A Comparison of Health Literacy and Health-Related Quality of Life between Orphan and Normal Adolescents

Document Type : Original Article

Authors

1 Department of Pediatric & Neonatal Intensive Care Nursing, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Pediatric & Neonatal Intensive Care Nursing, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 , PhD in Nursing, Assistant Professor, Department of Pediatric & Neonatal Intensive Care Nursing, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 PhD in Biostatistics, Assistant Professor of Biostatistics, Department of Basic Sciences, Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background and Objective: Adolescence is one of the most important periods of life. Adolescents living in Orphanages are more exposed to health risks. One of the factors influencing health in Adolescence is health literacy and the health-related quality of life. This study aimed to compare health literacy and health-related quality of life between Orphan and Normal Adolescents. 

Materials and Methods: In this cross-sectional descriptive study, 72 Orphanage adolescents and 160 adolescents at home were selected from Tehran Province through cluster sampling from Sep 13, 2020 to Jan 9, 2021. The data was collected using adolescents’ health literacy (HELMA) questionnaire and HRQOL (Kidscreen-27) questionnaire. In order to analyze the data, ANCOVA, Chi-square test, Independent Samples t-test, Fisher's exact test, and Mann-Whitney test were used in SPSS 22.

Results: There is no significant difference in health literacy among the two groups (p=0.84) and only in the subclass calculation, Orphanage  adolescents obtained a significantly higher score (p=0.007). There was also no significant difference in HRQOL between the two groups (p=0.11). However, in the subclasses school environment (P=0.03) and psychological well-being (p=0.01) adolescents at home and in the subclass social support and peers (p=0.02) Orphanage adolescents gained significantly higher scores.

Conclusion: Despite the special conditions of Orphanage adolescents, the health literacy and HRQOL were not significantly different between the two groups. In the subclass calculation of health literacy, Orphanage adolescents obtained a significantly higher score and the subclasses of HRQOL, school environment, and psychological well-being adolescents at home, and the subclass social support and peers Orphanage adolescents gained significantly higher scores.

Keywords


 Burdette AM, Needham BL, Taylor MG, Hill TD. Health lifestyles in adolescence and self-rated health into adulthood. Journal of health and social behavior. 2017;58(4):520-36.
https://doi.org/10.1177/0022146517735313
PMid:29172769
 
2. Vahedian-Shahroodi M, Tehrani H, Robat-Sarpooshi D, GHolian-Aval M, Jafari A, Alizadeh-Siuki H. The impact of health education on nutritional behaviors in female students: An application of health belief model. International Journal of Health Promotion and Education. 2021;59(2):70-8
https://doi.org/10.1080/14635240.2019.1696219  
 
3. Crone EA, Fuligni AJ. Self and others in adolescence. Annual review of psychology. 2020;71:447-69.
https://doi.org/10.1146/annurev-psych-010419-050937
PMid:31337274  
 
4. Khosravi M, Saemi H, Hosseinaei A, Bayani aA. Identifying the Components of a Healthy Lifestyle with Emphasis on Adolescence: A Qualitative Study. Iranian Journal of Health Education and Health Promotion. 2021;9(1):80-93.
https://doi.org/10.52547/ijhehp.9.1.80  
 
5. Klemera E, Brooks FM, Chester KL, Magnusson J, Spencer N. Self-harm in adolescence: protective health assets in the family, school and community. International journal of public health. 2017;62(6):631-8.
https://doi.org/10.1007/s00038-016-0900-2
PMid:27658811 PMCid:PMC5487889  
 
6. Ntuli B, Mokgatle M, Madiba S. The psychosocial wellbeing of orphans: The case of early school leavers in socially depressed environment in Mpumalanga Province, South Africa. Plos one. 2020;15(2):e0229487.
https://doi.org/10.1371/journal.pone.0229487
PMid:32101591 PMCid:PMC7043744  
 
7. Shafiq F, Haider SI, Ijaz S. Anxiety, Depression, Stress, and Decision-Making Among Orphans and Non-Orphans in Pakistan. Psychology research and behavior management. 2020;13:313.
https://doi.org/10.2147/PRBM.S245154
PMid:32280288 PMCid:PMC7125317  
 
8. unicef. Orphans 2017 [Available from: https://www.unicef.org/media/media_45279.html.  
 
9. Reza A, Breiding MJ, Gulaid J, Mercy JA, Blanton C, Mthethwa Z, et al. Sexual violence and its health consequences for female children in Swaziland: a cluster survey study. The Lancet. 2009;373(9679):1966-72.
https://doi.org/10.1016/S0140-6736(09)60247-6  
 
10. Iran SWOo. Statistical Yearbook of Welfare Organization 1398 [Available from: https://en.behzisti.ir/.  
 
11. Nguyen HC, Nguyen MH, Do BN, Tran CQ, Nguyen TT, Pham KM, et al. People with suspected COVID-19 symptoms were more likely depressed and had lower health-related quality of life: the potential benefit of health literacy. Journal of clinical medicine. 2020;9(4):965.
https://doi.org/10.3390/jcm9040965
PMid:32244415 PMCid:PMC7231234  
 
12. Simonds SK. Health education as social policy. Health Education Monographs. 1974;2(1_suppl):1-10.
https://doi.org/10.1177/10901981740020S102  
 
13. Domanska OM, Bollweg TM, Loer A-K, Holmberg C, Schenk L, Jordan S. Development and psychometric properties of a questionnaire assessing self-reported generic health literacy in adolescence. International journal of environmental research and public health. 2020;17(8):2860.
https://doi.org/10.3390/ijerph17082860
PMid:32326285 PMCid:PMC7216216  
 
14. Oh H, Rizo C, Enkin M, Jadad A. What is eHealth (3): a systematic review of published definitions. Journal of medical Internet research. 2005;7(1):e110.
https://doi.org/10.2196/jmir.7.1.e1
PMid:15829471 PMCid:PMC1550636  
 
15. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international. 2000;15(3):259-67.
https://doi.org/10.1093/heapro/15.3.259
https://doi.org/10.1093/heapro/15.3.183  
 
16. Berkman ND, Davis TC, McCormack L. Health literacy: what is it? Journal of health communication. 2010;15(S2):9-19.
https://doi.org/10.1080/10810730.2010.499985
PMid:20845189  
 
17. Olyani S, Gholian Aval M, Tehrani H, Mahdiadeh M. School-Based Mental Health Literacy Educational Interventions in Adolescents: A Systematic Review. Journal of Health Literacy. 2021;6(2):69-77.  
 
18. Hoffman S, Marsiglia FF, Nevarez L, Porta M. Health literacy among youth in Guatemala City. Social Work in Public Health. 2017;32(1):30-7.
https://doi.org/10.1080/19371918.2016.1188741
PMid:27392315  
 
19. Keikha F, Ansari H, khosravi M, Seraji M. The Effect of Educational Intervention on Health Literacy and Nutritional Performance of Female High School Students in Zahedan. Journal of Health Literacy. 2021;6(1):41-50.  
 
20. Sheeran P, Webb TL. The intention-behavior gap. Social and personality psychology compass. 2016;10(9):503-18.
https://doi.org/10.1111/spc3.12265  
 
21. Due P, Krølner R, Rasmussen M, Andersen A, Trab Damsgaard M, Graham H, et al. Pathways and mechanisms in adolescence contribute to adult health inequalities. Scandinavian journal of public health. 2011;39(6_suppl):62-78.
https://doi.org/10.1177/1403494810395989
PMid:21382850  
 
22. Manganello JA. Health literacy and adolescents: a framework and agenda for future research. Health education research. 2008;23(5):840-7.
https://doi.org/10.1093/her/cym069
PMid:18024979  
 
23. Ran M, Peng L, Liu Q, Pender M, He F, Wang H. The association between quality of life (QOL) and health literacy among junior middle school students: a cross-sectional study. BMC public health. 2018;18(1):1-10.
https://doi.org/10.1186/s12889-018-6082-5
PMid:30340479 PMCid:PMC6194633  
 
24. National Center for Chronic Disease Prevention and Health Promotion DoPH. HRQOL Concepts 2018 [Available from: https://www.cdc.gov/hrqol/concept.htm.  
 
25. Giachello AL. Health outcomes research on Hispanics/Latinos. Journal of medical Systems. 1996;20(5):235-54.
https://doi.org/10.1007/BF02257038
PMid:9001992  
 
26. Quittner AL, Schechter MS, Rasouliyan L, Haselkorn T, Pasta DJ, Wagener JS. Impact of socioeconomic status, race, and ethnicity on quality of life in patients with cystic fibrosis in the United States. Chest. 2010;137(3):642-50.
https://doi.org/10.1378/chest.09-0345
PMid:19820076  
 
27. Boehm JK, Kubzansky LD. The heart's content: the association between positive psychological well-being and cardiovascular health. Psychological bulletin. 2012;138(4):655.
https://doi.org/10.1037/a0027448
PMid:22506752  
 
28. Adili S, Mirzaie Ranjbar R, Abedi A. The effectiveness of filial therapy on the quality of parent-child interactions and health-related quality of life in children with behavioral/emotional problems. J of Exceptional Children. 2019;19(1):59-70.  
 
29. Hjern A, Rajmil L, Kling S, Vinnerljung B. Gender aspects of health‐related quality of life of youth in secure residential care in Sweden. International Journal of Social Welfare. 2018;27(4):358-63.
https://doi.org/10.1111/ijsw.12342  
 
30. Carroll D, Duffy T, Martin CR. A comparison of the quality of life of vulnerable young males with severe emotional and behaviour difficulties in a residential setting and young males in mainstream schooling. Journal of psychiatric and mental health nursing. 2014;21(1):23-30.
https://doi.org/10.1111/jpm.12042
PMid:23448617  
 
31. Khormehr M, Abdolahi Shahvali E, Ziaeirad M, Honarmandpour A. A comparison of quality of life and happiness of children and adolescents in residential care with children and adolescents in parental care of ahvaz in 2015. Journal of Comprehensive Pediatrics. 2020;11(3).
https://doi.org/10.5812/compreped.69049  
 
32. Amoah PA, Phillips DR, Gyasi RM, Koduah AO, Edusei J. Health literacy and self-perceived health status among street youth in Kumasi, Ghana. Cogent Medicine. 2017;4(1):1275091.
https://doi.org/10.1080/2331205X.2016.1275091  
 
33. Dumbray S, Munighati ST. IJNH Innovational Journal of Nursing and Healthcare (IJNH).  
 
34. bin Shaziman S, Rani MDM, Aripin KbN, Hamid NA, Sulaiman WNW, Rahman ZA, et al. Assessing nutritional knowledge, attitudes and practices and body mass index of adolescent residents of orphanage institutions in Selangor and Malacca. Pakistan Journal of Nutrition. 2017.
https://doi.org/10.3923/pjn.2017.406.411  
 
35. Ghanbari S, Ramezankhani A, Montazeri A, Mehrabi Y. Health literacy measure for adolescents (HELMA): development and psychometric properties. PloS one. 2016;11(2):e0149202.
https://doi.org/10.1371/journal.pone.0149202
PMid:26881933 PMCid:PMC4755574  
 
36. Nik-Azin A, Naeinian MR, Shairi MR. Validity and Reliability of Health Related Quality of Life Questionnaire "KIDSCREEN-27" in a Sample of Iranian Students. Iranian Journal of Psychiatry and Clinical Psychology. 2013;18(4):310-21.  
 
37. Europe T. The KIDSCREEN Questionnaires. Quality of life questionnaires for children and adolescents. Lengerich: Pabst Science Publishers. 2006.  
 
38. Ravens-Sieberer U, Gosch A, Rajmil L, Erhart M, Bruil J, Duer W, et al. KIDSCREEN-52 quality-of-life measure for children and adolescents. Expert review of pharmacoeconomics & outcomes research. 2005;5(3):353-64.
https://doi.org/10.1586/14737167.5.3.353
PMid:19807604  
 
39. Boadu S, Osei-Tutu A, Osafo J. The Emotional experiences of children living in orphanages in Ghana. Journal of Children's Services. 2020.
https://doi.org/10.1108/JCS-10-2018-0027  
 
40. Roy RC, Sahabuddin M, Debnath SC, Hosaain MJ, Azmol M, Hossain SCB, et al. Nutritional status of the adolescent boys of a recognized charitable orphanage in Dhaka city, Bangladesh. Eur J Med Health Sci. 2019;1(3):10-8.
https://doi.org/10.34104/ejmhs.019.01018  
 
41. Ozturk FO, Ayaz-Alkaya S. Health literacy and health promotion behaviors of adolescents in Turkey. Journal of Pediatric Nursing. 2020;54:e31-e5.
https://doi.org/10.1016/j.pedn.2020.04.019
PMid:32446664  
 
42. Park A, Eckert TL, Zaso MJ, Scott‐Sheldon LA, Vanable PA, Carey KB, et al. Associations between health literacy and health behaviors among urban high school students. Journal of School Health. 2017;87(12):885-93.
https://doi.org/10.1111/josh.12567
PMid:29096408 PMCid:PMC5669371  
 
43. Karimi N, Saadat Gharin S, Tol A, Sadeghi R, Yaseri M, Mohebbi B. Role of Health Literacy and Demographic Variables in Determining Health-Promoting Behaviors Among High School Female Students in the City of Tehran, Iran. Journal of School of Public Health and Institute of Public Health Research. 2019;17(3):212-28.  
 
44. Rideout V, Robb MB. Social media, social life: Teens reveal their experiences. San Francisco, CA: Common Sense Media. 2018.  
 
45. Flammer A, Alsaker FD. Adolescents in school. Handbook of adolescent development: Psychology Press; 2020. p. 223-45.
https://doi.org/10.4324/9780203969861-12  
 
46. Wang J, Fan W, Cheung FM, Wang Q, Li M. Personality and Chinese adolescents' career exploration: The mediation effects of self-efficacy and perceived parental support. Journal of Pacific Rim Psychology. 2019;13.
https://doi.org/10.1017/prp.2019.16  
 
47. TEHRANI BANIHASHEMI SA, AMIRKHANI MA, ALAVIAN SM, ASGHARIFARD H, BARADARAN H, BARGHAMDI M, et al. HEALTH LITERACY AND THE INFLUENCING FACTORS: A STUDY IN FIVE PROVINCES OF IRAN. STRIDES IN DEVELOPMENT OF MEDICAL EDUCATION. 2007;4(1):-.  
 
48. MOZAFARI M, BORJI M. ASSESSING THE HEALTH LITERACY LEVEL OF PARENTS WITH SCHOOL CHILDREN IN ILAM, 2015. JOURNAL OF NURSING EDUCATION (JNE). 2017;5(6 (20)):-.
https://doi.org/10.21859/jne-05068  
 
49. Chehri M. Assessing the health literacy level of parents of preschool children. 2015.  
 
50. Guo S, Yu X, Davis E, Armstrong R, Riggs E, Naccarella L. Adolescent health literacy in Beijing and Melbourne: A cross-cultural comparison. International journal of environmental research and public health. 2020;17(4):1242.
https://doi.org/10.3390/ijerph17041242
PMid:32075168 PMCid:PMC7068382  
 
51. Dehghankar L, Panahi R, Kekefallah L, Hosseini N, Hasannia E. The study of health literacy and its related factors among female students at high schools in Qazvin. Journal of Health Literacy. 2019;4(2):18-26.  
 
52. Paakkari O, Torppa M, Villberg J, Kannas L, Paakkari L. Subjective health literacy among school-aged children. Health Education. 2018.
https://doi.org/10.1108/HE-02-2017-0014  
 
53. Yendork JS, Somhlaba NZ. Stress, coping and quality of life: An exploratory study of the psychological well-being of Ghanaian orphans placed in orphanages. Children and Youth Services Review. 2014;46:28-37.
https://doi.org/10.1016/j.childyouth.2014.07.025  
 
54. Carbone JA, Sawyer MG, Searle AK, Robinson PJ. The health-related quality of life of children and adolescents in home-based foster care. Quality of life research. 2007;16(7):1157-66.
https://doi.org/10.1007/s11136-007-9227-z
PMid:17616839  
 
55. Andrews JL, Foulkes L, Blakemore S-J. Peer influence in adolescence: Public-health implications for COVID-19. Trends in Cognitive Sciences. 2020;24(8):585-7.
https://doi.org/10.1016/j.tics.2020.05.001
PMid:32444200 PMCid:PMC7205648  
 
56. Richter D, Mehnert A, Forstmeyer D, Ernst J, Geue K. Health literacy in adolescent and young adult cancer patients and its association with health outcomes. Journal of adolescent and young adult oncology. 2019;8(4):451-7.
https://doi.org/10.1089/jayao.2018.0118
PMid:30869557  
 
57. Khaleghi M, AMIN SF, Peyman N. The relationship between health literacy and health-related quality of life in students. 2019.
https://doi.org/10.30699/ijhehp.7.1.66  
 
58. Hoffman S, Rueda HA, Beasley L. Health-related quality of life and health literacy among Mexican American and Black American youth in a southern border state. Social work in public health. 2020;35(3):114-24.
https://doi.org/10.1080/19371918.2020.1747584
PMid:32248757