Construction and Validity of Chinese Translation of the Universal Mental Health Literacy Scale for Adolescents

Background:In this study,the Universal Mental Health Literacy Scale for Adolescents(UMHL-A)was revised and tested for its reliability and validity in Chinese middle school students,thus establishing a useful tool for assessing the mental health of individuals in this occupation.Methods:Our sample comprised 1208 junior high school students(58.85%male),aged between 11 and 15 years old.The Chinese version of the scale includes a mental health attitude subscale and mental health knowledge subscale,including attitudes towards seeking help,attitudes related to stigma,general mental health knowledge,and knowledge about specific mental illnesses,encapsulated in a total of 17 items.A series of psychometric analyses such as exploratory factor analysis(EFA),confirmatory factor analysis(CFA),and internal consistency reliability estimation were carried out in this study.Results:The results of the CFA indicated that the two-factor model had an acceptable model fit(Attitude(UMHL-A Likert):χ^(2)/df=4.107;RMSEA=0.072;SRMR=0.045;TLI=0.932;CFI=0.954;Knowledge(UMHL-A T/F):χ^(2)/df=3.647;RMSEA=0.066;SRMR=0.044;TLI=0.923;CFI=0.945).The Cronbach’s alpha coefficient of subscales of the Chinese version UMHL-A were 0.80 and 0.78,respectively.Conclusion:In general,the Chinese version of the Universal Mental Health Literacy Scale for adolescents has good reliability and validity and can be used as a tool to measure the mental health literacy of Chinese adolescents.

An Experimental Study on the Effectiveness of Individualized Online Intervention for Mental Health Literacy of Community Residents

Background:Understanding how to improve mental health literacy is conducive to maintaining and promoting individuals’mental health and well-being.However,to date,interventions for mental health literacy primarily depend on traditional education and contact interventions,which have limitations with regard to pertinence and individualization.Artificial intelligence(AI)and big data technology have influenced mental health services to be more intellectual and digital,and they also provide greater technical convenience for individualized interventions for promoting mental health literacy.However,there is relatively little research on the effectiveness of individualized online intervention for mental health literacy in the literature.This study aims to fill this void.To verify whether individualized online intervention can improve the level of mental health literacy.Methods:We conducted a pretest–post-test control experiment.The participants were recruited from a large community located in central China.A total of 152 participants completed the research.We use mixed linear model estimation and paired t-tests to analyze the data.Results:Individualized online intervention can effectively improve the mental health literacy level of participants.Specifically,we found that compared with the control group,the mental health literacy in the experimental group was significantly improved after receiving individualized online intervention.Likewise,the mental health literacy of the control group has also improved after receiving individualized online intervention.In addition,we compared the mental health literacy level of the experimental group at Time 3 to those at Time 2 and found that the mental health literacy level at Time 3 had not decreased one month later.This shows that individualized online intervention was not only momentarily effective,but also had long-term efficacy.Conclusion:This study illustrates that the individualized online intervention has both great momentary and long-term effectiveness in improving community residents’mental health literacy.

Association between Mental Health Literacy and Workplace Well-Being of Chinese Grassroots Civil Servants:The Chain Mediating Effects of Regulatory Emotional Self-Efficacy and Resilience

This study aimed to investigate the relationship between mental health literacy(MHL)and workplace well-being(WWB)of Chinese grassroots civil servants,with regulatory emotional self-efficacy(RESE)and resilience as mediating variables.A questionnaire survey was conducted among Chinese grassroots civil servants,with a valid sample size of 2673 after excluding missing values and conducting relevant data processing.The PROCESS was used to examine the relationship between MHL,RESE,resilience,and WWB.The study found that MHL among grassroots civil servants was positively and significantly correlated with WWB(r=0.73,p<0.01).RESE partially mediated the relationship between MHL and WWB(β=0.25,95%CI[0.22,0.28]).Resilience partially mediated the relationship between MHL and WWB(β=0.22,95%CI[0.19,0.26]).MHL had a positive effect on WWB through the chain mediating effect of RESE and resilience(β=0.05,95%CI[0.03,0.07]).There is a close relationship between MHL and WWB,where Chinese grassroots civil servants with higher levels of MHL can develop stronger RESE and resilience,leading to higher WWB.The results of this study remind organizational institutions of Chinese grassroots civil servants that enhancing MHL,RESE,and resilience is an important pathway to promoting their WWB.

Assessing the relationship between health literacy intervention and hypertension self-management:A 7-year systematic review from January 2016 to December 2022

Hypertension(HTN)is one of the most common chronic diseases affecting over 30%of the adult population globally,with a growing incidence rate.This review assesses the relationship between health literacy(HL)intervention and hypertension(HTN)self-management among people with HTN.The study design was a systematic review of empirical research articles using a well-defined strategy.Online journals were accessed through databases such as PubMed,CINAHL,Google Scholar,ProQuest,Global Health,WHOLIS,Embase,and EbscoHost,spanning from January 2016 to December 2022 as the scope of the study.Articles selected for inclusion were those published in English during the specified time frame and adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Sample,Phenomenon of Interest,Design,Evaluation,Research Type framework for systematic review,focusing on criteria related to the sample,the phenomenon of interest,study design,evaluation,and research type.Out of 180 studies initially identified in the database search,20 studies were ultimately included in the review.The findings were reported based on these five emerging themes:Relationship between HL and HTN self-management;Effect of HL intervention on HTN self-management;Factors predicting self-care behaviors among HTN patients with low HL;Effect of HL and self-management efficacy on health-related quality of life(HRQoL);and level of self-care practices.This review highlights a relationship between HL,self-efficacy,self-care,and HRQoL,underscoring the necessity for further well-designed intervention studies focused on enhancing HL in individuals with HTN in Nigeria to enhance their quality of life.

The Relationship between Mental Health Literacy and Subjective Well-Being of Young and Middle-Aged Residents: Perceived the Mediating Role of Social Support and Its Urban-Rural Differences

This study investigates mental health literacy among young and middle-aged urban and rural residents and the differences in mental health literacy,perceived social support and subjective well-being.From January to February 2022,620 participants(320 rural and 300 urban residents)from three provinces of China were selected by con-venience sampling.A general data questionnaire,mental health literacy scale,perceived social support scale and subjective well-being scale were administered.The mental health literacy scores of urban residents were 3.34±0.57 and those of rural residents were 2.73±0.79.The results of multiple regression analysis showed that the mental health literacy scores of rural residents were more significant than those of urban residents in terms of sex and age,while urban residents’mental health literacy scores were more significant than those of rural resi-dents in terms of monthly income.Mental health literacy,perceived social support and subjective well-being of young and middle-aged urban and rural residents were all positively correlated(P<0.01).While the level of mental health literacy is better among urban residents than rural residents,perceived social support plays a partial mediating role between mental health literacy and subjective well-being of both urban and rural residents,and should be the focus of researchers seeking to improve the level of well-being of residents.

Study on the Relationship between Mental Health Literacy and Psychological Symptoms of University Students: Mediating Effect of Grit

Background:The occurrence of mental health symptoms is higher in individuals aged between 18 and 24 years than in other age groups.Mental health literacy is derived from health literacy,and focuses on the knowledge,attitudes,and competencies that individuals need to acquire to manage their own health effectively.Low mental health literacy is associated with poorer mental health.Grit is also a known protective factor against mental disorders.Despite a heightened focus on mental health literacy and grit as important factors for decreasing mental health symptoms,knowledge of the effect of mental health literacy and grit on mental health symptoms is very limited.This study aimed to evaluate the relationship between mental health literacy and psychological symptoms and the mediating effect of grit on these relationships.Methods:This cross-sectional descriptive study used survey data from 178 university students in Korea.Data were collected between March and May 2022.The SPSS PROCESS macro(Model 4)was used to analyze the data.Results:Mental health literacy was not directly associated with psychological symptoms.However,an indirect pathway was observed between mental health literacy,depression,and anxiety,through grit.Conclusion:Mental health literacy affects psychological symptoms through grit.Therefore,to improve the mental health of university students,it is necessary to develop programs that increase mental health literacy and grit.

Workplace Wellness,Mental Health Literacy,and Usage Intention of E-Mental Health amongst Digital Workers during the COVID-19

The prevalence of mental health problems in both Malaysian and global workplaces has significantly increased due to the presence of the coronavirus disease(COVID-19)pandemic,globalization,technology advancement in Industry 4.0,and other contributing factors.The pervasiveness of the issue poses a huge challenge to improving the occupational safety and health(OSH)of workers in various industries,especially in the digital industry.The emergence of the innovative industry is evident mainly due to the rapid development of Industry 4.0 and the rele-vant demands of multiple businesses in the digital transformation.Nonetheless,limited studies and academic dis-cussions were conducted on the OSH topic of digital employees.Hence,the current study serves tofill the existing gap and provide academic contributions by scrutinising the perceptions of digital workers regarding their work-place well-being,mental health literacy,and the impression of employing e-mental health.The objectives of this study are:1)To examine the mental health literacy and workplace wellness of digital workers,2)to explore the e-mental health usage intention and actual e-mental health utilization,and 3)to identify digital workers’feedback on e-mental health.In the current context,e-mental health focuses on three dimensions,namely,1)“health in our hand(HIOH)”,2)“interacting for health(IFH)”,and 3)“data enabling health(DEH)”.The present study employed an online cross-sectional survey and received 326 digital workers’completed responses.Variables,such as“mental health literacy(MHL)”,“workplace wellness(WW)”,and e-mental health intention and usage were explicated by analysing the data through descriptive statistics.The study results indicated a moderate to a high level of the MHL and the WW.More than half of the workers possessed a high intention level to employ e-mental health,with the HIOH dimension being the most prevalent domain.Nevertheless,the actual e-mental health usage was very low,owing to the online resources being a new concept amongst digital employees.Numerous confounding factors also existed in affecting the low usage,such as privacy concerns,data security levels,and health verification issues.In addition,the mental health issue has not been openly and widely discussed in Malay-sian workplaces due to stigmatisation.As such,the currentfindings could provide additional insights into the OSH literature;it could serve as a guideline for the OSH decision-makers,employers,and eHealth developers when establishing a feasible framework for the practical adoption of e-mental health services by digital workers.

Systematic evaluation of maternal and infant health literacy assessment tools based on COSMIN guidelines

Background:To systematically evaluate the measurement performance of the maternal and child health literacy scale and the study’s methodological quality and to provide a reference for selecting and developing related health outcome measurement tools.Methods:Databases such as CNKI,PubMed,and Embase were searched,and the search time frame was established until January 2023.The literature was independently screened by two researchers.The methodological quality and measurement performance of the included scales were evaluated using the health measurement tool selection criteria,and the evaluation results were summarized and analyzed using descriptive analysis.Results:A total of six papers were included,covering six specific scales,with significant differences in the methodological quality and measurement performance of their development studies,none of which evaluated hypothesis testing,the validity of scales,cross-cultural validity,measurement error,or responsiveness.Conclusion:The methodological quality and scale measurement performance of the maternal health literacy inventory in pregnancy,the women’s reproductive health literacy in pregnancy questionnaire,and the maternal and infant health literacy scale development studies are relatively high,but the number of studies on maternal and infant health literacy specific scales is relatively insufficient,and more studies should be conducted in the future.

基于美国健康素养(Health Literacy Tool Shed)数据库的健康素养量表分析

针对健康素养测评量表在应用方面存在适用条件差异大、数量多且分散、查找不方便等问题,美国建立了健康素养测评工具屋(Health Literacy Tool Shed,HLTS)数据库。在介绍该库功能与特点的基础上,采用内容分析法分析健康素养测评量表研究现状的结果表明,测评方式多样化、开发方法现代化、测评内容简洁化、填写方式网络化、语言版本多元化、主客观相结合的评估方法是健康素养评估工具研究的发展趋势。

Translation and psychometric evaluation of the Chinese version of the Heart Failure-Specific Health Literacy Scale

Objective:Health literacy is closely associated with self-care behaviors in heart-failure patient.A reliable,valid,and practical measuring tool would evaluated the level of health literacy in Chinese patients with heart failure,and provide evidence for individualized education.Aim of this study was to translate Heart Failure-Specific Health Literacy Scale(HF-Specific HL Scale)into Chinese and test the reliability and validity of the Chinese version.Methods:The original HF-specific HL scale was translated into Chinese and modified for cultural adaption.Totally 164 HF inpatients were investigated with the Chinese version of HF-specific HL scale.To test the reliability and validity of the scale,item analysis,exploratory factor analysis(EFA),confirmatory factor analysis(CFA),and correlation analysis were conducted.Result:Cronbach's a value for the scale is 0.87;the correlation coefficients between each item and the total score ranged from 0.61 to 0.91.Three factors was extracted by EFA,which could explain 64.62%of the total variance.The result of CFA also showed that the scale demonstrated an acceptable model fit.The scale was significantly correlated with the Chinese version of the Heart Failure Knowledge Test(C-HFKT).Conclusion:The Chinese version of HF-specific HL scale is reliable and valid,and is suitable for assessment of HL in Chinese HF patients.

Health literacy and health outcomes in hypertension: An integrative review

Objective:The aim of this study was to summarize the evidence of health literacy and health outcomes in hypertensive patients.Methods:Articles published in English were searched from six databases:MEDLINE,CINAHL,Embase,ERIC,psycINFO,and SCOPUS.The articles published up to September 2017 were included.Results:Nineteen publications were included in the review.There was quality and consistent evidence that hypertensive patients with lower literacy had poorer knowledge.There was inconsistent evidence to show the relationship between health literacy and clinical outcomes,of systolic and diastolic blood pressure,and blood pressure control;behavioral outcomes,of self-care,self-efficacy,adherence;patientphysician interactions outcomes,of patient-physician communication,patient trust,involvement in decision making and other outcomes.Conclusion:The person with low health literacy is likely to have poor knowledge of hypertension.However,there is insufficient evidence to suggest that health literacy is associated with outcomes of hypertension independently.

Multidimensional health literacy profiles and health-related behaviors in the elderly:A cross-sectional survey

Objectives:To investigate health literacy profiles using a multidimensional tool in the elderly,analyze the factors related to health literacy,and explore the relationships between health literacy and health-related behaviors.Methods:A cross-sectional survey including 440 participants was conducted at a community health center and a village health center in Changsha,Hunan Province,between June 2020 and August 2020.We used the Health Literacy Questionnaire(HLQ)to assess the elderly’s health literacy.Sociodemographic data and health-related behaviors of them were surveyed with a self-designed questionnaire.Latent profile analysis,Pearson’s chi-squared and ordinal logistic regression were used to analyze the data.Results:The median age of the 440 respondents was 68 years.The participants had the lowest scores in the“appraisal of health information”subscale(2.22±0.52),followed by“navigating the healthcare system”subscale(2.89±0.81)of HLQ.Based on the analysis of three profiles,respondents who were 60 e74 years(OR=2.06,95%CI:1.23e3.42,P=0.006),living in urban areas(OR=3.28,95%CI:2.17e4.94,P<0.001),with secondary education or above(OR=2.86,95%CI:1.92e4.27,P<0.001),and having health insurance(OR=1.89,95%CI:1.02e3.51,P=0.042)were significantly associated with health literacy.Statistically significant associations were found between health literacy level and health-related behaviors,including medical service-seeking behavior(χ^(2)=25.14,P<0.001),exercising regularly(χ^(2)=34.08,P<0.001),and taking a medical examination in the past 12 months(χ^(2)=24.76,P<0.001).Conclusion:The multidimensional health literacy survey has identified the low health literacy level among the elderly in community settings.It revealed the relationships of sociodemographic character-istics,including age,education level and residence,with health literacy.These findings emphasized the importance of health literacy in promoting health behaviors,guiding a profound understanding of the Chinese elderly’s health needs and health literacy to develop community-based health promotion interventions.

The effect of health literacy level on health outcomes in patients with diabetes at a type v health centre in Western Jamaica

Objective:To identify the effects of health literacy levels on health outcomes in patients with diabetes in a type V health center in Western Jamaica.Method:A correlational survey design with a random sampling technique was used.An 18-item questionnaire and the Newest Vital Sign tool were administered to 88 consenting adults with diabetes to assess their health literacy levels.Their health outcomes were evaluated with docket review.Data were analyzed using SPSS version 18.Results:The participants were predominantly female(77.3%),aged 51-70 years,married(44%),employed(46%),and diagnosed with diabetes>10 years(42%).Only 13.6%of the study population was adequately health literate.The health literacy scores for gender were not significant(P=0.84).The health literacy scores of the patients with different ages and educational levels were significant(P<0.001).Pearson's correlations revealed no linear relationship between health literacy scores and health outcome(r=0.185,P=0.084).Conclusion:Limited health literacy and high likelihood of limited health literacy are predominant in the study population.Age and educational level are significantly associated with health literacy levels.However,these findings suggest no association between health literacy level and diabetic health outcomes.

Health literacy in kidney disease: Review of the literature and implications for clinical practice

Health literacy is the capacity of an individual to understand information related to a disease in order to make an informed decision. In patients with kidney diseases, studies have reported increasing impact of limited health literacy on health outcomes. Our paper discusses current literature on health literacy in kidney diseases.

Age- and Sex-Specific Impact of Health Literacy on Healthy Lifestyle Characteristics among Japanese Residents in a Rural Community

The study aimed to examine age- and sex-specific associations between health literacy (HL) and healthy lifestyle characteristics. The cross-sectional study was conducted to examine a total 1348 Japanese participants (613 male and 735 female) who took the health check-up program in April 2013, at Tsumagoi Village, Japan. Information was collected by self-administered questionnaire on three communicative and two critical HL items, and healthy lifestyle characteristics listed in Bres-low’s seven health practices. In multivariate logistic analysis, high HL (≥18) was significantly asso-ciated with healthy lifestyle characteristics in both non-elderly (<65 years old) and elderly (≥65 years old) [Odds ratio (OR) = 1.40, 95% Confidence interval (CI) = 1.13 - 1.75 for non-elderly, OR = 1.34, 95% CI = 1.02 - 1.76 for elderly], as well as female participants (OR = 1.43, 95% CI = 1.06 - 1.94), while the significance was borderline in male participants (OR = 1.34, 95% CI = 0.96 - 1.88). Among 5 HL items, the ability to extract health-related information was significantly associated with healthy lifestyle characteristics (OR = 1.52, 95% CI = 1.11 - 2.07 for non-elderly, OR = 1.55, 95% CI = 1.04 - 2.30 for elderly, OR = 1.95, 95% CI = 1.28 - 2.97 for female participants. HDL-C concentration in the high HL group was significantly higher than that in the low HL group. Among healthy lifestyle characteristics, proportions of smoking behavior (non-smoker), exercise frequency (twice or more per week), and sleep duration (7 - 8 hours) were significantly higher in the high HL group than in the low HL group. The present study revealed a positive association between HL and healthy lifestyle characteristics, which suggests that people are likely to engage in health-promoting behaviours based on access and ability to understand medical information for both age groups and female participants. Significant findings among female participants may be emphasized since it’s important from the entire family's perspective as women are the caretakers of the family. These findings may indicate the importance of comprehensive assessment, including HL, for health promotion in the community.

Development of Health Literacy for Regular Hemodialysis Patients in Menoufia Governorate: A Cross-Sectional Study

Health literacy (HL) is essential to access, comprehend, assess and use health data allowing patients to make better health and quality of life decisions. To assess the health literacy level of hemodialysis Egyptian patients, a cross-sectional study from March to September 2020 was conducted at 4 hemodialysis (HD) units on 439 patients. A translated questionnaire including demographic characteristics and health literacy components was conducted. This study adapted Nutbeam’s model incorporating critical health literacy, interactive health literacy, and functional health literacy. Health literacy of hemodialysis patients was satisfactory among 35.5% of the studied patients. The average total score of health literacy questionnaire was (15.53 ± 4.32) distributed as (2.90 ± 1.26) for functional literacy, (3.10 ± 1.26) for basic health knowledge, (1.65 ± 1.21) for communicative literacy, (2.53 ± 0.70) for interactive literacy, (1.75 ± 1.30) for advanced health knowledge, (1.74 ± 0.48) for critical literacy, and (1.83 ± 0.93) for patient safety. It was found that poor health literacy was associated with low income (OR = 2.54, CI 95%: 1.66_3.89, p < 0.001), of increasing age (OR = 0.12 CI 95%: 0.07_0.19, p < 0.001), low education (OR = 1.08, CI 95%: 1.04_1.11, p < 0.001) and the patient did not undergo kidney transplant (OR = 4.19 CI 95%: 1.12_15.62, p = 0.033). There was a prevalent low health literacy among the studied regular hemodialysis patients which was affected by education, age and income and in turn it affected the adherence to treatment. Understanding the linkage between HL and self-care attitudes should enhance efforts to improve hemodialysis outcomes.

Social capital and health literacy in Taiwan

The argument of this study is that social capital is a key factor of health literacy. Data came from an island-wide sample. Position generator was adopted to measure social capital. A regression model is constructed to test the social capital which is known as a robust predictor of health literacy after controlling gender, age, education, income, and health communication ability. The results reveal that female, higher education, and better health communication ability are also correlated with health literacy. Implications for public health are discussed.

Mental health literacy and the anxiety disorders

Context: This study set out to investigate the mental health literacy (MHL) about eight anxiety disorders (ADs), using vignette methodology. Methods: In all 317 British Adult participants completed a questionnaire with vignettes describing eight anxiety disorders including OCD, PTSD, Agoraphobia, Specific Phobias, Social Phobia, Separation Anxiety Disorder, GAD and Panic Disorder. Recognition, beliefs about treatments and perceived life adjustment (happiness, success at work) of specific people with these disorders were assessed. Results: Literacy levels varied across anxiety disorders, with high recognition of OCD (64.67%), but very poor for panic disorder (1.26%), GAD (2.84%) and separation anxiety disorder (5.99%). There were few significant effects of vignette gender on literacy levels. MHL for most anxiety disorders was relatively low;particularly panic disorder, GAD and separation anxiety disorder. Social Phobics were judged as least happy and adjusted and agoraphobics least successful at work and would benefit most from psychological help. Conclusions: Overall recognition of the anxiety disorders was poor. Beliefs about adjustment and treatment varied widely as a function of each disorder. Implications of the research for education of the public and limitations of this research are considered.

Kidney health for all: bridging the gap in kidney health education and literacy

The high burden of kidney disease,global disparities in kidney care,and poor outcomes of kidney failure bring a concomitant growing burden to persons affected,their families,and carers,and the community at large.Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find,understand,and use information and services to make informed health⁃related decisions and actions for themselves and others.Rather than viewing health literacy as a patient deficit,improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease.For kidney policy makers,health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care.The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders.Advances in telecommunication,including social media platforms,can be leveraged to enhance persons’and providers’education;The World Kidney Day declares 2022 as the year of“Kidney Health for All”to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy.Kidney organizations should work toward shifting the patient⁃deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers.By engaging in and supporting kidney health-centered policy making,community health planning,and health literacy approaches for all,the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.

Awareness, self-management behaviors, health literacy and kidney function relationships in specialty practice

AIM To determine the relationship between chronic kidney disease(CKD) awareness(CKD-A), self-management behaviors(CKD-SMB) knowledge, performance of CKDSMBs, health literacy(HL) and kidney function. METHODS Participants were eligible patients attending an outpatient nephrology clinic. Participants were administered: Newest Vital Sign to measure HL, CKD self-managementknowledge tool(CKD-SMKT) to assess knowledge, past performance of CKD-SMB, CKD-A. Estimated GFR(e GFR) was determined using the MDRD-4 equation. Duration of clinic participation and CKD cause were extracted from medical charts. RESULTS One-hundred-fifty patients participated in the study. e GFRs ranged from 17-152 m L/min per 1.73 m2. Majority(83%) of respondents had stage 3 or 4 CKD, low HL(63%), and were CKD aware(88%). Approximately 40%(10/25) of patients in stages 1 and 2 and 6.4%(8/125) in stages 3 and 4 were unaware of their CKD. CKD-A differed with stage(P < 0.001) but not by HL level, duration of clinic participation, or CKD cause. Majority of respondents(≥ 90%) correctly answered one or more CKD-SMKT items. Knowledge of one behavior, "controlling blood pressure" differed significantly by CKD-A. CKD-A was associated with past performance of two CKD-SMBs, "controlling blood pressure"(P = 0.02), and "keeping healthy body weight"(P = 0.01). Adjusted multivariate analyses between CKD-A and:(1) HL; and(2) CKD-SMB knowledge were nonsignificant. However, there was a significant relationship between CKD-A and kidney function after controlling for demographics, HL, and CKD-SMB(P < 0.05). CONCLUSION CKD-A is not associated with HL, or better CKD-SMBs. CKD-A is significantly associated with kidney function and substantially lower e GFR, suggesting the need for focused patient education in CKD stages 1.