JMIR Publications

ABSTRACT

Background:

China is a country with a high burden of hepatitis B (HB) but a low treatment rate. One of the key reasons for the low treatment rate is inadequate awareness of HB.

Objective:

This study analyzed how health literacy (HL) contributed to scale-up of the antiviral treatment of HB in China. We expect that the findings of this study could be used to inform resource allocation for health education and other approaches intending to improve the HL of the Chinese population, thus facilitating the nationwide scale-up of Hep B treatment, and contributing to the achievement of the 2030 goal in China.

Methods:

We used the two-stage least squares regression and took the mobile phone penetration rate as the instrumental variable to estimate the effect of improved HL on the number of 12-month standard HB antiviral treatment in China based on the panel data of 31 provinces during 2013-2020.

Results:

In the cross-sectional dimension, the higher the HL, the higher the number of treatment in the provinces in a specific year. In the time-series dimension, the number of treatment of a specific province increased with the improvement of HL over time. After controlling the time-invariant inherent attributes of provinces, the IV estimation with 2SLS regression based on the province fixed-effect model showed that for every 1%increase of HL in each province, the number of treatment increased by 7.15% (0.0715= e0.0691-1, P<.001). The estimation interval drawn from the Union of Confidence Intervals method [-0.0331, 0.0960] included the above estimation, which indicated that the deviation of the IV estimation is within a tolerable range. The Falsification test verified that the assumption of the exogeneity of the IV and restriction exclusion for the IV estimation holds.

Conclusions:

Our findings suggest that improved HL of the population is an important favourable facilitator for the scale-up of HB treatment. Knowledge of HB and health system can help building awareness and understanding individual health status, forming a healthier lifestyle and appropriate healthcare seeking behaviour, and better service utilization, so that to be diagnosed and treated appropriately. Enhancing resource allocation to improve overall HL of the population and HB specific messages to HBV infected people would be a feasible and effective approach to scale up the treatment of HB in the developing settings with high HB disease burden but limited resources, and contribute to achieving the 2030 global goal for elimination of the public health threat of HB.