Journal of preventive medicine and hygiene最新文献

{"title":"Performance-based payment systems for general practitioners and specialists in selected countries: a comparative study.","authors":"Mohammad Ebrahim Eghbali, Hamid Pourasghari, Hasan Abolghasem Gorji, Mariano Martini, Jalal Arabloo, Masoud Behzadifar, Aidin Aryankhesal","doi":"10.15167/2421-4248/jpmh2025.66.1.3511","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3511","url":null,"abstract":"<p><strong>Background: </strong>Due to the growing increase in the needs of health systems in the field of financial and human resources management, performance-based payment has been the subject of attention by health and welfare policymakers. This study aimed to compare the components of performance-based payment in selected countries.</p><p><strong>Methods: </strong>This comparative study was conducted in 2021. The selection of countries was based on three measures: the type of health insurance system, the development of the performance-based payment system, and the state of economic development of the countries. The findings were organized using comparative analysis tables. The general framework of performance-based payment systems, including goals, activities and actions, people involved in the program, and the way of encouraging and punishing, was used for analysis.</p><p><strong>Results: </strong>The findings of the study showed that in most of the programs, aspect of clinical quality has the highest weight. Other dimensions include patient experience and satisfaction, physician financial performance, and patients' access to services. In most programs, various risk adjustment methods such as exception reporting, combined payments, payment according to demographic characteristics, were used to reduce provider risk, and clinical service providers were actively involved in the program design progressive.</p><p><strong>Conclusions: </strong>Despite the widespread use of performance-based payment programs in most countries, these programs face limitations and shortcomings. By linking incentives to individual, team, and organizational performance, a performance-based payment program can improve teamwork, and create integrated health care.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E114-E125"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777442","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":"Validity and reliability of the Home Health Care Survey of the Consumer Assessment of Healthcare Providers and System (HHCAHPS) tool: a multicentre cross-sectional study.","authors":"Paolo Iovino, Ilaria Marcomini, Marco DI Nitto, Valeria Caponnetto, Yari Longobucco, Valentina Vanzi, Francesco Zaghini, Rosaria Alvaro, Alessandra Burgio, Stefano Domenico Cicala, Giancarlo Cicolini, Loreto Lancia, Paolo Landa, Duilio Fiorenzo Manara, Beatrice Mazzoleni, Laura Rasero, Gennaro Rocco, Maurizio Zega, Loredana Sasso, Annamaria Bagnasco","doi":"10.15167/2421-4248/jpmh2025.66.1.3526","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3526","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to investigate the psychometric properties of the Home Health Care Survey of the Consumer Assessment of Healthcare Providers and System (HHCAHPS) in the Italian context.</p><p><strong>Methods: </strong>This is a secondary analysis of data from the AIDOMUS-IT study. A total of 9,780 patients cared for by home healthcare services completed the HHCAHPS along with a measure of satisfaction for the care received. Structural validity was assessed with a confirmatory analytical approach (CFA). Construct validity was ascertained via hypothesis testing (convergent validity) by correlating the HHCAHPS scores with the scores derived from the measure of patient satisfaction for care. Internal consistency was assessed with the Omega (ω) coefficient.</p><p><strong>Results: </strong>Structural validity was confirmed, with satisfactory fit indices of the CFA model specified according to the conceptualized three-factor structure (\"care of patients\", \"communication with the providers\", and \"specific care issues\"). Construct validity was confirmed with moderate correlations between the level of satisfaction for care and the factors \"communication with the providers\" (r = 0.39, p < 0.001), \"care of patients\" (r = 0.34, p < 0.001), and \"specific care issues\" (r = 0.19, p < 0.001). Internal consistency was satisfactory for the \"specific care issues\" factor (ω = 0.81), while it was at the threshold of acceptability for the other factors (ω = 0.60-0.62).</p><p><strong>Conclusions: </strong>This study shows that the HHCAHPS is valid and sufficiently reliable when tested on the Italian population. Therefore, this tool can be supportive for promoting research and designing interventions to promote patient-centered care within home healthcare settings.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E102-E109"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777459","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-care associated infections in the two university hospitals of southern Tunisia: a point prevalence survey.","authors":"Mouna Baklouti, Mariem Ben Hmida, Houda Ben Ayed, Maissa Ben Jmeaa, Maroua Trigui, Bouthaina Trabelsi, Ahmed Trigui, Ghada Nasri, Jamel Dammak, Mondher Kassis, Sourour Yaich","doi":"10.15167/2421-4248/jpmh2025.66.1.3397","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3397","url":null,"abstract":"<p><strong>Introduction: </strong>Despite advances in the prevention of healthcare-associated infections (HAI) in recent decades, this once-almost-usual adverse event remains relatively common and still has a definite impact on patients and public health. In light of this, this study aimed to determine the HAI prevalence, to describe their main specificities and to identify their associated factors, in Southern Tunisia.</p><p><strong>Methods: </strong>We conducted a cross-sectional study to assess HAI point prevalence in two university hospitals in southern Tunisia. The study was started on February 20^th to March 13^th, 2023.</p><p><strong>Results: </strong>There were 1.028 patients included in the survey and (47.3%) of them were women (n=486). The median age was 48 years (Interquartile Range (IQR)=[30-65]) years. We noted 86 HAI in the two establishments visited, with a global HAI prevalence of 8.4%. Multivariate analyses showed that independent factors of HAI were immune suppression (AOR=2.5; p=0.004), hospital stay duration ≥ 6 (AOR=4.5; p<0.001), surgery 30 days prior to the study date (AOR=1.9; p=0.021), having central vascular catheter (AOR=2.44; p=0.032) and having intubation or endotracheal tube (AOR=3.5; p=0.002).</p><p><strong>Conclusions: </strong>This study highlighted a relatively high prevalence of HAI in southern Tunisia. Therefore, urgent and ongoing corrective measures should be implemented, maintained and re-evaluated continuously in order to control HAI and promote care safety.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E94-E101"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777436","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":"New integrations in patient care: the role of the pharmacist between couselling and medication adherence.","authors":"Rosagemma Ciliberti, Alessandro Bonsignore","doi":"10.15167/2421-4248/jpmh2025.66.1.3222","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3222","url":null,"abstract":"<p><p>The changing scenarios in healthcare in recent years underscore the need to promote diverse, articulated, and complex care approaches capable of paying greater attention to people's vulnerability and responding to multiple care needs. A multidimensional approach to healthcare also suggests a review of the role that pharmacies can assume within the healthcare system, with particular regard to the possibility of creating a relational space with the citizen aimed at strengthening the fiduciary relationship with him or her and promoting greater user empowerment in therapy adherence. The promotion of this ethically relevant service could yield several benefits: greater protection of public health, rationalization of public spending, and shifts in the demand for healthcare services. This paper aims to illustrate some socially and ethically relevant aspects of collaboration between pharmacists, general practitioners, and pediatricians of free choice.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E38-E44"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777441","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":"Assessment of hygienic knowledge and oral health practices among children under dynamic observation for periodontosis in Aktobe.","authors":"Nurgul Zholdassova, Lyudmila Yermukhanova, Miras Umbetov, Samat Saparbayev, Gulnar Sadykova","doi":"10.15167/2421-4248/jpmh2025.66.1.3130","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3130","url":null,"abstract":"<p><strong>Introduction: </strong>Oral diseases are a serious global public health problem affecting more than 3.5 billion people, are among the most common diseases in the world, and carry serious medical and economic problems, substantially reducing the quality of life of those affected. Oral diseases undoubtedly represent a global public health problem, with particular concern about their growing prevalence in many countries, which is associated with broader social, economic, and commercial changes. The purpose of the study is to establish the level of hygienic education among schoolchildren undergoing orthodontic treatment in Aktobe.</p><p><strong>Material and methods: </strong>The design of the study is experimental and descriptive. The sample was gathered without pre-selection. It included children from 6 to 18 years old who were on dynamic observation, with a diagnosis of periodontal diseases.</p><p><strong>Results: </strong>According to the data obtained, it was identified that 300 respondents aged 6 to 18 years took part in the survey, the average age of the respondents was 13.75 ± 1.38 years. The survey identified a low level of dental education in hygiene and oral care among children and a lack of motivation to maintain dental health.</p><p><strong>Conclusions: </strong>It is necessary to strengthen educational work with the involvement of dentists, teachers, and parents to increase the low level of knowledge on dental health and oral care among the interviewed schoolchildren.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E110-E113"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777433","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":"Population-based cross-sectional study of the correlation of physical inactivity and sedentary behaviour with sociodemographic factors among Bangladeshi adults.","authors":"Mohammad Jobair Khan, Priya Kannan, Balasankar Ganesan, Sufia Khatun, Mohammed Usman Ali, S M Mahmudul Hasan, Stanley John Winser","doi":"10.15167/2421-4248/jpmh2025.66.1.3275","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3275","url":null,"abstract":"<p><strong>Background: </strong>Physical inactivity and sedentary behaviour are influenced by various interconnected variables. In Bangladesh, studies on physical inactivity and sedentary behaviour are scarce, regardless of age in the adult population. This study aims to determine the correlates of adults' physical inactivity and sedentary behaviour with sociodemographic factors, including gender, age, residential, educational, and occupational status.</p><p><strong>Methods: </strong>This is a secondary analysis of a cross-sectional survey conducted from February to May 2018 across eight divisions of Bangladesh. Global Physical Activity Questionnaire was used to measure physical inactivity and sedentary behaviour. The data consisted of 8,185 adults aged 18 to 69 years. The Bayesian regression model was used to analyse the correlates.</p><p><strong>Results: </strong>Physical inactivity, including work, active transport, and recreation, males and urban residents were more likely to be inactive than their female counterparts and rural residents. Married adults had greater (Odd Ratio [OR]: 6.6, 95% CI: 5.46 to 7.98) recreation-related physical inactivity. Unemployed adults were more likely to engage in sedentary behaviour (OR: 4, 95% CI: 2.48 to 6.12) and less likely to engage in moderate physical activity (OR: 2.2, 95% CI: 1.43 to 3.39).</p><p><strong>Conclusions: </strong>A notable pattern of insufficient recreational physical activity among adults in Bangladesh was noted. Establishing nationwide surveillance systems to detect physical activity and sedentary behaviour trends to evaluate potential interventions for improving physical activity and reducing sedentary behaviour. Expanding school-based physical activity programs help children and adolescents learn lifelong healthy behaviours. Community sports programs for all ages promote active living.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E45-E55"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777443","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":"Virtual Reality as a Tool for Wellbeing in Public Healthcare: Analysis of a Clinical Case.","authors":"Fabiana Nuccetelli, Valeria Gabellone, Pier Luigi Lopalco","doi":"10.15167/2421-4248/jpmh2025.66.1.3498","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3498","url":null,"abstract":"<p><strong>Background: </strong>Virtual Reality (VR) is a technology that enables the creation of immersive, interactive, and collaborative environments, with extensive applications in the realm of e-Health.</p><p><strong>Methods: </strong>This study aimed to reduce stress and anxiety in hospitalised patients by employing guided virtual scenarios and non-invasive biosensors.</p><p><strong>Results: </strong>During the initial experimental phase, conducted on 33 patients in a cardiac rehabilitation ward, improvements were observed in stress levels (-11.3%), depression (-4.2%), and anxiety (-3.2%). Supporting these results, a specific clinical case analysis revealed significant improvements in an 82-year-old woman with moderate depression and severe social isolation. Following the VR intervention, the patient experienced a substantial reduction in isolation, heightened motivation for daily activities, and enhanced social interaction quality, with a 35% increase in perceived quality of life. Physiological improvements included reduced sympathetic nervous system arousal and greater heart rate variability stability.</p><p><strong>Conclusions: </strong>These findings underscore VR's potential to promote psychophysical wellbeing and improve healthcare service quality, advocating innovative preventive and therapeutic methods.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E61-E66"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777460","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":"Attitudes and knowledge of the adult population on arboviral diseases.","authors":"Fabiana Nuccetelli, Valeria Gabellone, Sara Ciampini, Luigi Roberto Biasio, Pier Luigi Lopalco","doi":"10.15167/2421-4248/jpmh2025.66.1.3493","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3493","url":null,"abstract":"<p><strong>Background: </strong>Climate change and globalization have heightened the risk of vector-borne diseases (VBDs) in Europe, including Italy. VBDs cause over 1 billion cases and 1 million deaths annually, accounting for 17% of all communicable diseases worldwide. With competent vectors present, effective control measures and surveillance are vital. This study assessed adults' knowledge, attitudes, and practices regarding Arbovirus infections.</p><p><strong>Methods: </strong>An 11-question survey targeting individuals aged 18 and over at the LHU Roma 1 vaccination clinic evaluated knowledge and experiences with Arbovirus diseases. Data were coded and analyzed.</p><p><strong>Results: </strong>Of 308 participants, 58.1% were female, 63.65% had no children, and 84.1% held a degree or higher. Tick-Borne Encephalitis (TBE) was the most recognized disease (65.9%), followed by Zika (52.3%), while West Nile virus risk in Italy was underestimated (20%). Dengue awareness was high (91.6%), but Usutu awareness was low (47.4%). Vaccination was supported by 93.8%, with the 41-50 age group most willing to vaccinate children. Overall, knowledge of Arbovirus diseases was limited.</p><p><strong>Conclusions: </strong>Public awareness of VBDs and preventive measures must improve to support effective risk prevention strategies. Education campaigns are essential to address gaps in knowledge and promote informed decision-making.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E84-E93"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777434","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":"Designing a performance-based payment model for physicians at outpatient clinics contracted with Iran health insurance: a case study from Iran.","authors":"Mohammad Ebrahim Eghbali, Hasan Abolghasem Gorji, Jalal Arabloo, Mariano Martini, Masoud Behzadifar, Hamid Pourasghari","doi":"10.15167/2421-4248/jpmh2025.66.1.3497","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3497","url":null,"abstract":"<p><strong>Background: </strong>Providing quality healthcare services relies on capable physicians with high performance levels. A performance-based payment system can enhance physician productivity, clinical service quality, and patient satisfaction. This study aimed to design a performance-based payment model for physicians in outpatient clinics contracted with the Iran Health Insurance Organization, tailored to its specific context and structure.</p><p><strong>Methods: </strong>The study employed a mixed-methods approach, combining quantitative and qualitative data collection and analysis. Through a literature review and expert interviews, 47 performance indicators and 18 selection criteria were identified. These indicators were reviewed in expert panels, and 49 questionnaires were used to prioritize them based on health insurance structures. The final indicators were categorized into current, transitional, and desired statuses, aligned with organizational infrastructures.</p><p><strong>Results: </strong>The study identified 24 key indicators, including 9 for general physicians and 13 for specialized physicians. These indicators covered aspects such as the average number of prescribed medications, electronic prescription usage, per capita diagnostic procedures, timely physician presence, patient complaints, work history, guideline adherence, electronic record completion, patient satisfaction, training participation, and test prescription rates. Each indicator was detailed with a title, formula, standard, data collection method, and source.</p><p><strong>Conclusions: </strong>The proposed performance-based payment model, utilizing the selected indicators, can guide physicians toward achieving organizational goals such as cost reduction, process efficiency, and improved patient satisfaction. By clarifying expe tations and assessing various performance dimensions, the model provides a framework for enhancing physician performance and aligning it with the objectives of the Health Insurance Organization. Policymakers can use this model to drive systemic improvements in healthcare delivery.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E126-E137"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777435","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":"Network Analysis of the HLS₁₉-Q12 Health Literacy Questionnaire: insights from an Italian Pilot Study.","authors":"Sara Maria Pani, Stefania Matta, Matteo Fraschini, Claudia Sardu, Alessandra Mereu, Paolo Contu","doi":"10.15167/2421-4248/jpmh2025.66.1.3520","DOIUrl":"10.15167/2421-4248/jpmh2025.66.1.3520","url":null,"abstract":"<p><strong>Background: </strong>The widespread use of the internet and social media has transformed how people access health information impacting health literacy. Health literacy, the ability to access, understand, and use health information, is crucial to promote and maintain good health. This study is the first exploring with network analysis the correlation and distribution of the items of the Health Literacy Survey Questionnaire (HLS-Q) 12 short form to verify their correspondence to the principal domains of the health literacy conceptual model proposed by Sorensen et al. in 2013.</p><p><strong>Materials and methods: </strong>A digital version of the Italian HLS19-Q12 questionnaire was distributed online through social media and informal channels in May 2024. The sample consisted of 352 participants from the metropolitan area of Cagliari, Italy. Network analysis was employed to examine the clustering and relationships between the questionnaire items, via JASP using the Ising Fit method.</p><p><strong>Results: </strong>Key findings include significant difficulties in accessing professional help and understanding medical emergencies. Network centrality measures highlighted the prominence of items related to understanding medical emergencies and making health decisions. Three clusters corresponding to healthcare, disease prevention, and health promotion, were visually identified with the last two closely interconnected. The item \"making decisions to improve health\" is crucial, acting as a bridge between clusters. Some items traditionally belonging to one domain shifted to another.</p><p><strong>Conclusions: </strong>The network analysis provided a clear depiction of health literacy as complex system, emphasizing interactions. Health literacy involves accessing, evaluating, and applying information, with empowerment playing a key role according to our findings. By addressing identified needs and focusing on prominent items, healthcare professionals and policymakers can enhance health literacy and improve health outcomes for individuals and communities. This pilot study's findings could benefit future research and interventions to improve health literacy.</p>","PeriodicalId":94106,"journal":{"name":"Journal of preventive medicine and hygiene","volume":"66 1","pages":"E9-E19"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777440","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}