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Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

Factors associated with health literacy in rural areas of Central China: structural equation model

Authors: Yaofei Xie, Mengdi Ma, Ya’nan Zhang, Xiaodong Tan

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Health literacy is a strong predictor of health status. This study develops and tests a structural equation model to explore the factors that are associated with the health literacy level of rural residents in Central China.

Methods

The participants were recruited from a county-level city in Central China (N = 1164). Face-to-face interviews were conducted to complete the self-designed questionnaire of each participant. The questionnaire included items for the (1) demographic information, (2) socioeconomic status, and (3) health literacy of the participants. Mplus analyses were performed to evaluate the proposed model.

Results

The final model showed good fit for the data, and both demographic characteristics (i.e., age, BMI, and residence) and socioeconomic status (i.e., monthly income, occupation, and education level) were significantly associated with health literacy level. The effects of these two variables were − 0.277 (P < 0.05) and 0.615 (P < 0.001), respectively, and the model explained 70.2% of the variance in health literacy.

Conclusions

Health literacy was significantly associated with age, BMI, distance between residence and nearest medical institution, monthly income, occupation, and education level, whereas socioeconomic status was a dominant predictor of health literacy level. Targeting these factors might be helpful in allocating health resources rationally when performing health promotion work.
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Literature
1.
go back to reference Katz A. Health literacy: what do you know? Oncol Nurs Forum. 2017;44:521–2.CrossRef Katz A. Health literacy: what do you know? Oncol Nurs Forum. 2017;44:521–2.CrossRef
2.
go back to reference Wang X, Guo H, Wang L, Li X, Huang M, Liu Z, et al. Investigation of residents' health literacy status and its risk factors in Jiangsu Province of China. Asia Pac J Public Health. 2015;27:NP2764–72.CrossRef Wang X, Guo H, Wang L, Li X, Huang M, Liu Z, et al. Investigation of residents' health literacy status and its risk factors in Jiangsu Province of China. Asia Pac J Public Health. 2015;27:NP2764–72.CrossRef
3.
go back to reference Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. Health literacy impact on National Healthcare Utilization and expenditure. Int J Health Policy Manag. 2015;4:747–55.CrossRef Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. Health literacy impact on National Healthcare Utilization and expenditure. Int J Health Policy Manag. 2015;4:747–55.CrossRef
4.
go back to reference Curtis LM, Wolf MS, Weiss KB, Grammer LC. The impact of health literacy and socioeconomic status on asthma disparities. J Asthma. 2012;49:178–83.CrossRef Curtis LM, Wolf MS, Weiss KB, Grammer LC. The impact of health literacy and socioeconomic status on asthma disparities. J Asthma. 2012;49:178–83.CrossRef
5.
go back to reference Dorner TE, Schulte-Hermann K, Zanini M, Leichsenring B, Stefanek W. Health literacy, source of information and impact on adherence to therapy in people living with HIV. J Int AIDS Soc. 2014;17:19599.CrossRef Dorner TE, Schulte-Hermann K, Zanini M, Leichsenring B, Stefanek W. Health literacy, source of information and impact on adherence to therapy in people living with HIV. J Int AIDS Soc. 2014;17:19599.CrossRef
6.
go back to reference Edward J, Carreon LY, Williams MV, Glassman S, Li J. The importance and impact of patients' health literacy on low back pain management: a systematic review of literature. Spine J. 2018;18:370–6.CrossRef Edward J, Carreon LY, Williams MV, Glassman S, Li J. The importance and impact of patients' health literacy on low back pain management: a systematic review of literature. Spine J. 2018;18:370–6.CrossRef
7.
go back to reference Altin SV, Stock S. Impact of health literacy, accessibility and coordination of care on patient's satisfaction with primary care in Germany. BMC Fam Pract. 2015;16:148.CrossRef Altin SV, Stock S. Impact of health literacy, accessibility and coordination of care on patient's satisfaction with primary care in Germany. BMC Fam Pract. 2015;16:148.CrossRef
8.
go back to reference Beatty CR, Flynn LA, Costello TJ. The impact of health literacy level on inhaler technique in patients with chronic obstructive pulmonary disease. J Pharm Pract. 2017;30:25–30.CrossRef Beatty CR, Flynn LA, Costello TJ. The impact of health literacy level on inhaler technique in patients with chronic obstructive pulmonary disease. J Pharm Pract. 2017;30:25–30.CrossRef
9.
go back to reference Chen AM, Noureldin M, Plake KS. Impact of a health literacy assignment on student pharmacist learning. Res Social Adm Pharm. 2013;9:531–41.CrossRef Chen AM, Noureldin M, Plake KS. Impact of a health literacy assignment on student pharmacist learning. Res Social Adm Pharm. 2013;9:531–41.CrossRef
10.
go back to reference De Oliveira GS Jr, McCarthy RJ, Wolf MS, Holl J. The impact of health literacy in the care of surgical patients: a qualitative systematic review. BMC Surg. 2015;15:86.CrossRef De Oliveira GS Jr, McCarthy RJ, Wolf MS, Holl J. The impact of health literacy in the care of surgical patients: a qualitative systematic review. BMC Surg. 2015;15:86.CrossRef
11.
go back to reference Wu SS, Yang P, Li HY, Ma CN, Zhang Y, Wang QY. [analysis of status and influence factors of health literacy related to infectious diseases in residents of Beijing]. Beijing da xue xue bao Yi xue ban = journal of Peking University. Health sciences. 2012;44:607–11. Wu SS, Yang P, Li HY, Ma CN, Zhang Y, Wang QY. [analysis of status and influence factors of health literacy related to infectious diseases in residents of Beijing]. Beijing da xue xue bao Yi xue ban = journal of Peking University. Health sciences. 2012;44:607–11.
12.
go back to reference Wu Y, Wang L, Cai Z, Bao L, Ai P, Ai Z. Prevalence and risk factors of low health literacy: a community-based study in Shanghai, China. Int J Environ Res Public Health. 2017;14(6):628.CrossRef Wu Y, Wang L, Cai Z, Bao L, Ai P, Ai Z. Prevalence and risk factors of low health literacy: a community-based study in Shanghai, China. Int J Environ Res Public Health. 2017;14(6):628.CrossRef
13.
go back to reference Protheroe J, Whittle R, Bartlam B, Estacio EV, Clark L, Kurth J. Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health expect. 2017;20:112–9.CrossRef Protheroe J, Whittle R, Bartlam B, Estacio EV, Clark L, Kurth J. Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health expect. 2017;20:112–9.CrossRef
14.
go back to reference Ye XH, Yang Y, Gao YH, Chen SD, Xu Y. Status and determinants of health literacy among adolescents in Guangdong, China. Asian Pac J cancer Prev. 2014;15:8735–40.CrossRef Ye XH, Yang Y, Gao YH, Chen SD, Xu Y. Status and determinants of health literacy among adolescents in Guangdong, China. Asian Pac J cancer Prev. 2014;15:8735–40.CrossRef
15.
go back to reference Yang X, Zhao CX, Li S, Chen FZ, Li JG. Health literacy level and influence factors of occupational population in one province. Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases. 2017;35:683–7.PubMed Yang X, Zhao CX, Li S, Chen FZ, Li JG. Health literacy level and influence factors of occupational population in one province. Zhonghua lao dong wei sheng zhi ye bing za zhi = Zhonghua laodong weisheng zhiyebing zazhi = Chinese journal of industrial hygiene and occupational diseases. 2017;35:683–7.PubMed
16.
go back to reference Park SE, Lee KS, Yun SN, Cui W. Structural model of factors influencing smoking behavior among Korean-Chinese adolescent boys. Appl Nurs Res. 2014;27:192–7.CrossRef Park SE, Lee KS, Yun SN, Cui W. Structural model of factors influencing smoking behavior among Korean-Chinese adolescent boys. Appl Nurs Res. 2014;27:192–7.CrossRef
17.
go back to reference Kim SJ, Kim HY, Park YA, Kim SH, Yoo SY, Lee JE, et al. Factors influencing fatigue among mothers with hospitalized children: a structural equation model. J Spec Pediatr Nurs. 2017;22. Kim SJ, Kim HY, Park YA, Kim SH, Yoo SY, Lee JE, et al. Factors influencing fatigue among mothers with hospitalized children: a structural equation model. J Spec Pediatr Nurs. 2017;22.
18.
go back to reference Huang YM, Shiyanbola OO, Chan HY. A path model linking health literacy, medication self-efficacy, medication adherence, and glycemic control. Patient Educ Couns. 2018;101:1906–13.CrossRef Huang YM, Shiyanbola OO, Chan HY. A path model linking health literacy, medication self-efficacy, medication adherence, and glycemic control. Patient Educ Couns. 2018;101:1906–13.CrossRef
19.
go back to reference Schrauben SJ, Wiebe DJ. Health literacy assessment in developing countries: a case study in Zambia. Health Promot Int. 2017;32:475–81.PubMed Schrauben SJ, Wiebe DJ. Health literacy assessment in developing countries: a case study in Zambia. Health Promot Int. 2017;32:475–81.PubMed
20.
go back to reference Zhang PP, Chang C. Health literacy and its relative factors to residents in three cities in China. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2012;46:822–4. Zhang PP, Chang C. Health literacy and its relative factors to residents in three cities in China. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2012;46:822–4.
21.
go back to reference Alberti TL, Morris NJ. Health literacy in the urgent care setting: what factors impact consumer comprehension of health information? J Am Assoc Nurse Pract. 2017;29:242–7.PubMed Alberti TL, Morris NJ. Health literacy in the urgent care setting: what factors impact consumer comprehension of health information? J Am Assoc Nurse Pract. 2017;29:242–7.PubMed
22.
go back to reference Li JJ, Appleton SL, Wittert GA, Vakulin A, McEvoy RD, Antic NA, et al. The relationship between functional health literacy and obstructive sleep apnea and its related risk factors and comorbidities in a population cohort of men. Sleep. 2014;37:571–8.CrossRef Li JJ, Appleton SL, Wittert GA, Vakulin A, McEvoy RD, Antic NA, et al. The relationship between functional health literacy and obstructive sleep apnea and its related risk factors and comorbidities in a population cohort of men. Sleep. 2014;37:571–8.CrossRef
23.
go back to reference Adeseun GA, Bonney CC, Rosas SE. Health literacy associated with blood pressure but not other cardiovascular disease risk factors among dialysis patients. Am J Hypertens. 2012;25:348–53.CrossRef Adeseun GA, Bonney CC, Rosas SE. Health literacy associated with blood pressure but not other cardiovascular disease risk factors among dialysis patients. Am J Hypertens. 2012;25:348–53.CrossRef
24.
go back to reference Yang SC, Luo YF, Chiang CH. The associations among individual factors, eHealth literacy, and health-promoting lifestyles among college students. J Med Internet Res. 2017;19:e15.CrossRef Yang SC, Luo YF, Chiang CH. The associations among individual factors, eHealth literacy, and health-promoting lifestyles among college students. J Med Internet Res. 2017;19:e15.CrossRef
25.
go back to reference Kumar VA, Albert NM, Medado P, Mango LM, Nutter B, Yang D, et al. Correlates of health literacy and its impact on illness beliefs for emergency department patients with acute heart failure. Crit Pathw Cardiol. 2017;16:27–31.CrossRef Kumar VA, Albert NM, Medado P, Mango LM, Nutter B, Yang D, et al. Correlates of health literacy and its impact on illness beliefs for emergency department patients with acute heart failure. Crit Pathw Cardiol. 2017;16:27–31.CrossRef
26.
go back to reference Saeed H, Saleem Z, Naeem R, Shahzadi I, Islam M. Impact of health literacy on diabetes outcomes: a cross-sectional study from Lahore, Pakistan. Public Health. 2018;156:8–14.CrossRef Saeed H, Saleem Z, Naeem R, Shahzadi I, Islam M. Impact of health literacy on diabetes outcomes: a cross-sectional study from Lahore, Pakistan. Public Health. 2018;156:8–14.CrossRef
27.
go back to reference Chesser AK, Reyes J, Keene Woods N. Identifying health literacy in Kansas using the behavioral risk factor surveillance system. International quarterly of community health education. 2018:272684X18821305. Chesser AK, Reyes J, Keene Woods N. Identifying health literacy in Kansas using the behavioral risk factor surveillance system. International quarterly of community health education. 2018:272684X18821305.
28.
go back to reference Estacio EV, Whittle R, Protheroe J. The digital divide: examining socio-demographic factors associated with health literacy, access and use of internet to seek health information. J Health Psychol. 2017:1359105317695429. Estacio EV, Whittle R, Protheroe J. The digital divide: examining socio-demographic factors associated with health literacy, access and use of internet to seek health information. J Health Psychol. 2017:1359105317695429.
29.
go back to reference Macha-Quillama LF, Samanamu-Leandro AE, Rodriguez-Hurtado DC. [health literacy and associated factors in patients attending the outpatient internal medicine service of a national hospital of Lima, Peru]. Revista de salud. publica. 2017;19:679–85. Macha-Quillama LF, Samanamu-Leandro AE, Rodriguez-Hurtado DC. [health literacy and associated factors in patients attending the outpatient internal medicine service of a national hospital of Lima, Peru]. Revista de salud. publica. 2017;19:679–85.
30.
go back to reference Verney SP, Gibbons LE, Dmitrieva NO, Kueider AM, Williams MW, Meyer OL, et al. Health literacy, sociodemographic factors, and cognitive training in the active study of older adults. Int J Geriatr Psychiatry. 2019;34:563-70. Verney SP, Gibbons LE, Dmitrieva NO, Kueider AM, Williams MW, Meyer OL, et al. Health literacy, sociodemographic factors, and cognitive training in the active study of older adults. Int J Geriatr Psychiatry. 2019;34:563-70.
Metadata
Title
Factors associated with health literacy in rural areas of Central China: structural equation model
Authors
Yaofei Xie
Mengdi Ma
Ya’nan Zhang
Xiaodong Tan
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4094-1

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