Health literacy research and practice最新文献

{"title":"Barriers to the Development of Health Literacy in Iran's Health System: A Qualitative Study.","authors":"Fateme Darabi, Arash Ziapour, Fatemeh Mohammadkhah, Murat Yıldırım, Nazila Nejhaddadgar","doi":"10.3928/24748307-20250612-03","DOIUrl":"10.3928/24748307-20250612-03","url":null,"abstract":"<p><strong>Background: </strong>Despite the significance of health literacy, studies show the inadequacy of health literacy in the health system of Iran. Inadequate health literacy is considered a warning for service providers. It needs to be integrated into educational programs that are administered within health and medical centers.</p><p><strong>Objective: </strong>Therefore, the present study was conducted to explore the barriers to health literacy in Iran's health system.</p><p><strong>Methods: </strong>The present qualitative study was conducted in 2023 using a conventional content analysis. To this aim, 18 participants were selected among urban health center staff, 21 from rural health centers, 10 health volunteers, and 8 trainees (people participating in training classes) for interviews and group discussions. After the first interview, continuous data analysis began and continued to saturation level. The data were collected through semi-structured interviews and focus group discussions and were simultaneously analysed using a conventional qualitative analysis.</p><p><strong>Key results: </strong>Two main categories of internal and external barriers were detected. The data analysis led to the extraction of four main subcategories: (1) personal barriers (trainee's inadequate competence, lack of physical or mental health, low motivation and commitment of health staff, beliefs, contextual barriers); (2) interpersonal barriers (health care providers' misunderstanding of correct training, malcommunication or miscommunication in training sessions, the trainer's limited skill, underestimated role of education in behavior change); (3) organizational barriers (high workload of health care staff, inadequate human resources, poor management and distrust in the health system, low organizational motivation); and (4) social barriers (uninterest in learning about health issues, issues related to the internet and cyberspace, lack of interpectoral cooperation).</p><p><strong>Conclusion: </strong>Considering the multidimensional nature of barriers to health literacy, it is recommended to make and implement a comprehensive plan to integrate efforts by health authorities and institutions, mass media, experts, decision-makers, policymakers, and service providers to remove barriers.</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 4","pages":"e105-e116"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12517698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Listen, Empower, Co-Create: Adapting Boot Camp Translation Methods to Create Culturally Responsive Health Messages and Materials.","authors":"Jamie H Thompson, Jennifer S Rivelli, Priyanka Gautom, Gloria D Coronado","doi":"10.3928/24748307-20250612-01","DOIUrl":"10.3928/24748307-20250612-01","url":null,"abstract":"<p><strong>Background: </strong>Community engagement is key to developing culturally responsive public health interventions that resonate with diverse populations and promote health equity.</p><p><strong>Brief description of activity: </strong>We applied an adapted version of Boot Camp Translation (BCT), a community-based participatory approach, to develop culturally and locally relevant messaging and materials for diverse populations. This adapted BCT approach focuses on three core themes: (1) Listen, (2) Empower, and (3) Co-Create, or LEC. The LEC method helps community leaders and champions learn from community members about barriers and gaps in health care (listen), share health information in a collaborative way (empower), and develop messages and materials that resonate with and motivate community members to take control of their own health (co-create).</p><p><strong>Implementation: </strong>LEC follows a 3 to 4 month process: an in-person session with expert presentations and group discussions, followed by two virtual meetings to share and refine co-created messages and materials.</p><p><strong>Results: </strong>The LEC approach was successfully conducted in diverse communities, engaging participants in preferred venues like churches, clinics, and tribal centers over 3 to 4 months. Tailored messages resonated with cultural values, while common themes included family and faith. Preferred materials were fact sheets, pamphlets, posters, videos, and visual stories. Participant evaluations showed high satisfaction, comfort sharing opinions, and improved understanding of how to take care of one's health.</p><p><strong>Lessons learned: </strong>The LEC method fosters collective responsibility between community members and researchers to collaboratively address health needs. To support implementation, we offer best practices for LEC application, and customizable materials and guidance tailored to community preferences. This flexible, adaptable approach may enhance effectiveness, relevance, and sustainability of public health efforts across diverse settings.</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 3","pages":"e93-e104"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building Community Health Literacy With a Social Network Perspective.","authors":"Tetine Sentell, Meliza Roman, Kara Saiki, Mary Ann Abrams, Alexandria Jones, Krizia Melendez, Jessica Chevrolet, Allison Riggle, Emily Szollosy, Opal Vanessa Buchthal","doi":"10.3928/24748307-20250224-01","DOIUrl":"10.3928/24748307-20250224-01","url":null,"abstract":"<p><p>Advancing Health Literacy Franklin County was initiated in June 2021 with a goal of building a sustainable health literate community in Franklin County, Ohio, USA. The project was a collaboration among public health departments, health care organizations, an academic institution, and community organizations and included capacity-building over a 2-year period. Project evaluation included social network analysis mapping of organizational relationships over two project time periods to document change in this area. This brief report describes the social network analysis mapping as a project outcome, a valuable approach to advancing organizational health literacy and health equity, and a practical tool for other health literacy projects as sustainable relationships and networks are important in health literacy research and practice. [<b><i>HLRP: Health Literacy Research and Practice</i>. 2025;9(3):e78-e82.</b>].</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 3","pages":"e78-e82"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Cultural Adaptation of Health Literacy Instrument for Hispanic and Latino/a/e Communities.","authors":"Jennifer Contreras, Chun Wang, Wendy Camelo Castillo, Juan Caicedo, Monica Guerrero Vázquez, Tania Robalino, Aida Hidalgo-Arroyo, Ester Villalonga-Olives","doi":"10.3928/24748307-20250224-02","DOIUrl":"10.3928/24748307-20250224-02","url":null,"abstract":"<p><p>Hispanic and Latino/a/e individuals are more likely to have lower levels of health literacy compared to other ethnic and racial groups. Additionally, 32% of this population also has limited English proficiency. There is a need to develop culturally valid instruments in Spanish to assess health literacy in this population. The Health Literacy Skills Instrument Short Form (HLSI-SF) was developed and validated in English by RTI International, but not in Spanish. Our aim was to culturally adapt the HLSI-SF to be used for Hispanic and Latino/a/e individuals living in the United States. We followed the Patient-Reported Outcome Consortium guidelines for cross-cultural adaptation of measures for content and linguistic validity. This included two forward-translations, reconciliation, two back-translations, revision and harmonization, cognitive interviews (total of six), revision, external expert review, and final version. We involved an expert panel of health professionals and community representatives throughout the process. The panel (<i>n</i> = 4) all self-identified as Hispanic or Latino/a/e and were fluent in English and Spanish. To evaluate the adapted HLSI-SF measure, we conducted cognitive interviews through six online focus groups involving 22 Hispanic and Latino/a/e community members, followed by a psychometric assessment using a sample of 726 Hispanic and Latino/a/e individuals with Spanish as their primary language. Focus group-based cognitive interviews revealed that while most items on the adapted HLSI-SF measure performed well, some participants had difficulties with a few items, which may suggest limited health knowledge. Psychometric analyses revealed that all but the Nutrition Label and Calories items performed well. Further validation of the HLSI-SF is needed to produce a valid and reliable instrument to measure health literacy in Hispanic and Latino/a/e populations in the U.S. [<b><i>HLRP: Health Literacy Research and Practice</i>. 2025;9(3):e83-e92.</b>].</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 3","pages":"e83-e92"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Application-Based Information Provision on Parents' Health Literacy: An Open-Label, Nonrandomized, Parallel-Controlled Trial.","authors":"Masahiko Sakamoto, Asuka Suzuki, Hirono Ishikawa","doi":"10.3928/24748307-20241205-01","DOIUrl":"https://doi.org/10.3928/24748307-20241205-01","url":null,"abstract":"<p><strong>Background: </strong>In recent years, parents have had more opportunities to use applications (apps) to access health care information.</p><p><strong>Objective: </strong>In this study, we aimed to evaluate whether the use of an app that provides health care information on children improves parents' health literacy.</p><p><strong>Methods: </strong>This open-label, nonrandomized, parallel-controlled trial was conducted at two health centers in Japan. We recruited parents of 1.5-year-old children and introduced the Oshiete! Doctor app to the intervention group. The primary outcome was a change in the parents' health literacy scores (HLSs).</p><p><strong>Key results: </strong>A total of 200 parents were included in this study. The mean HLSs slightly improved in both groups, with greater improvement observed in the intervention group than in the control group. However, the difference was not statistically significant. In the intervention group, participants with higher app ratings showed greater improvement in their HLSs after the intervention.</p><p><strong>Conclusions: </strong>The introduction of an app that provides health care information on children did not show a statistically significant improvement in parents' health literacy. In the intervention group, participants with higher app ratings showed greater improvement in their HLSs after the intervention. Future research on apps and parental health literacy should also consider the frequency of app use. Larger, longer-term studies are needed. [<b><i>HLRP: Health Literacy Research and Practice</i>. 2025;9(2):e64-e71.</b>].</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 2","pages":"e64-e71"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Cardiac Rehabilitation Barriers Across Health Literacy Levels.","authors":"Ana Paula Delgado Bomtempo, Gabriela Lima de Melo Ghisi","doi":"10.3928/24748307-20241127-02","DOIUrl":"10.3928/24748307-20241127-02","url":null,"abstract":"<p><p>This study aimed to explore the barriers to cardiac rehabilitation (CR) participation across individuals with different levels of health literacy. A cross-sectional study was conducted among individuals referred to a CR program. Participants completed online surveys assessing CR barriers using the Cardiac Rehabilitation Barriers Scale and health literacy using the Brief Health Literacy Screening Tool. Descriptive statistics and comparisons were performed. Among 881 individuals invited, 400 responded, with varying levels of health literacy: 22(6%) limited, 305(76%) marginal, and 72(18%) adequate. The greatest barriers included family responsibilities, lack of energy, and a preference for managing health alone. However, distinct patterns emerged based on health literacy levels, with individuals citing different barriers. Although no significant differences were observed in CR barriers based on health literacy, understanding individual-specific challenges is crucial for intervention development. Addressing common barriers such as family responsibilities and logistical challenges could enhance CR engagement and adherence. [<b><i>HLRP: Health Literacy Research and Practice</i>. 2025;9(2):e72-e77.</b>].</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 2","pages":"e72-e77"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12143842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovating a Teach-Back Model for Community Health Workers Led Health Literacy Practice to Improve COVID-19 Health Equity.","authors":"Kathryn Anderson, Eddie Rojas-Alvarado, Leyna Aragon, Joshua Bradshaw, Emily Fontana, Fred Hernandez, Colleen McCuskey, Hanna Nguyen, Terry Schlader, Jenny Vazquez, Janet Page-Reeves","doi":"10.3928/24748307-20241127-01","DOIUrl":"10.3928/24748307-20241127-01","url":null,"abstract":"<p><strong>Background: </strong>From 2021 to 2023, the City of Albuquerque, the University of New Mexico (UNM) Office for Community Health, the UNM Hospital Health Literacy Office (UNMH HLO), and partners in Albuquerque, New Mexico, implemented the Albuquerque COVID-19 Health Literacy Project (AHLP). The goal of the program was to develop a network of Community Health Workers (CHWs) and community agency partners able to use health literacy (HL) best practices to reduce coronavirus disease 2019 (COVID-19)-related health disparities in Albuquerque, New Mexico.</p><p><strong>Brief description of activity: </strong>AHLP created a training and support infrastructure to provide CHWs with the knowledge, skills and tools for using HL strategies and approaches for COVID-19 health promotion. The UNMH HLO guided integration of HL practices into the work. We collected and visualized data to identify geographies of need, map project outreach activities, and monitor population health indicators of the project's coordinated service efforts.</p><p><strong>Implementation: </strong>Trainings, a core feature of the AHLP, were primarily conducted via video conference and included a project launch training, weekly check-ins, monthly workshops, and a series of on-site open house events at the facilities of agency partners. We conducted 10 trainings at which Teach Back and plain language strategies were taught and practiced with CHWs for this project. CHWs conducted outreach through events, phone calls, individual in-person meetings, group meetings, spur-of the moment conversations, and shorter and less structured CHW conversations.</p><p><strong>Results: </strong>The AHLP reached 44,690 people-2.5 times our goal. Seventy two percent of clients indicated they were likely to get the COVID-19 vaccine. The COVID-19 booster gap closed for those living in high versus low Social Vulnerability Index geographies, reducing this disparity nearly 3-fold in 6 months. CHWs implemented this work using HL best practices that have primarily been developed for use in clinical settings and in the process, they innovated ways to adapt these practices to be appropriate for community contexts.</p><p><strong>Lessons learned: </strong>HL practices were seen as valuable by AHLP CHWs. They reframed plain language as a path to empowerment. But for Teach Back to be used by CHWs in nonclinical settings, there needed to be changes to the way that Teach Back is taught, conceptualized, and implemented. CHWs in the AHLP refocused these tools and brought them into the CHW work they are already doing. [<b><i>HLRP: Health Literacy Research and Practice</i>. 2025;9(2):e56-e63.</b>].</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 2","pages":"e56-e63"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Literacy Curricula in Pediatric Residency Programs: A National Survey.","authors":"Nicole Meyers, Suzanne Friedman, Andrea Morrison, Marguerite Costich, Aditi Gupta, Brittany Moore, Mary Ann Abrams, Margaret Wood, Joy Solano","doi":"10.3928/24748307-20240813-01","DOIUrl":"10.3928/24748307-20240813-01","url":null,"abstract":"<p><strong>Objective: </strong>Using health literacy informed communication strategies can mitigate health inequities. Despite the high prevalence of limited health literacy among parents and children, pediatricians infrequently use clear communication techniques and further education is imperative. There is minimal literature exploring health literacy curricula in pediatric residencies. We sought to evaluate health literacy education across pediatric residency programs.</p><p><strong>Methods: </strong>The Academic Pediatric Association's Health Literacy Special Interest Group performed a national, cross-sectional survey of pediatric associate program directors from July 2022 to September 2022. We asked about the presence of health literacy curricula, teaching strategies used, content highlighted, outcomes assessed, and barriers encountered.</p><p><strong>Results: </strong>Among 55 associate program directors from programs diverse in setting, size, and geographic region who participated, most (84%) reported their residents would benefit from more health literacy training. Only 44% reported the presence of health literacy education, with minimal teaching of evidence-based principles, such as the universal precautions approach to clear communication.</p><p><strong>Conclusion: </strong>Health literacy is infrequently taught in pediatric residency programs and there is appreciable variability among existing curricula. There is need for greater dissemination of existing resources, as well as standardization of curricula and assessment tools to ensure pediatricians are well-versed in use of health literacy-informed communication techniques. [<b><i>HLRP: Health Literacy Research and Practice</i>. 2025;9(1):e3-e7.</b>].</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 1","pages":"e3-e7"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural Determinants of Health Literacy Among Formerly Incarcerated Individuals: Insights From the Survey of Racism and Public Health.","authors":"Jemar R Bather, Melody S Goodman, Kimberly A Kaphingst","doi":"10.3928/24748307-20241219-01","DOIUrl":"10.3928/24748307-20241219-01","url":null,"abstract":"<p><strong>Background: </strong>Formerly incarcerated individuals (FIIs) encounter difficulties with covering the cost of dental and medical care, adhering to medication regimens, and receiving fair treatment from health care providers. Yet, no published research has examined modifiable pathways to increase FIIs' health literacy (HL), which is essential for addressing the health needs of this vulnerable population.</p><p><strong>Objective: </strong>The aim of this article is to examine neighborhood characteristics (neighborhood deprivation, racial and economic polarization, and residential segregation) and public assistance program enrollment as structural determinants of limited health literacy (LHL) among FIIs.</p><p><strong>Methods: </strong>Using a socioecological framework, we analyzed a subsample of 578 FIIs from the 2023 Survey of Racism and Public Health, an online cross-sectional survey spanning U.S. Department of Health & Human Services Regions 1, 2, and 3. HL was assessed using the Brief Health Literacy Screen. Logistic regression models estimated unadjusted and adjusted associations of LHL with neighborhood characteristics and public assistance program enrollment. Adjusted models controlled for age, race and ethnicity, gender identity, educational attainment, marital and employment status, number of children, chronic health conditions, and incarceration length.</p><p><strong>Key results: </strong>The 578 FIIs had an average age of 46, with 42% having LHL. We observed a statistically significant association between public assistance program enrollment and LHL (unadjusted odds ratio [OR] = 2.72, 95% confidence interval [CI]: 1.87, 4.01; adjusted <i>OR</i> = 2.50, 95% CI: 1.62, 3.88). We found no statistically significant associations of LHL with neighborhood deprivation, racial and economic polarization, and residential segregation.</p><p><strong>Conclusions: </strong>Our findings suggest that there may be an opportunity to develop tailored interventions for increasing HL among FIIs through public assistance programs. Dissemination of HL resources among this marginalized group can improve their self-management of chronic diseases. This is of paramount importance because FIIs must simultaneously navigate other challenges after incarceration (e.g., unstable housing). [<b><i>HLRP: Health Literacy Research and Practice</i>. 2025;9(1):e8-e18.</b>].</p>","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 1","pages":"e8-e18"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Puzzling Thank You #3.","authors":"Michael K Paasche-Orlow, Sam Barocas","doi":"10.3928/24748307-20241216-01","DOIUrl":"10.3928/24748307-20241216-01","url":null,"abstract":"","PeriodicalId":36651,"journal":{"name":"Health literacy research and practice","volume":"9 1","pages":"e1-e2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}