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Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Examining income-related inequality in health literacy and health-information seeking among urban population in China

Authors: Chengxiang Tang, Xueji Wu, Xiongfei Chen, Bingying Pan, Xiaocong Yang

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Health literacy and health-information seeking behaviour (HISB) play vital roles in health outcome improvements. This study examines the extent of income-related inequality in health literacy and health-information seeking as well as the contributions of the main socioeconomic determinants in China.

Methods

We analysed representative data of participants aged over 18 years as well as older adults from the Guangzhou Community Health Survey. A concentration index (CI) was used to quantify the degree of income-related inequity in health literacy and health-information seeking. Probit regression models were employed to decompose the CI into the contributions to each factor.

Results

Results showed a significant pro-rich distribution of adequate health literacy (CI: 0.0602, P < 0.001; horizontal index [HI]: 0.0562, P < 0.001) and HISB from healthcare professionals (CI: 0.105, P < 0.001; HI: 0.0965, P < 0.001). The pro-rich distribution of health literacy was mainly attributable to education background (contribution: 54.76%), whereas income inequalities contributed most to the pro-rich distribution of health-information seeking among an urban population (contribution: 62.53%).

Conclusion

Public interventions in China to reduce inequality in health literacy and HISBs among the urban population, coupled with easily accessible information sources on health, warrant further attention from policymakers.
Footnotes
1
We slightly modified the mix of questions because of two reasons: the one is that the questions about health literacy in our questionnaire is not a structured part targeted only health literacy, thus we could not find out exact questions corresponding to the published paper; the other is that nearly half of the women had no formal education in the surveyed sample in Wang et al [24] and that survey covered only rural women from a Chinese poor minority area, in contrast, our survey targeted only urban population in Guangzhou, one of top metro city in China.
 
2
We appreciate the reviewers’ comment on migrancy, ethnicity/language influencing health literacy and health seeking behaviour, unfortunately, the survey provided no such information.
 
Literature
1.
go back to reference Ishikawa H, Yano E. Patient health literacy and participation in the health-care process. Health Expect. 2008;11:113–22.CrossRef Ishikawa H, Yano E. Patient health literacy and participation in the health-care process. Health Expect. 2008;11:113–22.CrossRef
2.
go back to reference Anker AE, Reinhart AM, Feeley TH. Health information seeking: a review of measures and methods. Patient Educ Couns. 2011;82:346–54.CrossRef Anker AE, Reinhart AM, Feeley TH. Health information seeking: a review of measures and methods. Patient Educ Couns. 2011;82:346–54.CrossRef
3.
go back to reference Jeong SH, Kim HK. Health literacy and barriers to health information seeking: A nationwide survey in South Korea. Patient Educ Couns. 2016;99:1880–7.CrossRef Jeong SH, Kim HK. Health literacy and barriers to health information seeking: A nationwide survey in South Korea. Patient Educ Couns. 2016;99:1880–7.CrossRef
4.
go back to reference Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67:2072–8.CrossRef Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67:2072–8.CrossRef
5.
go back to reference Ouyang Y. Student's death highlights gaps in China's health regulations. Lancet Oncol. 2016;17:709.CrossRef Ouyang Y. Student's death highlights gaps in China's health regulations. Lancet Oncol. 2016;17:709.CrossRef
6.
go back to reference Ad HCOH, American MA. Health literacy: Report of the council on scientific affairs. JAMA. 1999;281:552–7.CrossRef Ad HCOH, American MA. Health literacy: Report of the council on scientific affairs. JAMA. 1999;281:552–7.CrossRef
7.
go back to reference Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107.CrossRef Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107.CrossRef
8.
go back to reference Cho YI, Lee SD, Arozullah AM, Crittenden KS. Effects of health literacy on health status and health service utilization amongst the elderly. Soc Sci Med. 2008;66:1809–16.CrossRef Cho YI, Lee SD, Arozullah AM, Crittenden KS. Effects of health literacy on health status and health service utilization amongst the elderly. Soc Sci Med. 2008;66:1809–16.CrossRef
9.
go back to reference Schillinger D, Barton LR, Karter AJ, Wang F, Adler N. Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep. 2006;121:245–54.CrossRef Schillinger D, Barton LR, Karter AJ, Wang F, Adler N. Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep. 2006;121:245–54.CrossRef
10.
go back to reference Doorslaer EV, Koolman X, Jones AM. Explaining income-related inequalities in doctor utilisation in Europe. Health Econ. 2004;13:629–47.CrossRef Doorslaer EV, Koolman X, Jones AM. Explaining income-related inequalities in doctor utilisation in Europe. Health Econ. 2004;13:629–47.CrossRef
11.
go back to reference Pickett KE, Wilkinson RG. Income inequality and health: A causal review. Soc Sci Med. 2015;128:316–26.CrossRef Pickett KE, Wilkinson RG. Income inequality and health: A causal review. Soc Sci Med. 2015;128:316–26.CrossRef
12.
go back to reference Koh HK, Berwick DM, Clancy CM, Baur C, Brach C, Harris LM, et al. New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care'. Health Affair. 2012;31:434–43. Koh HK, Berwick DM, Clancy CM, Baur C, Brach C, Harris LM, et al. New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care'. Health Affair. 2012;31:434–43.
13.
go back to reference Finney Rutten LJ, Hesse BW, Moser RP, Ortiz Martinez AP, Kornfeld J, Vanderpool RC, et al. Socioeconomic and Geographic Disparities in Health Information Seeking and Internet Use in Puerto Rico. J Med Internet Res. 2012;14:e104.CrossRef Finney Rutten LJ, Hesse BW, Moser RP, Ortiz Martinez AP, Kornfeld J, Vanderpool RC, et al. Socioeconomic and Geographic Disparities in Health Information Seeking and Internet Use in Puerto Rico. J Med Internet Res. 2012;14:e104.CrossRef
14.
go back to reference Mantwill S, Monestel-Umaña S, Schulz PJ. The Relationship between Health Literacy and Health Disparities: A Systematic Review. PLOS ONE. 2015;10:e145455.CrossRef Mantwill S, Monestel-Umaña S, Schulz PJ. The Relationship between Health Literacy and Health Disparities: A Systematic Review. PLOS ONE. 2015;10:e145455.CrossRef
15.
go back to reference Wolf MS, Knight SJ, Lyons EA, Durazo-Arvizu R, Pickard SA, Arseven A, et al. Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer. Urology. 2006;68:89–93.CrossRef Wolf MS, Knight SJ, Lyons EA, Durazo-Arvizu R, Pickard SA, Arseven A, et al. Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer. Urology. 2006;68:89–93.CrossRef
16.
go back to reference Li X, Lu J, Hu S, Cheng KK, De Maeseneer J, Meng Q, et al. The primary health-care system in China. The Lancet. 2017;390:2584–94.CrossRef Li X, Lu J, Hu S, Cheng KK, De Maeseneer J, Meng Q, et al. The primary health-care system in China. The Lancet. 2017;390:2584–94.CrossRef
17.
go back to reference Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Affair. 2017;21:60–76. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Affair. 2017;21:60–76.
18.
go back to reference Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31:S19–26.CrossRef Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31:S19–26.CrossRef
19.
go back to reference Lambert SD, Loiselle CG. Health information—seeking behavior. Qualitative Health Res. 2007;17:1006–19.CrossRef Lambert SD, Loiselle CG. Health information—seeking behavior. Qualitative Health Res. 2007;17:1006–19.CrossRef
20.
go back to reference Weaver JB III, Mays D, Weaver SS, Hopkins GL, Eroğlu D, Bernhardt JM. Health information–seeking behaviors, health indicators, and health risks. Am J Public Health. 2010;100:1520–5.CrossRef Weaver JB III, Mays D, Weaver SS, Hopkins GL, Eroğlu D, Bernhardt JM. Health information–seeking behaviors, health indicators, and health risks. Am J Public Health. 2010;100:1520–5.CrossRef
21.
go back to reference Miller SM. Cognitive informational styles in the process of coping with threat and frustration. Adv Behav Res Ther. 1989;11:223–34.CrossRef Miller SM. Cognitive informational styles in the process of coping with threat and frustration. Adv Behav Res Ther. 1989;11:223–34.CrossRef
22.
go back to reference Pan B, Chen X, Wu X, Li J, Li J, Li Y. Prevalence of Noncommunicable Diseases and Their Risk Factors in Guangzhou, China. Prev Chronic Dis. 2014;11:E49.CrossRef Pan B, Chen X, Wu X, Li J, Li J, Li Y. Prevalence of Noncommunicable Diseases and Their Risk Factors in Guangzhou, China. Prev Chronic Dis. 2014;11:E49.CrossRef
23.
go back to reference Wu X, Pan B, Chen X, Zhuang X, Zhu K, Zeng L, et al. Useful information for hypertension management reform in community health care: prevalence, awareness, treatment and control among Guangzhou adults. Clin Exp Hypertens. 2014;36:227–35.CrossRef Wu X, Pan B, Chen X, Zhuang X, Zhu K, Zeng L, et al. Useful information for hypertension management reform in community health care: prevalence, awareness, treatment and control among Guangzhou adults. Clin Exp Hypertens. 2014;36:227–35.CrossRef
24.
go back to reference Lee SD, Tsai T, Tsai Y, Kuo KN. Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health. 2010;10:614.CrossRef Lee SD, Tsai T, Tsai Y, Kuo KN. Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health. 2010;10:614.CrossRef
25.
go back to reference Lam LT, Yang L. Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12–16 years old population, Nanning, China, 2012. Arch Public Health. 2014;72:11.CrossRef Lam LT, Yang L. Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12–16 years old population, Nanning, China, 2012. Arch Public Health. 2014;72:11.CrossRef
26.
go back to reference Wang C, Li H, Li L, Xu D, Kane RL, Meng Q. Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area. Health Qual Life Outcomes. 2013;11:153.CrossRef Wang C, Li H, Li L, Xu D, Kane RL, Meng Q. Health literacy and ethnic disparities in health-related quality of life among rural women: results from a Chinese poor minority area. Health Qual Life Outcomes. 2013;11:153.CrossRef
27.
go back to reference Xiao L, Ying-Hua LI, Chen GY, Yu MA, Jun-Feng HU, Cheng YL. Development of health literacy comprehensive index. Chin J Health Educ. 2009;25:103–05. Xiao L, Ying-Hua LI, Chen GY, Yu MA, Jun-Feng HU, Cheng YL. Development of health literacy comprehensive index. Chin J Health Educ. 2009;25:103–05.
28.
go back to reference Xiao L, Cheng YL, Ma Y, Chen GY, Hu JF, Li YH, et al. A study on applying Delphi method for screening evaluation indexes of health literacy of China adults. Chin J Health Educ. 2008;129:e10–1. Xiao L, Cheng YL, Ma Y, Chen GY, Hu JF, Li YH, et al. A study on applying Delphi method for screening evaluation indexes of health literacy of China adults. Chin J Health Educ. 2008;129:e10–1.
29.
go back to reference Wang C, Kane RL, Xu D, Meng Q. Health literacy as a moderator of health-related quality of life responses to chronic disease among Chinese rural women. BMC Womens Health. 2015;15:34.CrossRef Wang C, Kane RL, Xu D, Meng Q. Health literacy as a moderator of health-related quality of life responses to chronic disease among Chinese rural women. BMC Womens Health. 2015;15:34.CrossRef
30.
go back to reference Kim SH. Health literacy and functional health status in Korean older adults. J Clin Nurs. 2009;18:2337–43.CrossRef Kim SH. Health literacy and functional health status in Korean older adults. J Clin Nurs. 2009;18:2337–43.CrossRef
31.
go back to reference O'Donnell O, O'Neill S, Ourti TV, Walsh B. conindex: Estimation of concentration indices. Stata J. 2016;16:112–38.CrossRef O'Donnell O, O'Neill S, Ourti TV, Walsh B. conindex: Estimation of concentration indices. Stata J. 2016;16:112–38.CrossRef
32.
go back to reference Wagstaff A, O'Donnell O, Van Doorslaer E, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, D.C.: The World Bank Publications, 2007. Wagstaff A, O'Donnell O, Van Doorslaer E, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington, D.C.: The World Bank Publications, 2007.
33.
go back to reference Deaton A, Zaidi S. Guidelines for constructing consumption aggregates for welfare analysis. Washington, D.C.: The World Bank Publications, 2002. Deaton A, Zaidi S. Guidelines for constructing consumption aggregates for welfare analysis. Washington, D.C.: The World Bank Publications, 2002.
34.
go back to reference Guangzhou Statistics Bureau. Guangzhou: Guangzhou Statistical Yearbook, 2014. Guangzhou Statistics Bureau. Guangzhou: Guangzhou Statistical Yearbook, 2014.
35.
go back to reference Bakkeli NZ. Income inequality and health in China: A panel data analysis. Soc Sci Med. 2016;157:39–47.CrossRef Bakkeli NZ. Income inequality and health in China: A panel data analysis. Soc Sci Med. 2016;157:39–47.CrossRef
36.
go back to reference Yang W, Kanavos P. The less healthy urban population: income-related health inequality in China. BMC Public Health. 2012;12:804.CrossRef Yang W, Kanavos P. The less healthy urban population: income-related health inequality in China. BMC Public Health. 2012;12:804.CrossRef
37.
go back to reference Zhou Z, Su Y, Gao J, Campbell B, Zhu Z, Xu L, et al. Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008. Int J Equity in Health. 2013;12:34.CrossRef Zhou Z, Su Y, Gao J, Campbell B, Zhu Z, Xu L, et al. Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008. Int J Equity in Health. 2013;12:34.CrossRef
38.
go back to reference Elwell-Sutton TM, Jiang CQ, Zhang WS, Cheng KK, Lam TH, Leung GM, et al. Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study. Health Policy Plann. 2013;28:467–79.CrossRef Elwell-Sutton TM, Jiang CQ, Zhang WS, Cheng KK, Lam TH, Leung GM, et al. Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study. Health Policy Plann. 2013;28:467–79.CrossRef
39.
go back to reference Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, et al. Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med. 2006;21:806–12.CrossRef Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, et al. Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med. 2006;21:806–12.CrossRef
40.
go back to reference Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002;92:1278–83.CrossRef Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM, Green D, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002;92:1278–83.CrossRef
41.
go back to reference 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 Commun Health. 2007;61:1086–90.CrossRef 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 Commun Health. 2007;61:1086–90.CrossRef
42.
go back to reference Wang MP, Viswanath K, Lam TH, Wang X, Chan SS. Social Determinants of Health Information Seeking among Chinese Adults in Hong Kong. PLOS ONE. 2013;8:e73049.CrossRef Wang MP, Viswanath K, Lam TH, Wang X, Chan SS. Social Determinants of Health Information Seeking among Chinese Adults in Hong Kong. PLOS ONE. 2013;8:e73049.CrossRef
43.
go back to reference Lalazaryan A, Zare-Farashbandi F. A review of models and theories of health information seeking behavior. Int J Health Syst Disaster Manag. 2014;2:193.CrossRef Lalazaryan A, Zare-Farashbandi F. A review of models and theories of health information seeking behavior. Int J Health Syst Disaster Manag. 2014;2:193.CrossRef
44.
go back to reference Nölke L, Mensing M, Krämer A, Hornberg C. Sociodemographic and health-(care-) related characteristics of online health information seekers: a cross-sectional German study. BMC Public Health. 2015;15:31.CrossRef Nölke L, Mensing M, Krämer A, Hornberg C. Sociodemographic and health-(care-) related characteristics of online health information seekers: a cross-sectional German study. BMC Public Health. 2015;15:31.CrossRef
45.
go back to reference Cotten SR, Gupta SS. Characteristics of online and offline health information seekers and factors that discriminate between them. Soc Sci Med. 2004;59:1795–806.CrossRef Cotten SR, Gupta SS. Characteristics of online and offline health information seekers and factors that discriminate between them. Soc Sci Med. 2004;59:1795–806.CrossRef
46.
go back to reference Gutierrez N, Kindratt TB, Pagels P, Foster B, Gimpel NE. Health literacy, health information seeking behaviors and internet use among patients attending a private and public clinic in the same geographic area. J Community Health. 2014;39:83–9.CrossRef Gutierrez N, Kindratt TB, Pagels P, Foster B, Gimpel NE. Health literacy, health information seeking behaviors and internet use among patients attending a private and public clinic in the same geographic area. J Community Health. 2014;39:83–9.CrossRef
47.
go back to reference Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA. 2010;304:76–84.CrossRef Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA. 2010;304:76–84.CrossRef
Metadata
Title
Examining income-related inequality in health literacy and health-information seeking among urban population in China
Authors
Chengxiang Tang
Xueji Wu
Xiongfei Chen
Bingying Pan
Xiaocong Yang
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-6538-2

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