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Background A comprehensive and agreed-upon definition of vaccine literacy (VL) could support the understanding of vaccination and help policy-makers and individuals make informed decisions about vaccines. Methods To shed some light on this debate and provide clarity, a scoping review was conducted to collect, summarize, and analyse available definitions of VL. Based on the findings of the scoping review, a new and comprehensive definition was proposed by a panel of experts. Results Fifty-three articles were included, and two of them appeared to be the milestones around which the other definitions were grouped. The new definition proposed by the panel of experts included not only the personal perspective, but also the community, population, and organizational perspectives. Moreover, due to the increasing complexity of the social context with respect to the ability to navigate, understand, and use information and services, the definition of organizational vaccine literacy and the attributes of a vaccine literate healthcare organization have been proposed. Conclusion The new definition can contribute to the overall paradigm of health literacy and its distinct component of vaccine literacy, possibly improving the implementation of public health strategies to allow vaccination to be understood as a social practice by the entire community. This study describes the conceptual foundations, the competencies, and the civic orientation to be considered when developing measurement tools devoted to assessing VL at the different levels and in different contexts.

[...]we believe that there may not be much difference in whether individuals are considering an intervention as treatment or prevention, when they take part in a literacy survey. [...]in our opinion, it made sense to begin developing VL assessment tools based on consolidated self-rated measures for general HL. [...]HLVa and COVID-19-VLS have been translated and validated into multiple languages, allowing to compare literacy skills in different populations, albeit only descriptively, given the heterogeneity of available data. The pandemic experience will in any case affect VL with regard to other vaccines, at least in the near future. [...]while the experience of VL tools used primarily during the COVID-19 outbreak may be considered limited, it provides a relevant starting point for future research.

Vaccine literacy (VL) is the ability to find, understand, and evaluate vaccination-related information to make appropriate decisions about immunization. The tools developed so far for its evaluation have produced consistent results. However, some dimensions may be underestimated due to the complexity of factors influencing VL. Moreover, the heterogeneity of methods used in studies employing these tools hinders a comprehensive understanding of its role even more. To overcome these limitations, a path has been sought to propose new instruments. This has necessitated updating earlier literature reviews on VL and related tools, exploring its relationship with vaccine hesitancy (VH), and examining associated variables like beliefs, attitudes, and behaviors towards immunization. Based on the current literature, and supported by the re-analysis of a dataset from an earlier study, we propose a theoretical framework to serve as the foundation for creating future assessment tools. These instruments should not only evaluate the psychological factors underlying the motivational aspect of VL, but also encompass knowledge and competencies. The positioning of VL in the framework at the intersection between sociodemographic antecedents and attitudes, leading to behaviors and outcomes, explains why and how VL can directly or indirectly influence vaccination decisions by countering VH and operating at personal, as well as at organizational and community levels.

Background: Vaccinations are essential to protect travelers from infectious diseases, especially in high-risk destinations. However, awareness and adherence to vaccination recommendations vary, influenced by communication, personal beliefs, and behavior. Methods: A focus group was conducted in February 2025 at a local health authority in central Italy, specifically within its travel clinic, to explore travelers’ awareness, attitudes, and behaviors regarding vaccination. The discussion was analyzed using the “3Cs” Vaccine Hesitancy model. Participants were purposively selected to ensure diversity and representativeness. Discussions included past travel experiences, knowledge of required vaccines, motivations for immunization, and barriers to access. Results: Four key thematic areas emerged: socio-cultural/environmental factors, psychological/emotional influences, knowledge/information access, and general health perceptions. Communication gaps often weakened belief in vaccine efficacy and necessity. Cultural background, past experiences, and risk perception heavily influenced decisions. Discussion: Although vaccination is widely viewed as a protective measure, vaccine hesitancy persists due to misinformation and limited institutional trust. The COVID-19 pandemic intensified both awareness and skepticism. The 3Cs model clarified hesitancy levels and barriers, emphasizing the need for effective communication and trust-building. Conclusions: Enhancing access to accurate information, strengthening healthcare professionals’ communicative role, and reducing economic obstacles are crucial. Tailored awareness campaigns and integrated health policies are essential to increasing vaccine uptake, safeguarding traveler health, and limiting global disease spread. Patient or Public Contribution: Members of the public contributed to this study by participating in a focus group, where they shared their personal experiences, perceptions, and opinions regarding travel-related vaccinations. Their insights provided valuable qualitative data that helped inform the study’s findings. However, they were not involved in the study design, the analysis of the data, or the preparation of the manuscript. The role of participants was limited to the data collection phase of the study.

Background Population ageing increases frailty prevalence, a condition linked to higher disability risk. The Integrated Care for Older People (ICOPE) model promotes early frailty identification in primary care and integration of health, social, and community services. However, evidence of adaptations of ICOPE models in different contexts is scarce, as is knowledge of health literacy’s (HL) role in frailty screening. This study protocol describes a project applying ICOPE indications to identify frail older individuals early, through a multiple-step process (first level screening and second level screening). Methods The study has a longitudinal cohort design, including the recruitment of all residents aged 75 years in a defined area in the city of Florence (Italy). During the first visit participants will complete a brief Frailty Questionnaire, perform the Chair Rise Test and answer one health literacy question (Single Item Screening - SILS). Those who will result positive for frailty, will attend a second visit with tests covering multiple frailty domains: nutritional, functional, cognitive, psychological status and level of autonomy and HL. Discussion A statistically significant association is expected to be identified between positive first level screening and the domains assessed in the multidimensional assessment. Furthermore, low HL could be associated with an increased risk of frailty to evaluate the predictive validity of HL tools for early identification of at-risk individuals. The early identification of frailty, the analysis and the choice of performing the study in a primary care setting aim at defining targeted preventive interventions and strategies based on a multidisciplinary approach.

ObjectivesThis scoping review aimed to explore the relationship between health locus of control (HLOC) and vaccine hesitancy among parents of children aged 0–18 years, focusing on the tools and methods used to assess these constructs.DesignThe review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines and adhered to established methodologies for scoping reviews, including systematic searches across four electronic databases.Data sourcesPubMed, PsycINFO, Web of Science and CINAHL were searched using a comprehensive search strategy to identify relevant studies on 24 September 2024.Eligibility criteria for selecting studiesStudies were included if they examined HLOC and vaccine hesitancy in parents, measured these constructs with validated tools and focused on childhood vaccination.Data extraction and synthesisData were extracted into a structured table capturing study characteristics, HLOC and vaccine hesitancy measurements, and key findings. Results were synthesised narratively to highlight associations and patterns.ResultsFive studies involving a total of 11 758 parents and caregivers of children aged 0–18 years met inclusion criteria. Higher internal HLOC was consistently associated with lower vaccine hesitancy and higher compliance, while lower chance HLOC correlated with greater hesitancy. Powerful others HLOC (ie, trust in healthcare professionals) emerged as a key predictor of better vaccine adherence.ConclusionsThe findings suggest that internal HLOC and trust in healthcare providers are predictors of vaccine acceptance among parents. However, standardised tools and longitudinal studies are needed to further elucidate these relationships and inform targeted interventions to reduce vaccine hesitancy.

Background Hospitals can gain valuable insights into their current level of organizational health literacy (OHL) by using self-assessment tools. OHL self-assessment tools can serve as useful instruments for supporting the planning and implementation of OHL interventions aimed at promoting health equity and improving patient outcomes. This explorative study aimed to pilot the International Self-Assessment Tool for Organizational Health Literacy (Responsiveness) of Hospitals (OHL-Hos) among hospitals across six countries. Methods The OHL-Hos, grounded in a comprehensive theoretical framework consisting of eight standards, 21 sub-standards and 141 indicators, was piloted in seven hospitals: one in Austria, Germany, the Czech Republic, Norway and Serbia, and two in Italy. In each hospital, the feasibility of using the OHL-Hos was investigated regarding acceptability, implementation, practicality, and integration, identifying strengths and areas for improvement using descriptive analyses. The self-assessment process included individual rating of an interdisciplinary and inter-hierarchical assessment team regarding OHL-Hos indicators from their personal perspectives, followed by a joint assessment to reach a consensus on different ratings. The process and experiences were documented in semi-structured forms, while the ratings on the indicators were documented numerically. Results All hospitals successfully self-assessed their OHL, identifying strengths and areas for improvement. The self-assessment process varied slightly among countries. While the tool was considered important but lengthy and complex, introductory workshops facilitated successful implementation. The self-assessment process raised awareness and stimulated discussions on improving OHL, highlighting the tool’s potential for organizational development. Conclusions The OHL-Hos can serve as a useful tool to identify strengths and areas for improvement in OHL in hospitals. The overall experience with the tool was positive and the joint assessment with the tool was found to foster consensus and enable reflection on OHL, but its comprehensive nature poses challenges to its implementation, leading to recommendations for developing a shortened version of the tool with simple language. Certain indicators require specific knowledge, suggesting different professional groups should address relevant parts.

ObjectivesInformed consent forms are important for assisting patients in making informed choices regarding medical procedures. Because of their lengthy nature, complexity and specialised terminology, consent forms usually prove challenging for the general public to comprehend. This pilot study aims to use Chat Generative Pretrained Transformer (ChatGPT), a large language model (LLM), to improve the readability and understandability of a consent form for vaccination.MethodsThe study was conducted in Italy, within the Central Tuscany Local Health Unit. Three different consent forms were selected and approved: the standard consent form currently in use (A), a new form totally generated by ChatGPT (B) and a modified version of the standard form created by ChatGPT (C). Healthcare professionals in the vaccination unit were asked to evaluate the consent forms regarding adequacy, comprehensibility and completeness and to give an overall judgement. The Kruskal–Wallis test and Dunn’s test were used to evaluate the median scores of the consent forms across these variables.ResultsConsent forms A and C achieved the top scores in every category; consent form B obtained the lowest score. The median scores were 4.0 for adequacy on consent forms A and C and 3.0 on consent form B. Consent forms A and C received high overall judgement ratings with median scores of 4.0, whereas consent form B received a median score of 3.0.ConclusionsThe findings indicate that LLM tools such as ChatGPT could enhance healthcare communication by improving the clarity and accessibility of consent forms, but the best results are seen when these tools are combined with human knowledge and supervision.

BackgroundThe first thousand days, the period from the conception to the second year of life, play a fundamental role in establishing the foundation of a newborn’s health, growth and neurological development, finally impacting its entire life. Reading interventions during this period produce numerous positive outcomes for the infants, such as their language skills and development, as well as enhancing the relationship between caregivers and children, supporting the importance of studying the effectiveness of shared reading groups in this period among children without pathologies and their caregivers. This research aims to systematically review evidence on shared group activity in the first thousand days, including also their caregivers, exploring the following outcomes: children’s language skills, cognitive development, prosocial behaviour, parent–child relationship, reading habits, health literacy, quality of life and empowerment.MethodsWe conducted a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight experimental studies met the inclusion criteria: shared group reading intervention involving children up to 24 months with their caregivers (especially parents, but also other caregivers). These interventions typically consisted of 6–12 group sessions led by trained facilitators in community settings.ResultsThe results showed no clear conclusions. Both the narrative synthesis and meta-analysis suggested improvements on children’s language skills (comprehension), only the narrative analysis suggested positive changes in cognitive development and prosocial behaviour, alongside improved parent–child relationship and enhanced parental skills following the intervention. However, evidence was limited and inconsistent.ConclusionsThese findings highlighted the importance of evidence-based interventions in supporting infant development, particularly in disadvantaged contexts addressing inequalities, and the promising role of shared reading as an integral part of such interventions. However, further studies are needed to confirm the effectiveness of these early interventions in fostering optimal developmental outcomes during the critical first thousand days.