Health literacy levels of mothers of under 5-year-old children in two districts in Ghana

Document Type : Original Article

Authors

1 Laboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana

2 Department of Health Administration and Education, Faculty of Science Education, University of Education Winneba, Ghana

3 Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

4 Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana

5 Department of Health Policy, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Ghana

Abstract

Background and Objective: Health literacy is a vital part of access and use of health interventions and well-being framework. However, there is a dearth of knowledge on health literacy levels of primary caregivers of children in Ghana. This study sought to investigate health literacy levels of mothers of children under the age of five years. 

Material and Methods: A community-based cross-sectional study was conducted among 1,234 mothers who had children aged <5 years in Ejisu-Juaben and Kwabre-East, two randomly selected districts, in the Ashanti Region of Ghana from January 1 to March 30, 2021. A consecutive sampling technique was used to select the mothers to participate in the study. Data was collected using the Health Literacy Questionnaire (HLQ) and analyzed using Statistical Package for Social Sciences (SPSS) software version 20. Sample mean scores were presented in the form of a table. A paired-simple t-test was used to examine the significant levels of the differences in the mean health literacy scores of the mothers in the two districts. A multiple logistic regression analysis was then used to examine the relationships between the demographic variables of the respondents and health literacy.  

Results: On a nine-point health literacy scores, mothers scored above average on scale 1-5 (mean = 2.61, ranges 2.55-2.68), while scale 5-9 had mean = 3.39 (ranges 3.33-3.44). Scales 3 and 6, ‘Actively managing my health’ (mean = 2.68) and ‘Ability to actively engage with healthcare providers’ (mean = 3.44), had the highest scores while scales 1 and 7, ‘Feeling understood and supported by healthcare providers’ (mean = 2.55) and ‘Navigating the healthcare system’ (mean = 3.33), had the lowest scores.   None of the HLQ scale items had a score below average. In the multiple logistic regression analysis, three variables had significant association with the mothers’ health literacy: age, educational level and speaking English at home. There was no statistically significant difference (p>0.05) in the mean health literacy scores between the two studied districts.

Conclusion: The mothers’ health literacy levels were above average. However, the results are not an indication of an outstanding performance. Thus, the country’s healthcare professionals and policy makers still need to do a lot to ensure that mothers in the country attain the level of health literacy they need to improve their health, as well as that of their children. 

Keywords

Acknowledgement: We acknowledge the 13 research assistants who assisted us in collecting data for this study
Conflicts of interest: The authors declare that there is no conflict of interest regarding the publication of this paper. 

 

Ethical consideration: Permission was obtained from the District Health Directorate of the Ejisu-Juaben and the Kwabre-East to carry out the research. The study protocol was submitted to the Committee on Human Research and Publication Ethics (CHRPE), the institutional Review Board of the School of Medical Sciences, Kwame Nkrumah University of Science and Technology (SMS-KNUST) for review and approval.

 

Funding statement: No funding was obtained for this study

 

Authors’ contributions: Emmanuel Kwasi Afriyie and Emmanuel Kumah conceptualized the study and led the project and writing. All authors contributed to the development of the coding scheme. Collins Kokuro and Charles Owusu-Aduomi Botchwey conducted the coding and analyses and drafted the methods. Agartha Afful Boateng, and Peter Agyei-Baffour reviewed the codes and results. All authors contributed to the writing and revision and approved the final version of the manuscript

References

1. Sørensen K, Nørgaard O, Maindal HT. Need for more research in patients' health literacy. Ugesk Laeg 2014;176(1), 40-43.
 
2. World Health Organization. The mandate for health literacy. Geneva: World Health Organization, 2016.
 
3. Beauchamp A, Buchbinder R, Dodson S, Batterham RW, Elsworth GR, McPhee C, Osborne RH. Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)". BMC Public Health 2015;15.
https://doi.org/10.1186/s12889-015-2056-z
PMid:26194350 PMCid:PMC4508810
 
4. Scott T, Gazmararian J, Williams M, Baker D. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002
https://doi.org/10.1097/00005650-200205000-00005
PMid:11961474
 
5. Nutbeam D. The evolving concept of health literacy. Soc Sci Med 2008; 67(12), 2072-2078. https://doi.org/10.1016/j.socscimed.2008.09.050
https://doi.org/10.1016/j.socscimed.2008.09.050
PMid:18952344
 
6. Ishikawa H, Yano E. Patient health literacy and participation in the health-care process. Health Expect 2008;11(2),113-122.
https://doi.org/10.1111/j.1369-7625.2008.00497.x
PMid:18494956 PMCid:PMC5060442
 
7. Maindal HT, Kayser L, Norgaard O, B A, Elsworth GR., Osborne R.H. Cultural adaptation and validation of the Health Literacy Questionnaire (HLQ): robust nine-dimension Danish language confirmatory factor model. Springer Plus 2016; 5:1232.
https://doi.org/10.1186/s40064-016-2887-9
PMid:27536516 PMCid:PMC4971008
 
8. Asgary R, Liu M, Naderi R, Grigoryan Z, Malachovsky M. Malnutrition ton prevalence and nutrition barriers in children under 5 years: A mixed methods study in Madagascar. Int Health 2015 ;7(6):426-32. [DOI: 10.1093/in health/ihv016] [PMID]
https://doi.org/10.1093/inthealth/ihv016
PMid:25788580
 
9. The Global Economy. Economic indicators for over 200 countries Secondary Economic indicators for over 200 countries, 2019. Available from: www.globaleconomy.com
 
10. Lori JR, Munro ML, Chuey MR. Use of a facilitated discussion model for antenatal care to improve communication. Int J Nurs Studies 2015;15: 00098-X.
 
11. Saaka, M. Relationship between mothers' nutritional knowledge in childcare practices and the growth of children living in impoverished rural communities. J Health, Population Nutri 2014;32(2), 237-248.
 
12. Ghana Statistical Service. 2021 population and housing census. Ghana Statistical Service: Accra, 2019. Accessed March 11, 2022
 
13. Amoah, PA, and Phillips, DR. Socio-demographic and behavioral correlates of health literacy: a gender perspective in Ghana. Women Heal 2020;60:123.
https://doi.org/10.1080/03630242.2019.1613471
PMid:31092133
 
14. Nolte S, Osborne RH, Dwinger S, Elsworth GR, Conrad ML, et al. German translation, cultural adaptation, and validation of the Health Literacy Questionnaire (HLQ). PloS One 2017;12(2): 1-12,
https://doi.org/10.1371/journal.pone.0172340
PMid:28234987 PMCid:PMC5325258
 
15. Nutbeam D. Health promotion glossary. Health Prom Int 1998:13(4), 349-364
https://doi.org/10.1093/heapro/13.4.349
 
16. Osborne, R.H., Batterham, R.W., Elsworth, G.R., Hawkins, M., & Buchbinder, R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health 2013;13:658.
https://doi.org/10.1186/1471-2458-13-658
PMid:23855504 PMCid:PMC3718659
 
17. Buchbinder R, Batterham R, Elsworth G, Dionne CE, Irvin E, Osborne RH. A validity-driven approach to the understanding of the personal and societal burden of low back pain: development of a conceptual and measurement model. Arthritis Res. Ther. 2011, 13, R152.
https://doi.org/10.1186/ar3468
PMid:21933393 PMCid:PMC3308082
 
18. Debussche X, Lenclume V, Balcou-Debussche M, Alakian D, Sokolowsky C, Ballet D, Elsworth GR, Osborne RH, Huiart L. Characterisation of health literacy strengths and weaknesses among people at metabolic and cardiovascular risk: Validity testing of the Health Literacy Questionnaire. SAGE Open Med 2018.
https://doi.org/10.1177/2050312118801250
PMid:30319778 PMCid:PMC6154264
 
19. Elsworth GR, Beauchamp A, Osborne RH. Measuring health literacy in community agencies: A Bayesian study of the factor structure and measurment invariance of the health literacy questionnaire (HLQ). BMC Health Serv Rese 2016; 16, 508
https://doi.org/10.1186/s12913-016-1754-2
PMid:27659559 PMCid:PMC5034518
 
20. Mathieson K. Making Sense of Biostatistics: Types of Nonprobability Sampling. J Clin Res Best Prac 2014; 10(10).
 
21. Lee SYD, et al. Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health 2010;10(1), 1-8.
https://doi.org/10.1186/1471-2458-10-614
PMid:20950479 PMCid:PMC2967535
 
22. Beier ME, Ackerman. PL. Determinants of health knowledge: an investigation of age, gender, abilities, personality, and interests. J Pers Soc Psycho 2003; 84 (2):439-48.
https://doi.org/10.1037/0022-3514.84.2.439
 
23. von Wagner C, K Knight K, Steptoe A, Wardle J. Functional health literacy and healthpromoting behaviour in a national sample of British adults. J Epi Community Health 2007;61 (12):1086-90.
https://doi.org/10.1136/jech.2006.053967
PMid:18000132 PMCid:PMC2465677
 
24. Quansah EB. Ghana Health Service Must Be Serious with CHPS Compound Implementation. Feature Article 2014:12-10 Available from: https://ghanaweb.com/GhanaHomePage/features/Ghana-Health-Service-Must-Be-Serious-With-Chps-Compound-Implementation-338564
 
25. Chesser AK, Keene Woods N, Smothers K, Rogers N. Health Literacy and Older Adults. Gerontology Geriatric Med 2016;l 2.
https://doi.org/10.1177/2333721416630492
PMid:28138488 PMCid:PMC5119904
 
26. Hakkak, H, et al. Health literacy level and related factors among pregnant women referring to bojnord health centers in 2017. Int J Pharm Res. 2019;11(1), 152-158
https://doi.org/10.31838/ijpr/2019.11.01.015
 
27. Phommachanh,S, et al. Maternal health literacy on mother and child health care: A community cluster survey in two southern provinces in Laos. PloS One 2021; 16(3), e0244181
https://doi.org/10.1371/journal.pone.0244181
PMid:33780460 PMCid:PMC8007003
 
28. Rouquette A, Nadot T, Labitrie P, Van den Broucke S, Mancini J, Rigal, L et al. Validity and Measurement Invariance across Sex, Age, and Education Level of the French Short Versions of the European Health Literacy Survey Questionnaire. PLoS One 2018: 13(12):e0208091.
https://doi.org/10.1371/journal.pone.0208091
PMid:30521552 PMCid:PMC6283623

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