Bridging the Gap: Assessing Health Literacy Practices Among Nurses and Midwives in Qatar

Bridging the Gap: Assessing Health Literacy Practices Among Nurses and Midwives in Qatar | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bridging the Gap: Assessing Health Literacy Practices Among Nurses and Midwives in Qatar Shemi Assis, Debbi Marais, Kalpana Singh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6713176/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Aim: This study aimed to assess the health literacy knowledge and experience among registered nurses and midwives and to determine the association between health literacy knowledge levels and selected demographic variables. Design and Methods: A descriptive cross-sectional survey design was used with a convenience sample of 290 registered nurses and midwives working in different units of a hospital in Qatar. Data collection involved a socio-demographic questionnaire and a validated health literacy knowledge and experience questionnaire. Descriptive statistics, independent-sample t-test , and a one-way analysis of variance (ANOVA) test were used to analyze the data. Results: The mean knowledge score was inadequate overall at 3.2 ± 2.3 out of 10, also indicating variability in nurses' understanding of health literacy principles. Among socio-demographic variables, age significantly influenced knowledge levels, with nurses aged 51 and above having the highest mean score (4.9±1.7). Gender also showed a significant difference, with female nurses (4.2±1.8) scoring higher than males (3.5±1.7, p=0.011). Overall, the findings suggest that older nurses and females tend to have greater knowledge of health literacy, while education level and experience do not strongly influence these scores. Conclusion: The current study reported significant variability in nurses' understanding of health literacy principles in Qatar. The integration of health literacy related education and training for nurses is paramount to enhance their health literacy knowledge and practices, especially for younger and male nursing staff. Therefore, it is recommended to develop health literacy related curriculum and programs for nurses to enhance quality patient care and promising patient outcomes. Patient or Public Contribution: No Patient or Public Contribution Health literacy patient education patient engagement healthcare professionals Figures Figure 1 Introduction According to the Centre for Disease Prevention and Control (CDC), health literacy is defined as ‘the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others’( 1 ). The term health literacy is defined as the ability of an individual to obtain and translate knowledge and information to maintain and improve health in a way that is appropriate to the individual and system contexts( 2 ). Globally it is recognized as one of the social determinants of health( 3 ).( 2 ) explicitly state in their systematic review that the term health literacy generally focuses on the ability of a person to understand the health demands to promote and maintain health. Both clinical and public health approaches tend to find common ground in that they focus on people's ability to find, understand, evaluate, and utilize information that will enhance their health and quality of life throughout their lives, even though there are still differences in definitions and conceptual approaches surrounding health literacy. Over the past two decades, considerable importance has been given to the concept of health literacy due to its vital role in health promotion and public health ( 4 ). The revived interest in health literacy has not only been noticeable in public health and medical care and this is amply demonstrated by the increasing quantity of scientific articles that are published and the inclusion of health literacy as a key topic in numerous policy agendas ( 5 ). Results of an exploratory bibliometric analysis show that, between 1997 and 2007, the number of international articles published on health literacy increased by almost ten times, supporting the growing attribution of relevance to this field of study ( 5 ). There are indeed solid grounds to believe that the numbers have only increased since then. Health literacy is a critical global issue, with low levels among the general population posing significant challenges. Healthcare professionals, particularly nurses, play a vital role in addressing this by enhancing patient engagement and improving care experiences ( 6 ). As frontline providers, nurses are uniquely positioned to foster health literacy and promote better health outcomes. However, research indicates that many healthcare professionals lack a thorough understanding of health literacy and its impact on patient well-being ( 7 , 8 )Given its complexity, health literacy must be assessed and addressed in every healthcare encounter to ensure patient safety, engagement, and quality care ( 9 ). Limited knowledge in this area among nurses contributes to poor patient outcomes and increased healthcare costs ( 10 ). Nurses’ expertise in health literacy—encompassing their knowledge, experience, and ability to implement effective strategies—not only shapes individual patient-provider interactions but also influences the broader healthcare system. Therefore, nurses’ ability to accurately assess and respond to patients’ health literacy levels is essential for effective patient management( 11 ). With a population of 2,891,000 (as of November 2022), Qatar reported a high literacy rate of 93.5% among individuals ≥ 15 years and 70.5% among the elderly (≥ 65 years) ( 12 ). However, high literacy level does not always reflect high health literacy due to situational and environmental factors although both aspects of literacy influence each other, and poor health literacy is still prevalent at high education levels( 3 ). Hence, healthcare worker’s knowledge and competency in assessing the health literacy of patients regardless of their literacy level is essential to provide high-quality care. This study aimed to assess the health literacy knowledge and experience among registered nurses and midwives in HMC-Qatar and the association between health literacy knowledge levels and the selected demographic variables. Methodology Study design and sampling A descriptive cross-sectional research design was utilized to identify the health literacy knowledge level and experience among registered nurses and midwives who work at different units of a government hospital in Qatar. All registered nurses and midwives with a valid nursing license (Department of health care professions-DHP) and currently working in the hospital were included, whereas anyone who had submitted their resignation was excluded. The hospital is a general hospital that has been designed, built, and staffed to support the healthcare needs of the southern area of the State of Qatar. The hospital has different departments to provide comprehensive care for patients of all ages, from emergency, general medicines, surgery, dialysis, and critical care. Moreover, it is the only Burns Centre in the country. The hospital has a capacity of 325 beds; 248 of which are for general patients and acute patients and 77 are for critical care, high dependency, and burns patients. Sample Size The sample size for the study was estimated using a standard formula for a finite population correction. As a previous similar study reported 29.3% knowledge about health literacy ( 10 ), 29.9% knowledge regarding health literacy was used in the power formula, with a 95% confidence interval, 5% relative precision, and the total number of nurses working in the selected facility to be 1232. The required sample size was calculated as 260. Considering a 10% non-response resulted in an expected sample size of ~ 290 nurses for the study. Data Collection tool A validated questionnaire was used to collect data, namely the Health Literacy Knowledge and Experiences Survey-2 (HLKES-2), which is a validated health literacy knowledge assessment tool( 13 ). HLKES-2 is a revised version of HLKES (Health Literacy Knowledge and Experiences Survey) which was originally developed in 2006 by Cormier to assess the health literacy knowledge and experience of nursing students in Louisiana, U.S. HLKES-2 has 14 questions, 10 knowledge questions, and 4 experience questions. The knowledge questions represent three foundational principles of health literacy which are, a-foundational knowledge of health literacy principles (represented by questions 1, 2 and 3), b-appropriate health literate communication techniques (represented by questions 7, 8, 9 and 10 and c- expected behaviors of people with low health literacy (represented by questions 4, 5 and 6) ( 13 ) (Table 1 ). Table 1 Foundational Health literacy Principles Foundational principles Representing questions a) Foundational knowledge of health literacy principles 1) Low health literacy is most prevalent among which age group? 2) What should a nurse consider when conducting health teaching with a patient? 3) What is the likelihood that a nurse will encounter a patient with low health literacy? b) Appropriate health literate communication techniques 7) What is the priority action of the nurse when conducting health teaching? 8) What is the best method for the nurse to evaluate the effectiveness of healthcare teaching? 9) The nurse is caring for a patient newly diagnosed with a health condition. What should be the priority focus during the first teaching session? 10) Which of the following questions would provide the nurse with the best estimate of the reading skills of the patient? c) Expected behaviors of people with low health literacy 4) Which health behavior is common among patients with low health literacy? 5) Patients with low health literacy skills compared to those with adequate health literacy skills: 6) What should the nurse consider when developing a plan of care for a client with low health literacy? In addition, socio-demographic questions were asked namely age, gender, educational qualifications, years of experience and position to enable comparisons and to identify factors impacting on knowledge scores. Moreover, the participant information sheet outlining the purpose of this study was integrated into the online survey, and participants were able to proceed to the survey tool link by clicking the agreement button, implying that their participation was voluntary. Thus, implied consent was obtained. Statistical Analysis Descriptive statistics was used to analyze the distributions of responses on the questionnaire items and subscales. The knowledge score was calculated by adding all the correct answers in the questionnaire. The maximum score for the health literacy knowledge questionnaire is 10. The mean of the knowledge score with different demographic characteristics was compared with an independent-sample t-test , a one-way analysis of variance (ANOVA) test. All the statistical analysis was done on STATA 17 software. Results The study included a total of 290 participants, most of them were aged between 31–40 years (73.8%), followed by those aged 41–50 years (15.9%), while smaller proportions were in the 20–30 years (6.9%) and 51 years and above (3.4%) age groups. The majority of participants were female (79.7%), while males accounted for 20.3%. In terms of educational qualifications, most participants had a Bachelor of Science in Nursing (BSN) degree (92.4%), while fewer held a Master of Science in Nursing (MSN) (7.2%), and only one had a PhD (0.3%). Regarding professional experience, half of the participants (50.0%) had 11–20 years of experience, 30.0% had 6–10 years, 10.3% had over 20 years, and 9.7% had 0–5 years. The most common job position was Graduate Registered Nurse (74.1%), followed by Graduate Registered Nurse and Midwife (23.1%) and Graduate Registered Midwife (2.8%) (Table 2 ). Table 2 Participant characteristics Variables Level Value N 290 Your age in years 20–30 years 20 (6.9%) 31–40 years 214 (73.8%) 41–50 years 46 (15.9%) 51 and above 10 (3.4%) Gender Male 59 (20.3%) Female 231 (79.7%) Educational Qualification BSN 268 (92.4%) MSN 21 (7.2%) PhD 1 (0.3%) Years of experience 0–5 years 28 (9.7%) 6–10 years 87 (30.0%) 11–20 years 145 (50.0%) Above 20 years 30 (10.3%) Position Graduate registered nurse 215 (74.1%) Graduate registered midwife 8 (2.8%) Graduate registered nurse and midwife 67 (23.1%) Figure 1 shows that 44.8% of nurses correctly identified the age group most affected by low health literacy, while 45.2% recognized the likelihood of encountering patients with limited health literacy skills. However, only 13.8% correctly identified key considerations for nurses when conducting health teaching, suggesting a gap in awareness of effective patient education strategies. Regarding health behaviors associated with low health literacy, 26.9% of respondents provided the correct response, while 34.8% correctly distinguished differences between patients with low and adequate health literacy skills. When developing a plan of care for these patients, 37.2% of nurses responded correctly. A notable finding was that 78.6% of nurses correctly identified the priority action when conducting health teaching, reflecting strong awareness of the importance of clear communication strategies. However, only 53.8% correctly identified the best method for evaluating the effectiveness of health teaching, suggesting potential inconsistencies in assessing patient understanding. Additionally, 29.0% of nurses correctly prioritized teaching focus for newly diagnosed patients, and 41.7% provided an accurate estimate of patients' reading skills. Overall, the mean knowledge score was 3.2 ± 2.3, indicating variability in nurses' understanding of health literacy principles. Table 3 presents the relationship between various demographic and professional variables and nurses' knowledge scores on health literacy. Age significantly influenced knowledge levels, with nurses aged 51 and above having the highest mean score (4.9 ± 1.7), followed by those aged 31–50 years (4.1 ± 1.5 to 4.1 ± 1.8), while the youngest group (20–30 years) had the lowest mean score (2.7 ± 1.3, p = 0.001). Gender also showed a significant difference, with female nurses (4.2 ± 1.8) scoring higher than males (3.5 ± 1.7, p = 0.011). Educational qualification did not significantly impact knowledge scores (p = 1.000), with BSN and MSN/PhD holders having similar scores (4.1 ± 1.8 vs. 4.0 ± 1.7). Years of experience and job position were not significantly associated with knowledge levels, though nurses with more than 11 years of experience had slightly higher scores. Overall, the findings suggest that older nurses and females tend to have greater knowledge of health literacy, while education level and experience do not strongly influence knowledge scores. Table 3 Socio-demographic factors associated with Nurses Knowledge of Health Literacy Variables N Knowledge, mean ± SD p -value Age 20–30 years 20 2.7 ± 1.3 0.001 31–40 years 214 4.1 ± 1.8 41–50 years 46 4.1 ± 1.5 51 and above 10 4.9 ± 1.7 Gender Male 59 3.5 ± 1.7 0.011 Female 231 4.2 ± 1.8 Educational Qualification BSN 268 4.1 ± 1.8 1.00 MSN/ PhD 21 4.0 ± 1.7 Years of experience 0–5 years 28 4.1 ± 1.7 0.30 6–10 years 87 3.8 ± 1.7 11–20 years 145 4.2 ± 1.7 Above 20 years 30 4.1 ± 2.0 Position Graduate registered nurse 215 4.1 ± 1.8 0.80 Graduate registered midwife 8 4.4 ± 1.2 Graduate registered nurse and midwife 67 4.0 ± 1.8 Discussion The competency of healthcare providers in accurately assessing patients' health literacy levels is fundamental to enhancing patient education and engagement. Effective patient and care provider communication is crucial for shared decision-making, which plays a key role in establishing and achieving patient care goals. However, limited knowledge of health literacy, particularly among nurses, poses a significant challenge that must be addressed to optimize patient outcomes. The current study indicated that nurses and midwives have limited knowledge regarding the prevalence of low health literacy and when to conduct patient education. While they understand the expected behaviors of people with low health literacy, they are unaware of the nursing considerations while developing a care plan for such patients, which is certainly alarming as nurses have a pivotal role in health teaching and patient engagement( 14 ). Globally, the term health literacy is not well understood by healthcare professionals and lack foundational health literacy principles( 7 , 8 , 10 , 14 ), possibly due to the inconsistent and the complex health literacy definitions ( 15 , 16 ). In our study, less than half of the nurses have either sometimes or frequently evaluated the written educational materials for readability, cultural appropriateness, and the use of illustrations before using them for patient teaching. Similarly, less than half of the nurses used such material at all, reflecting the knowledge gap in foundational principles of health literacy. As knowledge influences practice, attitude, and experience unawareness regarding health literacy principles can lead to poor integration of health literacy practices such as, professionals often overestimate patients’ health literacy, leading to unclear information delivery. Several studies have shown that nursing programs often lack health literacy in their curriculum and nurses lack appropriate health literacy-related training ( 16 – 19 ), despite the significant role of nurses in engaging their patients across the whole healthcare continuum. As a result, strategies to reduce the impact of low health literacy among patients are not routinely applied by nurses ( 20 ) likely due to the knowledge gap. Nurses’ health literacy competencies had a significant association with the patient–centered care and have a pivotal role in improving health and wellness of patients as nurses are always at the point of care ( 6 , 18 ). According to Güner &Ekmekci (2019), including the vital health literacy competencies in continuing education for nurses can have a positive impact on enhancing their health literacy knowledge ( 20 ). Therefore, incorporating educational programs is a necessary step to enhance the health literacy competencies among nurses ( 10 , 14 , 16 , 20 – 23 ). Furthermore, the role of nursing leaders and hospital administration is vital in improving health literacy practices at an organizational level by encouraging constant professional development through continuing education ( 24 ). On the contrary, ( 16 ) provide diverse evidence in their study indicating that nurses reported high levels of competency in health education. However, the study concluded that education, training and conferences influenced the health education competence of nurses. Our findings reported substantial variability in nurses’ use of appropriate health literate communication techniques alongside persistent knowledge gaps. Although most nurses could identify the key action in health teaching, only half of them correctly identified methods to evaluate teaching effectiveness and ways to assess patient reading ability. Moreover, the results showed that most of the nurses are unaware of the priority focus during the initial teaching session with newly diagnosed patients. These gaps echo ( 25 ) conclude that health literacy deficits among professionals are a principal barrier to effective communication despite the role of clear communication in obtaining better health literacy outcomes. This study identified significant links between age, gender, and health literacy knowledge: nurses aged ≥ 51 scored highest, while those 20–30 scored lowest. In contrast, years of experience showed no significant association with health literacy knowledge—although those with > 11 years’ experience had marginally higher scores, which corresponds with a previous study which explicitly stated that there is no significant relationship between nurse’s years of experience and their knowledge and experience regarding health literacy ( 26 ). ( 7 ) further reported that more experienced nurses struggle more with low–healthliteracy management and employ less principled reasoning, which might explain the reason that the experience is not related to health literacy knowledge. In relation to the gender, female nurses have higher knowledge than males. This aligns with studies showing female nurse’s greater health literacy knowledge is linked to more frequent healthcare interactions ( 4 , 15 , 27 ). In the cultural context of the current study, female nurses attend both male and female patients unlike male nurses, who only care for men resulting in broader patient exposure and more practice of communication skills. Such increased engagement likely underpins their superior competency, consistent with ( 28 ), who found that the nurses who are involved in more health literacy practices are more confident due to their experiential knowledge and skills. Strengths and Limitations To the best of the researcher’s knowledge, this is the first study to assess health literacy knowledge among nurses in Qatar. It provides valuable baseline data on nurses' understanding of health literacy, contributing to the nursing literature. The study utilized a validated data collection tool and achieved an adequate response rate based on sample size calculations. Despite its strengths, some limitations must be acknowledged. The use of convenience sampling from a single hospital in Qatar limits the generalizability of the findings. A larger regional or national study would provide a more comprehensive assessment. Additionally, the self-reported online questionnaire may introduce information or reporting bias. Lastly, the study had an imbalanced gender representation, as male nurses were underrepresented compared to female nurses in the study setting. Recommendations This study highlights the importance of health literacy education and training for nurses to enhance their knowledge and improve patient care. Integrating health literacy-related curricula into nursing programs and orientation sessions is recommended. Additionally, workshops on communication and patient-family education skills should be incorporated into clinical training. Hospital administration must support ongoing education to enhance nurses' ability to assess patient needs and provide personalized care. Nurse managers play a vital role in sustaining these programs by encouraging participation and collaborating with educators. Furthermore, health literacy competencies should be recognized as core skills for healthcare professionals to enhance accountability. Future research with larger samples is needed to explore health literacy trends among nurses in Qatar. Conclusion Health literacy has emerged as a critical determinant of health, significantly influencing patient outcomes and fostering resilience and empowerment at a global level. As healthcare systems evolve, the increasing complexity of patient needs necessitates a stronger emphasis on health literacy, particularly among nurses, who play a pivotal role in patient education and engagement. This study, the first to assess health literacy knowledge and experience among registered nurses in Qatar, identified significant variability in their understanding of health literacy principles. These findings underscore the urgent need to integrate health literacy competencies into nursing education, ensuring that nurses are equipped with the necessary skills to facilitate patient comprehension and application of healthcare information. Effective communication remains the foundation of health literacy proficiency, further reinforcing its growing importance in healthcare research, practice, and policy. Future efforts should focus on developing evidence-based interventions to enhance health literacy among healthcare providers, ultimately improving patient care and reducing disparities in health outcomes. Declarations Data Availability Statement: Data will be available on request due to privacy/ethical restriction. Conflicts of Interest : All the authors declare no conflict of interest. Author Contributions : SA had contributed to conceptualization, methodology, data collection. KS assisted with statistical analysis plan with sample calculation and result interpretation. KS and DM provided critical revisions, feedback and supervision to the study. All authors contributed towards writing and publication. Funding Qatar National Library supported the publication. Acknowledgments The study team would like to acknowledge the nurses in Alwakra hospital who participated in the study and Qatar National Library for funding this study for publication. Ethical approval This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All procedures involving human participants were reviewed and approved by the Institutional Review Board (IRB) of Hamad Medical Corporation (HMC) (MRC-01-23-438). Informed consent was implied through survey participation, as per the approved study protocol. All participants were informed that their participation in the survey was voluntary and completing the survey implied consent to participate in the study. This method of consenting has been previously practiced in similar research settings at Hamad Medical Corporation, as documented in a prior study. No identifiable data was collected, ensuring participant confidentiality throughout the research process. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6713176","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":465710970,"identity":"4d6d7213-4c7f-4fa2-b1ff-b30b5928f17a","order_by":0,"name":"Shemi Assis","email":"","orcid":"","institution":"Hamad Medical Corporation","correspondingAuthor":false,"prefix":"","firstName":"Shemi","middleName":"","lastName":"Assis","suffix":""},{"id":465710972,"identity":"8f14cdf1-c73f-4968-bb16-feb16b14f7a4","order_by":1,"name":"Debbi Marais","email":"","orcid":"","institution":"University of Warwick","correspondingAuthor":false,"prefix":"","firstName":"Debbi","middleName":"","lastName":"Marais","suffix":""},{"id":465710973,"identity":"6458f718-685d-4d6a-8d71-2e624059acb5","order_by":2,"name":"Kalpana Singh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACg/MHGxgYGyTkDEA8HmK0GM5IBGmxMCZei7EEkGBsqEjcQLQWMwnmtodfd0ikb2c/nfjhDYO1PEEtNvwH241lz0jk7uzJ3Sw5hyHdsIGgFobENmnJNoncDQdyN0jzMBxmJKjFDKol3eD8282/gVrsCWoxBmqR/NgmkWBwI3cbyJZEglqAgdwmzdgmYbjhxtttlnMM0pMJajE4f/yZ5M+2OnmD87mbb7ypsLYlqAUEmBHRYcBMjAZgTP5A0k6cllEwCkbBKBhRAAAKtkBIuiPL3wAAAABJRU5ErkJggg==","orcid":"","institution":"Hamad Medical Corporation","correspondingAuthor":true,"prefix":"","firstName":"Kalpana","middleName":"","lastName":"Singh","suffix":""}],"badges":[],"createdAt":"2025-05-21 06:38:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6713176/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6713176/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84199495,"identity":"658f7608-95de-4c68-b294-a80dd161d089","added_by":"auto","created_at":"2025-06-09 08:16:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95070,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNurses' Knowledge and Awareness of Health Literacy in Patient Education\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6713176/v1/a5697cfefdcd1077881542d1.jpg"},{"id":84200892,"identity":"a0241440-43dd-4e8f-8ff1-f5867b3e4c9f","added_by":"auto","created_at":"2025-06-09 08:24:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":688022,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6713176/v1/b6fb894a-8778-4498-b3b8-b48cc31793e8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bridging the Gap: Assessing Health Literacy Practices Among Nurses and Midwives in Qatar","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccording to the Centre for Disease Prevention and Control (CDC), health literacy is defined as \u0026lsquo;the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others\u0026rsquo;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The term health literacy is defined as the ability of an individual to obtain and translate knowledge and information to maintain and improve health in a way that is appropriate to the individual and system contexts(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Globally it is recognized as one of the social determinants of health(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) explicitly state in their systematic review that the term health literacy generally focuses on the ability of a person to understand the health demands to promote and maintain health. Both clinical and public health approaches tend to find common ground in that they focus on people's ability to find, understand, evaluate, and utilize information that will enhance their health and quality of life throughout their lives, even though there are still differences in definitions and conceptual approaches surrounding health literacy. Over the past two decades, considerable importance has been given to the concept of health literacy due to its vital role in health promotion and public health (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The revived interest in health literacy has not only been noticeable in public health and medical care and this is amply demonstrated by the increasing quantity of scientific articles that are published and the inclusion of health literacy as a key topic in numerous policy agendas (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Results of an exploratory bibliometric analysis show that, between 1997 and 2007, the number of international articles published on health literacy increased by almost ten times, supporting the growing attribution of relevance to this field of study (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). There are indeed solid grounds to believe that the numbers have only increased since then.\u003c/p\u003e \u003cp\u003eHealth literacy is a critical global issue, with low levels among the general population posing significant challenges. Healthcare professionals, particularly nurses, play a vital role in addressing this by enhancing patient engagement and improving care experiences (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). As frontline providers, nurses are uniquely positioned to foster health literacy and promote better health outcomes. However, research indicates that many healthcare professionals lack a thorough understanding of health literacy and its impact on patient well-being (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)Given its complexity, health literacy must be assessed and addressed in every healthcare encounter to ensure patient safety, engagement, and quality care (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Limited knowledge in this area among nurses contributes to poor patient outcomes and increased healthcare costs (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Nurses\u0026rsquo; expertise in health literacy\u0026mdash;encompassing their knowledge, experience, and ability to implement effective strategies\u0026mdash;not only shapes individual patient-provider interactions but also influences the broader healthcare system. Therefore, nurses\u0026rsquo; ability to accurately assess and respond to patients\u0026rsquo; health literacy levels is essential for effective patient management(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith a population of 2,891,000 (as of November 2022), Qatar reported a high literacy rate of 93.5% among individuals\u0026thinsp;\u0026ge;\u0026thinsp;15 years and 70.5% among the elderly (\u0026ge;\u0026thinsp;65 years) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, high literacy level does not always reflect high health literacy due to situational and environmental factors although both aspects of literacy influence each other, and poor health literacy is still prevalent at high education levels(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Hence, healthcare worker\u0026rsquo;s knowledge and competency in assessing the health literacy of patients regardless of their literacy level is essential to provide high-quality care.\u003c/p\u003e \u003cp\u003eThis study aimed to assess the health literacy knowledge and experience among registered nurses and midwives in HMC-Qatar and the association between health literacy knowledge levels and the selected demographic variables.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and sampling\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional research design was utilized to identify the health literacy knowledge level and experience among registered nurses and midwives who work at different units of a government hospital in Qatar. All registered nurses and midwives with a valid nursing license (Department of health care professions-DHP) and currently working in the hospital were included, whereas anyone who had submitted their resignation was excluded. The hospital is a general hospital that has been designed, built, and staffed to support the healthcare needs of the southern area of the State of Qatar. The hospital has different departments to provide comprehensive care for patients of all ages, from emergency, general medicines, surgery, dialysis, and critical care. Moreover, it is the only Burns Centre in the country. The hospital has a capacity of 325 beds; 248 of which are for general patients and acute patients and 77 are for critical care, high dependency, and burns patients.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eThe sample size for the study was estimated using a standard formula for a finite population correction. As a previous similar study reported 29.3% knowledge about health literacy (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), 29.9% knowledge regarding health literacy was used in the power formula, with a 95% confidence interval, 5% relative precision, and the total number of nurses working in the selected facility to be 1232. The required sample size was calculated as 260. Considering a 10% non-response resulted in an expected sample size of ~\u0026thinsp;290 nurses for the study.\u003c/p\u003e\n\u003ch3\u003eData Collection tool\u003c/h3\u003e\n\u003cp\u003eA validated questionnaire was used to collect data, namely the Health Literacy Knowledge and Experiences Survey-2 (HLKES-2), which is a validated health literacy knowledge assessment tool(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). HLKES-2 is a revised version of HLKES (Health Literacy Knowledge and Experiences Survey) which was originally developed in 2006 by Cormier to assess the health literacy knowledge and experience of nursing students in Louisiana, U.S. HLKES-2 has 14 questions, 10 knowledge questions, and 4 experience questions. The knowledge questions represent three foundational principles of health literacy which are, a-foundational knowledge of health literacy principles (represented by questions 1, 2 and 3), b-appropriate health literate communication techniques (represented by questions 7, 8, 9 and 10 and c- expected behaviors of people with low health literacy (represented by questions 4, 5 and 6) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFoundational Health literacy Principles\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFoundational principles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRepresenting questions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ea) Foundational knowledge of health literacy principles\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1) Low health literacy is most prevalent among which age group?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2) What should a nurse consider when conducting health teaching with a patient?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3) What is the likelihood that a nurse will encounter a patient with low health literacy?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eb) Appropriate health literate communication techniques\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7) What is the priority action of the nurse when conducting health teaching?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8) What is the best method for the nurse to evaluate the effectiveness of healthcare teaching?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9) The nurse is caring for a patient newly diagnosed with a health condition. What should be the priority focus during the first teaching session?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10) Which of the following questions would provide the nurse with the best estimate of the reading skills of the patient?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ec) Expected behaviors of people with low health literacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4) Which health behavior is common among patients with low health literacy?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5) Patients with low health literacy skills compared to those with adequate health literacy skills:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6) What should the nurse consider when developing a plan of care for a client with low health literacy?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn addition, socio-demographic questions were asked namely age, gender, educational qualifications, years of experience and position to enable comparisons and to identify factors impacting on knowledge scores. Moreover, the participant information sheet outlining the purpose of this study was integrated into the online survey, and participants were able to proceed to the survey tool link by clicking the agreement button, implying that their participation was voluntary. Thus, implied consent was obtained.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics was used to analyze the distributions of responses on the questionnaire items and subscales. The knowledge score was calculated by adding all the correct answers in the questionnaire. The maximum score for the health literacy knowledge questionnaire is 10. The mean of the knowledge score with different demographic characteristics was compared with an independent-sample \u003cem\u003et-test\u003c/em\u003e, a one-way analysis of variance (ANOVA) test. All the statistical analysis was done on STATA 17 software.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included a total of 290 participants, most of them were aged between 31\u0026ndash;40 years (73.8%), followed by those aged 41\u0026ndash;50 years (15.9%), while smaller proportions were in the 20\u0026ndash;30 years (6.9%) and 51 years and above (3.4%) age groups. The majority of participants were female (79.7%), while males accounted for 20.3%. In terms of educational qualifications, most participants had a Bachelor of Science in Nursing (BSN) degree (92.4%), while fewer held a Master of Science in Nursing (MSN) (7.2%), and only one had a PhD (0.3%). Regarding professional experience, half of the participants (50.0%) had 11\u0026ndash;20 years of experience, 30.0% had 6\u0026ndash;10 years, 10.3% had over 20 years, and 9.7% had 0\u0026ndash;5 years. The most common job position was Graduate Registered Nurse (74.1%), followed by Graduate Registered Nurse and Midwife (23.1%) and Graduate Registered Midwife (2.8%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipant characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLevel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYour age in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214 (73.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (15.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231 (79.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Qualification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268 (92.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (7.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate registered nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215 (74.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate registered midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGraduate registered nurse and midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that 44.8% of nurses correctly identified the age group most affected by low health literacy, while 45.2% recognized the likelihood of encountering patients with limited health literacy skills. However, only 13.8% correctly identified key considerations for nurses when conducting health teaching, suggesting a gap in awareness of effective patient education strategies. Regarding health behaviors associated with low health literacy, 26.9% of respondents provided the correct response, while 34.8% correctly distinguished differences between patients with low and adequate health literacy skills. When developing a plan of care for these patients, 37.2% of nurses responded correctly.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA notable finding was that 78.6% of nurses correctly identified the priority action when conducting health teaching, reflecting strong awareness of the importance of clear communication strategies. However, only 53.8% correctly identified the best method for evaluating the effectiveness of health teaching, suggesting potential inconsistencies in assessing patient understanding. Additionally, 29.0% of nurses correctly prioritized teaching focus for newly diagnosed patients, and 41.7% provided an accurate estimate of patients' reading skills.\u003c/p\u003e \u003cp\u003eOverall, the mean knowledge score was 3.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3, indicating variability in nurses' understanding of health literacy principles.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the relationship between various demographic and professional variables and nurses' knowledge scores on health literacy. Age significantly influenced knowledge levels, with nurses aged 51 and above having the highest mean score (4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7), followed by those aged 31\u0026ndash;50 years (4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 to 4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8), while the youngest group (20\u0026ndash;30 years) had the lowest mean score (2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3, p\u0026thinsp;=\u0026thinsp;0.001). Gender also showed a significant difference, with female nurses (4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8) scoring higher than males (3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7, p\u0026thinsp;=\u0026thinsp;0.011). Educational qualification did not significantly impact knowledge scores (p\u0026thinsp;=\u0026thinsp;1.000), with BSN and MSN/PhD holders having similar scores (4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 vs. 4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7). Years of experience and job position were not significantly associated with knowledge levels, though nurses with more than 11 years of experience had slightly higher scores. Overall, the findings suggest that older nurses and females tend to have greater knowledge of health literacy, while education level and experience do not strongly influence knowledge scores.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic factors associated with Nurses Knowledge of Health Literacy\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKnowledge, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational Qualification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBSN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSN/ PhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYears of experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePosition\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate registered nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate registered midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate registered nurse and midwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe competency of healthcare providers in accurately assessing patients' health literacy levels is fundamental to enhancing patient education and engagement. Effective patient and care provider communication is crucial for shared decision-making, which plays a key role in establishing and achieving patient care goals. However, limited knowledge of health literacy, particularly among nurses, poses a significant challenge that must be addressed to optimize patient outcomes.\u003c/p\u003e \u003cp\u003eThe current study indicated that nurses and midwives have limited knowledge regarding the prevalence of low health literacy and when to conduct patient education. While they understand the expected behaviors of people with low health literacy, they are unaware of the nursing considerations while developing a care plan for such patients, which is certainly alarming as nurses have a pivotal role in health teaching and patient engagement(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Globally, the term health literacy is not well understood by healthcare professionals and lack foundational health literacy principles(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), possibly due to the inconsistent and the complex health literacy definitions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In our study, less than half of the nurses have either sometimes or frequently evaluated the written educational materials for readability, cultural appropriateness, and the use of illustrations before using them for patient teaching. Similarly, less than half of the nurses used such material at all, reflecting the knowledge gap in foundational principles of health literacy. As knowledge influences practice, attitude, and experience unawareness regarding health literacy principles can lead to poor integration of health literacy practices such as, professionals often overestimate patients\u0026rsquo; health literacy, leading to unclear information delivery.\u003c/p\u003e \u003cp\u003eSeveral studies have shown that nursing programs often lack health literacy in their curriculum and nurses lack appropriate health literacy-related training (\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), despite the significant role of nurses in engaging their patients across the whole healthcare continuum. As a result, strategies to reduce the impact of low health literacy among patients are not routinely applied by nurses (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) likely due to the knowledge gap. Nurses\u0026rsquo; health literacy competencies had a significant association with the patient\u0026ndash;centered care and have a pivotal role in improving health and wellness of patients as nurses are always at the point of care (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). According to G\u0026uuml;ner \u0026amp;Ekmekci (2019), including the vital health literacy competencies in continuing education for nurses can have a positive impact on enhancing their health literacy knowledge (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Therefore, incorporating educational programs is a necessary step to enhance the health literacy competencies among nurses (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Furthermore, the role of nursing leaders and hospital administration is vital in improving health literacy practices at an organizational level by encouraging constant professional development through continuing education (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). On the contrary, (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) provide diverse evidence in their study indicating that nurses reported high levels of competency in health education. However, the study concluded that education, training and conferences influenced the health education competence of nurses.\u003c/p\u003e \u003cp\u003eOur findings reported substantial variability in nurses\u0026rsquo; use of appropriate health literate communication techniques alongside persistent knowledge gaps. Although most nurses could identify the key action in health teaching, only half of them correctly identified methods to evaluate teaching effectiveness and ways to assess patient reading ability. Moreover, the results showed that most of the nurses are unaware of the priority focus during the initial teaching session with newly diagnosed patients. These gaps echo (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) conclude that health literacy deficits among professionals are a principal barrier to effective communication despite the role of clear communication in obtaining better health literacy outcomes.\u003c/p\u003e \u003cp\u003eThis study identified significant links between age, gender, and health literacy knowledge: nurses aged\u0026thinsp;\u0026ge;\u0026thinsp;51 scored highest, while those 20\u0026ndash;30 scored lowest. In contrast, years of experience showed no significant association with health literacy knowledge\u0026mdash;although those with \u0026gt;\u0026thinsp;11 years\u0026rsquo; experience had marginally higher scores, which corresponds with a previous study which explicitly stated that there is no significant relationship between nurse\u0026rsquo;s years of experience and their knowledge and experience regarding health literacy (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) further reported that more experienced nurses struggle more with low\u0026ndash;healthliteracy management and employ less principled reasoning, which might explain the reason that the experience is not related to health literacy knowledge.\u003c/p\u003e \u003cp\u003eIn relation to the gender, female nurses have higher knowledge than males. This aligns with studies showing female nurse\u0026rsquo;s greater health literacy knowledge is linked to more frequent healthcare interactions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In the cultural context of the current study, female nurses attend both male and female patients unlike male nurses, who only care for men resulting in broader patient exposure and more practice of communication skills. Such increased engagement likely underpins their superior competency, consistent with (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), who found that the nurses who are involved in more health literacy practices are more confident due to their experiential knowledge and skills.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eTo the best of the researcher\u0026rsquo;s knowledge, this is the first study to assess health literacy knowledge among nurses in Qatar. It provides valuable baseline data on nurses' understanding of health literacy, contributing to the nursing literature. The study utilized a validated data collection tool and achieved an adequate response rate based on sample size calculations.\u003c/p\u003e \u003cp\u003eDespite its strengths, some limitations must be acknowledged. The use of convenience sampling from a single hospital in Qatar limits the generalizability of the findings. A larger regional or national study would provide a more comprehensive assessment. Additionally, the self-reported online questionnaire may introduce information or reporting bias. Lastly, the study had an imbalanced gender representation, as male nurses were underrepresented compared to female nurses in the study setting.\u003c/p\u003e\n\u003ch3\u003eRecommendations\u003c/h3\u003e\n\u003cp\u003eThis study highlights the importance of health literacy education and training for nurses to enhance their knowledge and improve patient care. Integrating health literacy-related curricula into nursing programs and orientation sessions is recommended. Additionally, workshops on communication and patient-family education skills should be incorporated into clinical training. Hospital administration must support ongoing education to enhance nurses' ability to assess patient needs and provide personalized care. Nurse managers play a vital role in sustaining these programs by encouraging participation and collaborating with educators. Furthermore, health literacy competencies should be recognized as core skills for healthcare professionals to enhance accountability. Future research with larger samples is needed to explore health literacy trends among nurses in Qatar.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHealth literacy has emerged as a critical determinant of health, significantly influencing patient outcomes and fostering resilience and empowerment at a global level. As healthcare systems evolve, the increasing complexity of patient needs necessitates a stronger emphasis on health literacy, particularly among nurses, who play a pivotal role in patient education and engagement. This study, the first to assess health literacy knowledge and experience among registered nurses in Qatar, identified significant variability in their understanding of health literacy principles. These findings underscore the urgent need to integrate health literacy competencies into nursing education, ensuring that nurses are equipped with the necessary skills to facilitate patient comprehension and application of healthcare information. Effective communication remains the foundation of health literacy proficiency, further reinforcing its growing importance in healthcare research, practice, and policy. Future efforts should focus on developing evidence-based interventions to enhance health literacy among healthcare providers, ultimately improving patient care and reducing disparities in health outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003e Data will be available on request due to privacy/ethical restriction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e: All the authors declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: SA had contributed to conceptualization, methodology, data collection. KS assisted with statistical analysis plan with sample calculation and result interpretation. KS and DM provided critical revisions, feedback and supervision to the study. All authors contributed towards writing and publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e Qatar National Library supported the publication. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003eThe study team would like to acknowledge the nurses in Alwakra hospital who participated in the study and Qatar National Library for funding this study for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. All procedures involving human participants were reviewed and approved by the Institutional Review Board (IRB) of Hamad Medical Corporation (HMC) (MRC-01-23-438). Informed consent was implied through survey participation, as per the approved study protocol. All participants were informed that their participation in the survey was voluntary and completing the survey implied consent to participate in the study. This method of consenting has been previously practiced in similar research settings at Hamad Medical Corporation, as documented in a prior study. No identifiable data was collected, ensuring participant confidentiality throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial-\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCDC. Health Literacy. 2024 [cited 2025 May 25]. Health Literacy. 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PLoS ONE. 2020;15(6):e0234926.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Fayyadh S, Al-Jubouri MB, AL-Hadrawi H, Jaafar SA, Hussein SM. Health Literacy-Related Knowledge and Experience among Nurses Practicing in Medical-Surgical Wards. Nurse Media J Nurs. 2022;12(1):24\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth literacy in. a high income Arab country: A nation-wide cross-sectional survey study - PubMed [Internet]. [cited 2025 May 25]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/36197929/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/36197929/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakarem A, Heshmati-Nabavi F, Afshar L, Yazdani S, Pouresmail Z, Hoseinpour Z. The Comparison of Professional Confidence in Nursing Students and Clinical Nurses: A Cross-Sectional Study. Iran J Nurs Midwifery Res. 2019;24(4):261\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health literacy, patient education, patient engagement, healthcare professionals","lastPublishedDoi":"10.21203/rs.3.rs-6713176/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6713176/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAim: \u0026nbsp;This study aimed to assess the health literacy knowledge and experience among registered nurses and midwives and to determine the association between health literacy knowledge levels and selected demographic variables.\u003c/p\u003e\n\u003cp\u003eDesign and Methods: A descriptive cross-sectional survey design was used with a convenience sample of 290 registered nurses and midwives working in different units of a hospital in Qatar. Data collection involved a socio-demographic questionnaire and a validated health literacy knowledge and experience questionnaire. Descriptive statistics, independent-sample \u003cem\u003et-test\u003c/em\u003e, and a one-way analysis of variance (ANOVA) test were used to analyze the data.\u003c/p\u003e\n\u003cp\u003eResults: \u0026nbsp;The mean knowledge score was inadequate overall at 3.2 ± 2.3 out of 10, also indicating variability in nurses' understanding of health literacy principles. Among socio-demographic variables, age significantly influenced knowledge levels, with nurses aged 51 and above having the highest mean score (4.9±1.7). Gender also showed a significant difference, with female nurses (4.2±1.8) scoring higher than males (3.5±1.7, p=0.011). Overall, the findings suggest that older nurses and females tend to have greater knowledge of health literacy, while education level and experience do not strongly influence these scores.\u003c/p\u003e\n\u003cp\u003eConclusion: The current study reported significant variability in nurses' understanding of health literacy principles in Qatar. The integration of health literacy related education and training for nurses is paramount to enhance their health literacy knowledge and practices, especially for younger and male nursing staff. Therefore, it is recommended to develop health literacy related curriculum and programs for nurses to enhance quality patient care and promising patient outcomes.\u003c/p\u003e\n\u003cp\u003ePatient or Public Contribution: No Patient or Public Contribution\u003c/p\u003e","manuscriptTitle":"Bridging the Gap: Assessing Health Literacy Practices Among Nurses and Midwives in Qatar","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 08:16:23","doi":"10.21203/rs.3.rs-6713176/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-03T08:02:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-02T16:57:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-02T16:03:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"10297943069081742262691479825574603109","date":"2025-06-02T13:42:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"182988570936269903471702720535552671445","date":"2025-06-02T12:10:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285205608094019361329209595378367854122","date":"2025-06-02T11:58:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-02T11:56:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-30T08:51:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-26T10:27:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-25T14:52:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-05-25T14:51:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51a85e6b-93e4-4c8c-80de-634b6629b22e","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-22T05:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-09 08:16:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6713176","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6713176","identity":"rs-6713176","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}