Inadequate functional health literacy and its associated gender inequality among an ethnic population: A social survey

Document Type : Original Article

Authors

1 Social Determinant of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran

2 Tabriz University of Medical Sciences

3 Department of Epidemiology, Faculty of Health, Arak University of Medical Sciences, Arak, Iran

4 Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran

5 Department of Public Health, Faculty of Health, Neyshabur University of Medical Sciences, Neyshabur

6 6Kawsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran

7 Department of Health Education and Promotion, Faculty of Health, Kerman University of Medical Sciences, Kerman, Iran

8 The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, Australia

9 Department of Epidemiology and International Health, Pôle Universitaire euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African Republic

Abstract

Background and Objective: Our objective was to determine the frequency of inadequate functional health literacy (FHL) among adult Kurd population, and infer the contribution index of sociodemographic factors for FHL across gender. 

Materials and Methods: In this cross-sectional study, multistage cluster sampling was employed to recruit 1000 people older than 18 years from 38 urban and 14 rural healthcare centers in Sanandaj, Iran. Data on FHL was collected from May to July 2019, through face-to-face interviews by using the validated Persian version of the Test of functional health literacy in adults (TOFHLA). The concentration index method was used to measure inequality in FHL. 

Results: Overall, 869 respondents (response rate: 86.9%) with a mean age of 33.68 (±13.0) completed the TOFHLA questionnaire. The average TOFHLA score was 51.9, which was 52.2 (±0.46) among males and 50.7 (±0.40) among females, p<0.001. Among females, the place of residence, monthly income, age, education level, and being head of the household contributed to 43%, 32%, 13%, 11.5%,  and 11% of FHL inequality, respectively. While, among males, the place of residence (45.2%), household size (15.1%), and monthly income (13.5%) contributed most to inequality in FHL.

Conclusion:  FHL has disparities by gender and location. Males and rural people are at particular risk for poor FHL. For ease and better resolution of poor FHL, each population, gender, and area type should be considered as a stand-alone, which may help in identifying tailored interventions for males and females with low levels of FHL. 

Keywords

Availability of data and materials: The datasets used and analyzed during the current study is included in this article

Conflicts of interest: There is no Conflicts of interest.

Ethical considerations: The study was approved by Ethics Committee in Islamic Azad University-Sanandaj Branch (Ethics Code: IR.IAU-SB.1397.469). Written informed consent was taken from all participants, and all signed consent form.

Funding: No financial support was received for this study.

Authors ‘contributions: All authors contributed to this project and article equally. All authors read and approved the final manuscript.

References

1. Baker DW. The meaning and the measure of health literacy. Journal of general internal medicine. 2006;21(8):878-83.
https://doi.org/10.1111/j.1525-1497.2006.00540.x
PMid:16881951 PMCid:PMC1831571
 
2. Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC public health. 2012;12(1):1-13.
https://doi.org/10.1186/1471-2458-12-80
PMid:22276600 PMCid:PMC3292515  
 
3. Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, et al. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PloS one. 2022;17(7):e0271524.
https://doi.org/10.1371/journal.pone.0271524
PMid:35839272 PMCid:PMC9286266  
 
4. O'carroll R. The assessment of premorbid ability: A critical review. Neurocase. 1995;1(1):83-9.
https://doi.org/10.1080/13554799508402350  
 
5. Berkman ND, DeWalt DA, Pignone M, Sheridan SL, Lohr KN, Lux L, et al. Literacy and health outcomes. Evidence report/technology assessment No. 87. 2004.  
 
6. Agency for Healthcare Research and Quality. Use the Teach-Back Method: Tool #5. Rockville, MD.: 2020 Content last reviewed September 2020. Report No.  
 
7. Houston TK, Allison JJ. Users of Internet health information: differences by health status. Journal of medical Internet research. 2002;4(2):e864.
https://doi.org/10.2196/jmir.4.2.e7
PMid:12554554 PMCid:PMC1761934  
 
8. Safeer RS, Keenan J. Health literacy: the gap between physicians and patients. American family physician. 2005;72(3):463-8.  
 
9. 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  
 
10. Abdullah A, Liew SM, Ng CJ, Ambigapathy S, V. Paranthaman PV. Health literacy experiences of multi‐ethnic patients and their health‐care providers in the management of type 2 diabetes in Malaysia: A qualitative study. Health Expectations. 2020;23(5):1166-76.
https://doi.org/10.1111/hex.13095
PMid:32686277 PMCid:PMC7696131  
 
11. Leung AYM, Bo A, Hsiao H-Y, Wang SS, Chi I. Health literacy issues in the care of Chinese American immigrants with diabetes: a qualitative study. BMJ open. 2014;4(11):e005294.
https://doi.org/10.1136/bmjopen-2014-005294
PMid:25406155 PMCid:PMC4244415  
 
12. Bollars C, Sørensen K, de Vries N, Meertens R. Exploring health literacy in relation to noncommunicable diseases in Samoa: a qualitative study. BMC Public Health. 2019;19(1):1-12.
https://doi.org/10.1186/s12889-019-7474-x
PMid:31438907 PMCid:PMC6704563  
 
13. Al-Jumaili AA, Al-Rekabi MD, Sorofman B. Evaluation of instruments to assess health literacy in Arabic language among Iraqis. Research in Social and Administrative Pharmacy. 2015;11(6):803-13.
https://doi.org/10.1016/j.sapharm.2015.02.002
PMid:25800139  
 
14. Mahmoodi H, Dalvand S, Gheshlagh RG, Kurdi A. A systematic review and meta-analysis of health literacy in the Iranian population: Findings and implications. Shiraz E-Medical Journal. 2019;20(4).
https://doi.org/10.5812/semj.81115  
 
15. Nair SC, Satish KP, Sreedharan J, Ibrahim H. Assessing health literacy in the eastern and middle-eastern cultures. BMC Public Health. 2016;16(1):1-8.
https://doi.org/10.1186/s12889-016-3488-9
PMid:27538529 PMCid:PMC4991078  
 
16. Wikkeling-Scott LF, Ajja RJY, Rikard RV. Health literacy research in the Eastern Mediterranean Region: An integrative review. International journal of public health. 2019;64(4):523-33.
https://doi.org/10.1007/s00038-018-01200-1
PMid:30815736  
 
17. Yari A, Soofimajidpoor M, Moradi G, Bidarpoor F, Nadrian H, Iranpoor A, et al. Measuring the constructs of health literacy in the Iranian adult Kurdish population. BMC Public Health. 2021;21(1):1-10.
https://doi.org/10.1186/s12889-021-10589-z
PMid:33761905 PMCid:PMC7992981  
 
18. Aghajanloo R, Nadrian H, Baraei B, Shirzadi S, Sarbakhsh P, Keshavarzian K, et al. Health literacy, treatment adherence, bone mass density and health-related quality of life among iranian older adults with osteoporosis. International Journal of Health Promotion and Education. 2022:1-16.
https://doi.org/10.1080/14635240.2022.2052145  
 
19. Tavakoly Sany SB, Doosti H, Mahdizadeh M, Orooji A, Peyman N. The health literacy status and its role in interventions in Iran: a systematic and meta-analysis. International Journal of Environmental Research and Public Health. 2021;18(8):4260.
https://doi.org/10.3390/ijerph18084260
PMid:33920508 PMCid:PMC8073744  
 
20. Heizomi H, Iraji Z, Vaezi R, Bhalla D, Morisky DE, Nadrian H. Gender differences in the associations between health literacy and medication adherence in hypertension: a population-based survey in Heris County, Iran. Vascular health and risk management. 2020;16:157.
https://doi.org/10.2147/VHRM.S245052
PMid:32368074 PMCid:PMC7186197  
 
21. Golboni F, Nadrian H, Najafi S, Shirzadi S, Mahmoodi H. Urban-rural differences in health literacy and its determinants in Iran: A community‐based study. Australian Journal of Rural Health. 2018;26(2):98-105.
https://doi.org/10.1111/ajr.12378
PMid:29214687  
 
22. Clouston SA, Manganello JA, Richards M. A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability. Age and ageing. 2017;46(3):493-9.
https://doi.org/10.1093/ageing/afw229
PMid:27940567 PMCid:PMC5405758  
 
23. Lee HY, Lee J, Kim NK. Gender differences in health literacy among Korean adults: do women have a higher level of health literacy than men? American journal of men's health. 2015;9(5):370-9.
https://doi.org/10.1177/1557988314545485
PMid:25122719  
 
24. Tabrizi JS, Pourasghar F, Nikjoo RG. Status of Iran's primary health care system in terms of health systems control knobs: a review article. Iranian journal of public health. 2017;46(9):1156.  
 
25. Tehrani Banihashemi S-A, Haghdoost AA, Amirkhani MA, Alavian S-M, Asgharifard H, Baradaran H, et al. Health literacy and the influencing factors: a study in five provinces of Iran. Strides in development of medical education. 2007;4(1):1-9.  
 
26. Chow S-C, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research: chapman and hall/CRC; 2017.
https://doi.org/10.1201/9781315183084  
 
27. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults. Journal of general internal medicine. 1995;10(10):537-41.
https://doi.org/10.1007/BF02640361
PMid:8576769  
 
28. Marques SRL, Lemos SMA. Health literacy assessment instruments: literature review. Audiology-Communication Research. 2017;22.
https://doi.org/10.1590/2317-6431-2016-1757  
 
29. Motulsky H. Intuitive biostatistics: a nonmathematical guide to statistical thinking: Oxford University Press, USA; 2014.  
 
30. O'Donnell O, O'Neill S, Van Ourti T, Walsh B. Conindex: estimation of concentration indices. The Stata Journal. 2016;16(1):112-38.
https://doi.org/10.1177/1536867X1601600112
PMid:27053927 PMCid:PMC4819995  
 
31. Moradzadeh R, Nadrian H, Golboni F, Kazemi-Galougahi MH, Moghimi N. Economic inequalities amongst women with osteoporosis-related fractures: an application of concentration index decomposition. Health promotion perspectives. 2016;6(4):190.
https://doi.org/10.15171/hpp.2016.31
PMid:27766236 PMCid:PMC5071786  
 
32. Fleurbaey M, Schokkaert E. Unfair inequalities in health and health care. Journal of health economics. 2009;28(1):73-90.
https://doi.org/10.1016/j.jhealeco.2008.07.016
PMid:18829124  
 
33. Freeman D, Freeman J. The stressed sex: Uncovering the truth about men, women, and mental health: Oxford University Press; 2013.  
 
34. Galdas PM, Cheater F, Marshall P. Men and health help‐seeking behaviour: literature review. Journal of advanced nursing. 2005;49(6):616-23.
https://doi.org/10.1111/j.1365-2648.2004.03331.x
PMid:15737222  
 
35. Zare E, Simbar M, Shahhosseini Z, Alavi Majd H. The priorities of Iranian male adolescents health needs. American Journal of Men's Health. 2017;11(4):1255-9.
https://doi.org/10.1177/1557988317693346
PMid:28421852 PMCid:PMC5675350  
 
36. Peak T, Gast J, Ahlstrom D. A needs assessment of Latino men's health concerns. American Journal of Men's Health. 2010;4(1):22-32.
https://doi.org/10.1177/1557988308327051
PMid:19477734  
 
37. Arber S, Ginn J. Gender differences in informal caring. Health & Social Care in the Community. 1995;3(1):19-31.
https://doi.org/10.1111/j.1365-2524.1995.tb00003.x  
 
38. Reisi M, Javadzade SH, Mostafavi F, Sharifirad G, Radjati F, Hasanzade A. Relationship between health literacy, health status, and healthy behaviors among older adults in Isfahan, Iran. Journal of education and health promotion. 2012;1(1):31.
https://doi.org/10.4103/2277-9531.100160
PMid:23555134 PMCid:PMC3577376  
 
39. Haghdoost AA, Rakhshani F, Aarabi M, Montazeri A, Tavousi M, Solimanian A, et al. Iranian health literacy questionnaire (IHLQ): An instrument for measuring health literacy in Iran. Iranian Red Crescent Medical Journal. 2015;17(6).
https://doi.org/10.5812/ircmj.17(6)2015.25831
PMid:26290752  
 
40. Johri M, Subramanian S, Sylvestre M-P, Dudeja S, Chandra D, Koné GK, et al. Association between maternal health literacy and child vaccination in India: a cross-sectional study. J Epidemiol Community Health. 2015;69(9):849-57.
https://doi.org/10.1136/jech-2014-205436
PMid:25827469 PMCid:PMC4552929  
 
41. OECD. Survey of adult skills-USA. USA.: 2012 Contract No.: USA  
 
42. Wolf MS, Davis TC, Shrank W, Rapp DN, Bass PF, Connor UM, et al. To err is human: patient misinterpretations of prescription drug label instructions. Patient Educ Couns. 2007;67(3):293-300.
https://doi.org/10.1016/j.pec.2007.03.024
PMid:17587533  
 
43. Kelly PA, Haidet P. Physician overestimation of patient literacy: a potential source of health care disparities. Patient education and counseling. 2007;66(1):119-22.
https://doi.org/10.1016/j.pec.2006.10.007
PMid:17140758  
 
44. Sentell T, Braun KL. Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal of health communication. 2012;17(sup3):82-99.
https://doi.org/10.1080/10810730.2012.712621
PMid:23030563 PMCid:PMC3552496  
 
45. Bilenkisi F, Gungor MS, Tapsin G. The Impact of Household Heads' Education Levels on the Poverty Risk: The Evidence from Turkey. Educational Sciences: Theory and Practice. 2015;15(2):337-48.  
 
46. Fleary SA, Ettienne R. Social disparities in health literacy in the United States. HLRP: Health Literacy Research and Practice. 2019;3(1):e47-e52.
https://doi.org/10.3928/24748307-20190131-01
PMid:31294307 PMCid:PMC6608915  
 
47. Farrer L, Leach L, Griffiths KM, Christensen H, Jorm AF. Age differences in mental health literacy. BMC Public Health. 2008;8(1):1-8.
https://doi.org/10.1186/1471-2458-8-125
PMid:18423049 PMCid:PMC2358892  
 
48. Dupre ME, George LK. Exceptions to the rule: Exceptional health among the disadvantaged. Research on Aging. 2011;33(2):115-44.
https://doi.org/10.1177/0164027510391988  
 
49. Smith JA, Braunack‐Mayer AJ, Wittert GA, Warin MJ. Qualities men value when communicating with general practitioners: implications for primary care settings. Medical Journal of Australia. 2008;189(11-12):618-21.
https://doi.org/10.5694/j.1326-5377.2008.tb02214.x
PMid:19061448  
 
50. Crimmins EM, Shim H, Zhang YS, Kim JK. Differences between men and women in mortality and the health dimensions of the morbidity process. Clinical chemistry. 2019;65(1):135-45.
https://doi.org/10.1373/clinchem.2018.288332
PMid:30478135 PMCid:PMC6345642  
 
51. Milner A, Shields M, King T. The influence of masculine norms and mental health on health literacy among men: Evidence from the ten to men study. American journal of men's health. 2019;13(5):1557988319873532.
https://doi.org/10.1177/1557988319873532
PMid:31690213 PMCid:PMC6728685  
 
52. Silva T. Masculinity Attitudes Across Rural, Suburban, and Urban Areas in the United States. Men and Masculinities. 2021:1097184X211017186.
https://doi.org/10.1177/1097184X211017186  
 
53. Gordon DM, Hawes SW, Reid AE, Callands TA, Magriples U, Divney A, et al. The many faces of manhood: Examining masculine norms and health behaviors of young fathers across race. American journal of men's health. 2013;7(5):394-401.
https://doi.org/10.1177/1557988313476540
PMid:23403774 PMCid:PMC3731397  
 
54. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: an updated systematic review. Evidence report/technology assessment. 2011 (199):1-941.  
 
55. Ishikawa H, Kiuchi T. Association of health literacy levels between family members. Frontiers in public health. 2019;7:169.
https://doi.org/10.3389/fpubh.2019.00169
PMid:31275918 PMCid:PMC6593243  
 
56. Peabody JW, Taguiwalo MM, Robalino DA, Frenk J. Improving the quality of care in developing countries. Disease Control Priorities in Developing Countries 2nd edition. 2006.  
 
57. Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC public health. 2013;13(1):1-17.
https://doi.org/10.1186/1471-2458-13-658
PMid:23855504 PMCid:PMC3718659  
 
58. Iwasa H, Yoshida Y. Personality and health literacy among community‐dwelling older adults living in Japan. Psychogeriatrics. 2020;20(6):824-32.
https://doi.org/10.1111/psyg.12600
PMid:32812314  

Files

Share

How to cite

Statistics