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BMC Public Health
Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey

Authors: Shoou-Yih D Lee, Tzu-I Tsai, Yi-Wen Tsai, Ken N Kuo

Published in: BMC Public Health | Issue 1/2010

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Abstract

Background

Low health literacy is considered a worldwide health threat. The purpose of this study is to assess the prevalence and socio-demographic covariates of low health literacy in Taiwanese adults and to investigate the relationships between health literacy and health status and health care utilization.

Methods

A national survey of 1493 adults was conducted in 2008. Health literacy was measured using the Mandarin Health Literacy Scale. Health status was measured based on self-rated physical and mental health. Health care utilization was measured based on self-reported outpatient clinic visits, emergency room visits, and hospitalizations.

Results

Approximately thirty percent of adults were found to have low (inadequate or marginal) health literacy. They tended to be older, have fewer years of schooling, lower household income, and reside in less populated areas. Inadequate health literacy was associated with poorer mental health (OR, 0.57; 95% CI, 0.35-0.91). No association was found between health literacy and health care utilization even after adjusting for other covariates.

Conclusions

Low (inadequate and marginal) health literacy is prevalent in Taiwan. High prevalence of low health literacy is not necessarily indicative of the need for interventions. Systematic efforts to evaluate the impact of low health literacy on health outcomes in other countries would help to illuminate features of health care delivery and financing systems that may mitigate the adverse health effects of low health literacy.

Literature
  1. Seldon CR, Zorn M, Ratzan SC, Parker RM: National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Volume NLM Pub. No. CBM 2000-1. 2000, National Institutes of Health
  2. Nutbeam D, Kickbusch I: Advancing health literacy: A global challenge for the 21st century. Health Promotion International. 2000, 15 (3): 183-184. 10.1093/heapro/15.3.183.View Article
  3. CSDH: Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. 2008, Geneva: World Health Organization
  4. Cho YI, Lee S-YD, Arozullah AM, Crittenden KS: Effects of health literacy on health status and health service utilization amongst the elderly. Social Science & Medicine. 2008, 66 (8): 1809-1816. 10.1016/j.socscimed.2008.01.003.View Article
  5. Davis TC, Wolf MS, Bass PF, Middlebrooks M, Kennen E, Baker DW, Bennett CL, Durazo-Arvizu R, Bocchini A, Savory S: Low literacy impairs comprehension of prescription drug warning labels. Journal of General Internal Medicine. 2006, 21 (8): 847-851. 10.1111/j.1525-1497.2006.00529.x.View ArticlePubMedPubMed Central
  6. Gazmararian JA, Williams MV, Peel J, Baker DW: Health literacy and knowledge of chronic disease. Patient Education and Counseling. 2003, 51 (3): 267-275. 10.1016/S0738-3991(02)00239-2.View ArticlePubMed
  7. Parker RM, Ratzan SC, Lurie N: Health literacy: A policy challenge for advancing high-quality health care. Health Affairs. 2003, 22 (4): 147-10.1377/hlthaff.22.4.147.View ArticlePubMed
  8. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J: Health literacy and use of outpatient physician services by Medicare managed care enrollees. J Gen Intern Med. 2004, 19 (3): 215-220. 10.1111/j.1525-1497.2004.21130.x.View ArticlePubMedPubMed Central
  9. Lindau ST, Tomori C, Lyons T, L L, Bennett CL, Garcia P: The association of health literacy with cervical cancer prevention knowledge and health behavior in a multiethnic cohort of women. American Journal of Obstetrics and Gynecology. 2002, 186: 938-943. 10.1067/mob.2002.122091.View ArticlePubMed
  10. Lindau ST, Basu A, Leitsch SA: Health literacy as a predictor of follow-up after an abnormal Pap smear: A prospective study. Journal of General Internal Medicine. 2006, 21: 829-834. 10.1111/j.1525-1497.2006.00534.x.View ArticlePubMedPubMed Central
  11. Scott TL, Gazmararian JA, Williams MV, Baker DW: Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002, 40 (5): 395-404. 10.1097/00005650-200205000-00005.View ArticlePubMed
  12. Rogers ES, Wallace LS, Weiss BD: Misperceptions of medical understanding in low-literacy patients: Implications for cancer prevention. Cancer Control. 2006, 13 (3): 225-229.PubMed
  13. von Wagner C, Knight K, Steptoe A, Wardle J: Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health. 2007, 61 (12): 1086-1090. 10.1136/jech.2006.053967.View ArticlePubMedPubMed Central
  14. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, Ren J, Peel J: Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002, 92 (8): 1278-1283. 10.2105/AJPH.92.8.1278.View ArticlePubMedPubMed Central
  15. Howard DH, Sentell T, Gazmararian JA: Impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of General Internal Medicine. 2006, 21 (8): 857-861. 10.1111/j.1525-1497.2006.00530.x.View ArticlePubMedPubMed Central
  16. Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, Newman AB, Rosano C, Rooks R, Rubin SM, et al: Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med. 2006, 21 (8): 806-812. 10.1111/j.1525-1497.2006.00539.x.View ArticlePubMedPubMed Central
  17. Department of Statistics: Statistical Yearbook of Interior. Edited by: Ministry of the Interior. 2007, Taipei: Ministry of the Interior, Taiwan, 2009
  18. Davis K, Tuang AT: Learning from Taiwan: Experience with universal health insurance. Annals of Internal Medicine. 2008, 148 (4): 313-314.View ArticlePubMed
  19. Tsai TI, Lee S-YD, Tsai YW, Kuo KN: Methodology and validation of health literacy scale development in Taiwan. Journal of Health Communication.
  20. Liu CY, Hung YT, Chuang YL, Chen YJ, Weng WS, Liu JS, Liang KY: Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. Journal of Health Management. 2006, 4 (1): 1-22.
  21. Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV: Shame and health literacy: the unspoken connection. Patient Education and Counseling. 1996, 27 (1): 33-39. 10.1016/0738-3991(95)00787-3.View ArticlePubMed
  22. Wolf MS, Williams MV, Parker RM, Parikh NS, Nowlan AW, Baker DW: Patients' shame and attitudes toward discussing the results of literacy screening. Journal of Health Communication. 2007, 12 (8): 721-732. 10.1080/10810730701672173.View ArticlePubMed
  23. Kutner M, Greenberg E, Yin J, Paulsen C, White S: The health literacy of America's adults: Results from the 2003 national assessment of adult literacy. 2006, US Department of Education. Washington, DC
  24. Tokuda Y, N D, Butler JP, Paasche-Orlow MK: Health literacy and physical and psychological wellbeing in Japanese adults. Patient Education and Counseling. 2009, 75 (3): 411-417. 10.1016/j.pec.2009.03.031.View ArticlePubMed
  25. Gazmararian JA, Baker DW, Williams MV, Parker RM, Scott TL, Green DC, Fehrenbach SN, Ren J, Koplan JP: Health literacy among Medicare enrollees in a managed care organization. Journal of the American Medical Association. 1999, 281 (6): 545-551. 10.1001/jama.281.6.545.View ArticlePubMed
  26. Jovic-Veanes A, Bejgovic-Mikanovic V, Marinkovic J: Functional health literacy among primary health-care patients: data from the Belgrade pilot study. Journal of Public Health. 2009, 31: 490-495. 10.1093/pubmed/fdp049.View Article
  27. Nielsen-Bohlman L, Panzer AM, Kindig DA: Health Literacy: A prescription to end confusion. 2004, Washington, D.C.: Institute of Medicine of The National Academies
  28. Weiss BD: Health literacy: an important issue for communicating health information to patients. Zhonghua Yi Xue Za Zhi (Taipei). 2001, 64 (11): 603-608.
  29. Baker DW, Parker RM, Williams MV, Clark WS, Nurss J: The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health. 1997, 87 (6): 1027-1030. 10.2105/AJPH.87.6.1027.View ArticlePubMedPubMed Central
  30. Tokuda T, Doba N, Butler JP, Passche-Orlow MK: Health literacy and physical and psychological wellbeing in Japanese adults. Patient Education and Counseling. 2009, 75: 411-417. 10.1016/j.pec.2009.03.031.View ArticlePubMed
  31. Wolf MS, Gazmararian JA, Baker DW: Health literacy and functional health status among older adults. Arch Intern Med. 2005, 165 (17): 1946-1952. 10.1001/archinte.165.17.1946.View ArticlePubMed
  32. Arozullah AM, Lee S-YD, Khan T, Kurup S, Ryan J, Bonner M, Soltysik R, Yarnold PR: The roles of low literacy and social support in predicting the preventability of hospital admission. Journal of General Internal Medicine. 2006, 21: 140-145.View ArticlePubMedPubMed Central
    1. The pre-publication history for this paper can be accessed here:http://​www.​biomedcentral.​com/​1471-2458/​10/​614/​prepub
Metadata
Title
Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey
Authors
Shoou-Yih D Lee
Tzu-I Tsai
Yi-Wen Tsai
Ken N Kuo
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-614

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