process we used to develop the theory of change and the pathways to achieve the joint goal are adaptable and could be used by other organisations that also aim to strengthen research capacity. This would lead to more coherence, better translation of research findings into decision-making and ultimately improvements in public health.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare access, attitudes and behaviours among Navajo adults during the COVID-19 pandemic: a cross-sectional study","authors":"Heidi E. Brown, Rachelle L Begay, Priscilla R Sanderson, Carmenlita Chief, Breanna Lameman, Robin B Harris","doi":"10.1136/bmjph-2023-000061","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000061","url":null,"abstract":"To assess factors associated with positive COVID-19 tests, perspectives on health-related care delivery during pandemic and factors supporting resilience among members of the Navajo Nation.From May through October 2021, a multi-institutional team recruited participants (n=154) to complete a 49-item questionnaire or participate in a focus group (n=14) about their experience with COVID-19 and the effects on their use and access to allopathic and traditional healthcare. A multi-investigator, phenomenological approach summarised focus group experiences.While 73% had been tested for COVID-19, only 27.8% reported a positive test. Positive tests were not associated with household size or multigenerational homes, though time to grocery store was (p=0.04). There were no significant differences in allopathic or traditional medical care experiences from before and during the pandemic. Despite limited internet access, 28.8% chose a telehealth appointment and 42% expressed satisfaction with their experience. Discussion themes revealed perceived disruptions of healthcare needs with acknowledgement that healthcare providers were supportive throughout the Navajo Nation quarantine.Presence of comorbidities and living in multigenerational homes do not explain the disproportionate effects of COVID-19 among American Indian communities. Strengthening family and community bonds supported resilience in these communities.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do clinicians use post-COVID syndrome diagnosis? Analysis of clinical features in a Swedish COVID-19 cohort with 18 months’ follow-up: a national observational cohort and matched cohort study","authors":"Hanna M Ollila, Osvaldo Fonseca-Rodríguez, I. H. Caspersen, Sebastian Kalucza, Johan Normark, L. Trogstad, P. Magnus, N. H. Rod, Andrea Ganna, Marie Eriksson, Anne-Marie Fors Connolly","doi":"10.1136/bmjph-2023-000336","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000336","url":null,"abstract":"SARS-CoV-2 infection causes acute COVID-19 and may result in post-COVID syndrome (PCS). We aimed to investigate how clinicians diagnose PCS and identify associated clinical and demographic characteristics.We analysed multiregistry data of all SARS-CoV-2 test-positive individuals in Sweden (n=1 057 174) between 1 February 2020 and 25 May 2021. We described clinical characteristics that prompt PCS diagnosis in outpatient and inpatient settings. In total, there were 6389 individuals with a hospital inpatient or outpatient diagnosis for PCS. To understand symptomatology, we examined individuals diagnosed with PCS at least 3 months after COVID-19 onset (n=6389) and assessed factors associated with PCS diagnosis.Mechanical ventilation correlated with PCS (OR 114.7, 95% CI 105.1 to 125.3) compared with no outpatient/inpatient contact during initial COVID-19. Dyspnoea (13.4%), malaise/fatigue (8%) and abnormal pulmonary diagnostic imaging findings (4.3%) were the most common features linked to PCS. We compared clinical features of PCS with matched controls (COVID-19 negative, n=23 795) and COVID-19 severity-matched patients (COVID-19 positive, n=25 556). Hypertension associated with PCS cohort (26.61%) than in COVID-19-negative (OR 17.16, 95% CI 15.23 to 19.3) and COVID-19-positive (OR 9.25, 95% CI 8.41 to 10.16) controls, although most individuals received this diagnosis before COVID-19. Dyspnoea was the second most common feature in the PCS cohort (17.2%), and new to the majority compared with COVID-19-negative (OR 54.16, 95% CI 42.86 to 68.45) and COVID-19-positive (OR 18.7, 95% CI 16.21 to 21.57) controls.Our findings highlight factors Swedish physicians associate with PCS.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antenatal care services in Benin and Tanzania 2021/2022: an equity analysis study","authors":"Walter Ochieng, Anna Munsey, Alen Kinyina, Melkior Assenga, Faustin Onikpo, Alexandre Binazon, Marie Adeyemi, Manzidatou Alao, Sijenunu Aron, Samwel L. Nhiga, Julie Niemczura, Julie Buekens, Chong Kitojo, Erik Reaves, Ahmed Saadani Husseini, Mary Drake, Katherine Wolf, S. Suhowatsky, Aurore Hounto, Ruth Lemwayi, Julie R Gutman","doi":"10.1136/bmjph-2023-000547","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000547","url":null,"abstract":"Antenatal care (ANC) interventions improve maternal and neonatal outcomes. However, access to ANC may be inequitable due to sociocultural, monetary and time factors. Examining drivers of ANC disparities may identify those amenable to policy change.We conducted an ANC services equity analysis in selected public facilities in Geita, Tanzania, where most services are free to the end-user, and Atlantique, Benin, where every visit incurs user fees. Data on total ANC contacts, quality of care (QoC) indicators and wait times were collected from representative household surveys in the catchment of 40 clinics per country and were analysed by education and wealth. We used indices of inequality, concentration indices and Oaxaca-Blinder decompositions to determine the distribution, direction and magnitude of inequalities and their contributing factors. We assessed out-of-pocket expenses and the benefit incidence of government funding.ANC clients in both countries received less than the recommended minimum ANC contacts: 3.41 (95% CI 3.36 to 3.41) in Atlantique and 3.33 (95% CI 3.27 to 3.39) in Geita. Wealthier individuals had more ANC contacts than poorer ones at every education level in both countries; the wealthiest and most educated had two visits more than the poorest, least educated. In Atlantique, ANC attendees receive similar QoC regardless of socioeconomic status. In Geita, there are wide disparities in QoC received by education or wealth. In Atlantique, out-of-pocket expenses for the lowest wealth quintile are 2.7% of annual income compared with 0.8% for the highest, with user fees being the primary expense. In Geita, the values are 3.1% and 0.5%, respectively; transportation is the main expense.Inequalities in total ANC visits favouring wealthier, more educated individuals were apparent in both countries. In Atlantique, reduction of user-fees could improve ANC access. In Geita, training and equipping healthcare staff could improve QoC. Community health services could mitigate access barriers.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic disparity in stage at cancer diagnosis among patients with type 2 diabetes in Dutch primary care: a cross-sectional study","authors":"Jing de Haan-Du, K. Groenier, N. Kleefstra, Bert van der Vegt, Sabine Siesling, G. Landman, G. H. de Bock","doi":"10.1136/bmjph-2023-000050","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000050","url":null,"abstract":"Disparities in cancer stage appear to exist by socioeconomic status (SES) in the Netherlands. We evaluated the association of SES and cancer stage among patients with type 2 diabetes (T2DM) treated in primary care.This cross-sectional study linked data from the primary care Zwolle Outpatient Diabetes Project Integrating Available Care database for T2DM (n=71 648, 1998–2019) to a cancer registry and personal records database in the Netherlands. Only cancers (excluding all skin cancers) diagnosed after the onset of diabetes were included and grouped by stages (III–IV or 0–II). SES was estimated as low, intermediate or high based on postal codes and Dutch social research status scores. Logistic regression was performed, with stratification by sex and correction for age, body mass index, smoking, diabetes duration, glycaemic control and metformin use. ORs and 95% CI are reported.Of the 5087 males and 4021 females with any cancer, 50.1% and 53.7% had low SES, respectively. Compared with patients with high SES, the ORs for diagnosing cancer at stages III–IV in patients with low SES were 1.00 (95% CI 0.84 to 1.19) for males and 1.32 (95% CI 1.06 to 1.67) for females. However, the ORs varied by cancer type: breast, 1.46 (95% CI 0.90 to 2.39); male colorectal, 1.00 (95% CI 0.70 to 1.43); female colorectal, 1.72 (95% CI 1.06 to 2.77); prostate, 0.81 (95% CI 0.57 to 1.15); male lung, 1.06 (95% CI 0.62 to 1.80) and female lung, 2.56 (95% CI 1.32 to 4.95).Among patients treated for T2DM in Dutch primary care, our data suggest the need to target females with low SES to decrease inequalities in the early detection of colorectal and lung cancer.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness, cost-effectiveness and return on investment of individual placement and support compared with traditional vocational rehabilitation for individuals with severe mental illness in the Netherlands: a nationwide implementation study","authors":"M. Vukadin, W. Zwinkels, F. Schaafsma, M. Spijkerman, Marloes de Graaf-Zijl, Philippe Delespaul, Jaap van Weeghel, Johanna Maria van Dongen, Johannes R Anema","doi":"10.1136/bmjph-2023-000393","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000393","url":null,"abstract":"To assess the effectiveness, cost-effectiveness and return on investment of individual placement and support (IPS) implemented through a reimbursement strategy on a nationwide scale compared with traditional vocational rehabilitation (TVR) regarding sustainable participation in competitive employment in individuals with severe mental illness receiving sickness or disability benefits.An observational study was conducted using administrative data regarding all Dutch individuals receiving sickness or disability benefits in the period 2012–2019. Exact matching and difference-in-difference fixed-effect estimations were performed to handle the non-randomised nature of the data. The matched sample consisted of 863 IPS and 16 466 TVR participants. The primary effect measure was the proportion of individuals having worked for at least 48 hours per month in competitive employment (ie, for 12 hours or more per week); the proportion of individuals having worked in competitive employment for at least 1 hour per month was also evaluated. Cost-effectiveness and return on investment were assessed from the societal perspective (intervention, sickness/disability benefit and healthcare costs) and payer perspective (sickness/disability benefit costs).IPS led to a statistically significant higher probability of being competitively employed for at least 12 hours per week of 3.7% points (95% CI 0.8% to 6.7%) to 7.5% points (95% CI 3.8% to 11.3%) and of being competitively employed for at least 1 hour per month of 4.7% points (95% CI 1.6% to 7.7%) to 8.9% points (95% CI 5.2 to 12.6%) from 6 to 36 months after starting the intervention. From the societal and payer perspective, IPS was—on average—less costly and more effective than TVR and return-on-investment estimates showed that IPS was—on average—cost saving (eg, societal perspective: ∆C: −364 (95% CI −3977 to 3249); ∆E: 0.104 (95% CI 0.046 to 0.164); benefit–cost ratio: 2.1 (95% CI −14.8 to 19.1)), but the uncertainty surrounding these estimates was large.IPS implemented through a reimbursement strategy on a nationwide scale is more effective and potentially cost-effective than TVR in people with severe mental illness receiving sickness or disability benefits. Based on these results, the implementation of IPS by a wide scale reimbursement strategy could be promoted to enhance sustainable participation in competitive employment in these individuals. Future economic evaluations should strive for a more robust sample size and a long follow-up period.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140270736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of NepaDengue mobile application for dengue prevention and control: user and stakeholder perspectives in Nepal","authors":"Anita Mahotra, Yuvraj Pokhrel, Tulsi Ram Thapa, E. Arguni, Riris Ahmad Andono","doi":"10.1136/bmjph-2023-000599","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000599","url":null,"abstract":"Dengue has emerged as a significant public health issue in Nepal since 2006, necessitating innovative approaches to disseminating timely information and promoting preventive behaviour. Our study focuses on developing and pretesting a mobile health app called NepaDengue, assessing its acceptance and factors influencing its implementation.A concurrent triangulation mixed-method design was used, and an intervention was conducted among 228 university students using the mobile application. Acceptability was assessed using the technology acceptance model (TAM) based on user experiences over 1 week. Focus group discussions among students and female community health volunteers and key informant interviews among key dengue stakeholders were conducted to explore facilitators and barriers. Descriptive statistics were calculated, and a thematic analysis was conducted.The high acceptability mean rating scores reported based on the TAM construct indicate that the application is perceived as useful and easy to use and exhibits good functioning and gestural design. The use of the NepaDengue application for dengue prevention and control activities has been perceived as acceptable by users and stakeholders. However, specific barriers were identified, including concerns about sustained usability, illiteracy and limited access to the internet and smartphones. We suggested promoting the application, fostering government ownership and encouraging collaboration to enhance its reach and effective implementation.The NepaDengue application has been perceived as a promising tool for dengue prevention and control in Nepal. Further piloting and implementation of the app in the community setting is recommended.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Varying circumstances surrounding opioid toxicity deaths across ethno-racial groups in Ontario, Canada: a population-based descriptive cross-sectional study","authors":"Tonya J Campbell, S. Kitchen, Mina Tadrous, Cynthia Damba, Colin H Johnson, Ashley Smoke, Frank Crichlow, Tara Gomes","doi":"10.1136/bmjph-2023-000480","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000480","url":null,"abstract":"The North American toxic drug crisis has been framed as an epidemic primarily affecting white people. However, evidence suggests that deaths are rising among racialised people. Accordingly, we sought to describe and compare characteristics and circumstances of opioid toxicity deaths across ethno-racial groups.We conducted a population-based, descriptive cross-sectional study of all individuals who died of accidental opioid toxicity in Ontario, Canada between 1 July 2017 and 30 June 2021. Decedents were categorised as Asian, black, Latin American or white. We summarised decedents’ sociodemographic characteristics, circumstances surrounding death and patterns of healthcare utilisation preceding death by ethno-racial group, and used standardised differences (SDs) to draw comparisons.Overall, 6687 Ontarians died of opioid toxicity, of whom 275 were Asian (4.1%), 238 were black (3.6%), 53 were Latin American (0.8%), 5222 were white (78.1%) and 899 (13.4%) had an unknown ethno-racial identity. Black people (median age: 35 years; SD: 0.40) and Asian people (median age: 37 years; SD: 0.30) generally died younger than white people (median age: 40 years), and there was greater male predominance in deaths among Asian people (86.2%; SD: 0.30), Latin American people (83.0%; SD: 0.21) and black people (80.3%; SD: 0.14) relative to white people (74.6%). Cocaine contributed to more deaths among black people (55.9%; SD: 0.37) and Asian people (45.1%; SD: 0.15) compared with white people (37.6%). Racialised people had a lower prevalence of opioid agonist treatment in the 5 years preceding death (black people: 27.9%, SD: 0.73; Asian people: 51.1%, SD: 0.22; white people: 61.9%).There are marked differences in the risk factors, context and patterns of drug involvement in opioid toxicity deaths across ethno-racial groups, and substantial disparities exist in access to harm reduction and treatment services. Prevention and response strategies must be tailored and targeted to racialised people.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140276858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between chronic pain and attrition: a prospective analysis of a national sample of midlife adults in the USA, 2004–2014","authors":"Yunlong Liang","doi":"10.1136/bmjph-2023-000564","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000564","url":null,"abstract":"Health conditions of participants can significantly affect longitudinal drop-out in population-based epidemiological surveys, yet few studies have examined the association between chronic pain (CP) and follow-up attrition.The Midlife in the United States study (MIDUS) was used to explore the longitudinal association between CP and survey attrition. CP was assessed by three measures: the presence of CP, CP interference and the number of pain sites at MIDUS 2. The types of sample attrition at MIDUS 3 encompassed several categories: complete, refusal to participate, inability to participate due to physical or mental constraints, deceased, non-working numbers, participants consistently unavailable for interviews, global refusal or withdrew from the study and not fielded. Multinomial logistic regression was employed to examine these relationships and to explore the moderation effects of sociodemographic variables and multiple chronic conditions on these associations.High-interference pain was associated with a 162% increased risk (RR 2.62, 95% CI 1.12 to 6.16, p=0.026) of being physically and mentally unable to participate in MIDUS 3. Individuals reporting the presence of CP (RR 0.65, 95% CI 0.45 to 0.95, p=0.028) and those with three or more CP sites (RR 0.48, 95% CI 0.27 to 0.87, p=0.016) were less likely to refuse participation in MIDUS 3. However, no further significant associations or moderating effects were identified.Population-based epidemiological surveys may be susceptible to attrition bias from participants with CP, necessitating the adoption of adaptive survey methodologies.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140281307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-of-life health literacy, knowledge and behaviours towards advance care planning among older adults: cross-sectional evidence from Switzerland","authors":"C. Meier, Sarah Vilpert, M. Wieczorek, C. Borrat-Besson, Ralf J Jox, Jürgen Maurer","doi":"10.1136/bmjph-2023-000600","DOIUrl":"https://doi.org/10.1136/bmjph-2023-000600","url":null,"abstract":"Population ageing, technological advancements and an increasing emphasis on patient empowerment imply that individuals are increasingly confronted with intricate end-of-life decisions. Personal end-of-life health literacy skills may help empower individuals to participate more actively in their own end-of-life decisions, including engagement in advance care planning (ACP). This study thus investigates the associations between individuals’ end-of-life health literacy and their knowledge and behaviours toward ACP among a population-based sample of adults aged 58+ years in Switzerland.We used data from 1319 respondents from Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe. The Subjective End-of-life Health Literacy Scale (S-EOL-HLS) served as the measurement tool. Respondents’ end-of-life knowledge was assessed using test-based questions about 11 end-of-life medical situations. Behaviours toward ACP were measured by whether respondents have discussed their end-of-life wishes, completed advance directives (AD) and appointed a potential surrogate for medical decisions in case of incapacity. Associations were estimated using separate ordinary least square and probit regressions, controlling for social, health and regional characteristics.Respondents with higher end-of-life health literacy tended to have better end-of-life knowledge and were more likely to have discussed their end-of-life wishes, to have completed AD and to have appointed a surrogate for medical decisions in case of incapacity. On regressing the outcomes on the three end-of-life health literacy dimensions, interactive health literacy positively correlated with end-of-life knowledge and the three behaviours toward ACP, while critical health literacy was only associated with having an AD and appointing a surrogate for medical decisions.Our findings suggest that end-of-life health literacy may play a significant role in individuals' level of end-of-life knowledge and their behaviour toward ACP. Thus, developing public health policies that aim at strengthening their end-of-life health literacy skills may increase individuals’ engagement in the ACP process and make ACP more effective.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140282566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}