JMIR Publications

ABSTRACT

Background:

Poor functional health literacy has been found to be independently associated with poor self-assessed health, poor understanding of one’s health condition and its management, and higher utilization of health services. Given the importance of functional health literacy, it is necessary to assess the overall status of functional health literacy in the general public. However, no studies of functional health literacy have been conducted among the Chinese populations.

Objective:

This study aimed to classify Chinese populations into different functional health literacy clusters and ascertain significant factors closely associated with low functional health literacy, to provide some implications for health education, medical research, and public health policy-making.

Methods:

We hypothesized that the participants’ functional health literacy levels were associated with various demographic characteristics. Therefore, we designed a 4-section questionnaire including the following information: (1) age, gender, and education; (2) self-assessed disease knowledge; (3) 3 validated health literacy assessment tools (i.e., the All Aspects of Health Literacy Scale (AAHLS), the eHealth Literacy Scale (eHEALS), and the General Health Numeracy Test (GHNT-6)); and (4) health beliefs and self confidence measured by the Multidimensional Health Locus of Control (MHLC) Scales Form B. Using randomized sampling, we recruited survey participants from Qilu Hospital Affiliated to Shandong University, China. The questionnaire was administered via wenjuanxing. A returned questionnaire was valid only when all question items included were answered, according to our predefined validation criterion. All valid data were coded according to the predefined coding schemes of Likert scales with different point (score) ranges. Finally, we utilized latent class analysis to classify Chinese populations into clusters of different functional health literacy and identify significant factors closely associated with low functional health literacy.

Results:

Table 1 shows the descriptive statistics of the data collected. All data in the 800 returned questionnaires proved valid according to the predefined validation criterion. The participants were aged 42.56 (SD=11.47) on average. 430 (54%) of them were females. The mean score for education was 3.26 (SD=1.46), showing that the participants’ average educational attainment was between Year 12 and Diploma. The mean score for their self-assessed disease knowledge (2.41 SD=0.95) indicates that they assessed their disease knowledge as between ‘knowing a lot’ and ‘knowing some.’ The mean scores of the sub-constructs in the AAHLS ranged from 2.05 (SD=0.74) to 2.12 (SD=0.745) for functional health literacy, 1.72 (SD=0.75) to 1.88 (SD=0.75) for communicative health literacy, and 1.56 (SD=0.73) to 2.02 (SD=0.50) for critical health literacy. These mean values imply that they basically ‘sometimes’ needed help to read health-related information, the frequency that they knew how to effectively communicate with doctors and nurses was between ‘always’ and ‘sometimes,’ and the frequency that they were critical about health information was between ‘always’ and ‘sometimes,’ respectively. The mean scores for the 8 items on the eHEAL scale ranged from 2.81 (SD=1.88) to 2.99 (SD=1.18), implying that they were more likely to disagreed or fell unsure that they had the skills and knowledge that enabled them to navigate electronic health platforms and find helpful health-related information. Each participant returned an average of 2.52 (SD=1.23) correct responses to the 6 numeracy question items on the GHNT scale. This means that a large share of participants answered the 6 questions wrongly. As with their scoring performance on the Multidimensional Health Locus of Control (MHLC) Scales Form B, they averagely scored a sum of 18.78 (SD=4.69), 16.54 (SD=4.51), and 17.89 (SD=4.24) on the ‘Internal,’ ‘Chance,’ and ‘Powerful Others’ subscales, respectively. The determined response of ‘slightly disagree’ for the ‘Internal’ subscale indicates that they somehow did not believe in their internal drives to maintain healthy. The determined response between ‘moderately disagree’ and ‘slightly disagree’ for the ‘Chance’ subscale implies that they were generally less likely to attribute their health to a matter of luck. The determined response between ‘moderately disagree’ and ‘slightly disagree’ for the ‘Powerful Others’ subscale means that they generally did nor believe in the role of others in the maintenance of their own health. Applying latent class analysis, we classified Chinese populations into low, low to moderate, and moderate to adequate functional health literacy groups and identified 5 factors associated with low communicative health literacy, including (1) the male gender (40-49), (2) lower educational attainment (below diploma), (3) age between 38 and 68, (4) lower self-efficacy, and (5) belief that staying healthy was a matter of luck.

Conclusions:

We classified Chinese populations into 3 functional health literacy groups and identified 5 factors associated with low functional health literacy. These associated factors can provide some implications for health education, medical research, and health policy-making.