BACKGROUND: Health literacy is a public health goal which can be used as an independent factor of health outcomes. This study aimed to assess the association between health literacy and health status, as well as the two mediating factors of behavior and self-efficacy among residents aged 15-69 years in Qingdao. METHODS: A cross-sectional survey was implemented among residents aged 15-69 years (N = 3793) in Qingdao, China. A combination of stratified cluster random and proportional probability sampling methods was used to select subjects for this study. Data were collected using "The Chinese Citizen Health Literacy Questionnaire (2019)". We proposed a hypothetical model for the relationship between sociodemographic characteristics, health literacy, self-efficacy, health behavior, and health status, and used path analysis to validate the hypothesis. RESULTS: The path analysis showed that higher education (β = 0.293) and income (β = 0.135) are positively and directly associated with greater health literacy, which was positively associated with health status (β = 0.057). Health literacy is a direct influencing factor of health behavior (β = 0.070) and self-efficacy (β = 0.099). Health behavior (β = 0.041) and self-efficacy (β = 0.173) exerted a positive direct effect on health status. The model explained 14.1% of variance for health literacy, 3.8% for self-efficacy, 5.7% for health behavior, and 15.0% for health status. CONCLUSIONS Health literacy was identified to be a critical factor in health status. The results emphasized that the dissemination of health knowledge, development of healthy behavior, and cultivation of self-efficacy should be jointly promoted to reinforce the level of health status among residents in future work.
Adolescent ; Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; Health Behavior ; Health Knowledge, Attitudes, Practice ; Health Literacy/statistics & numerical data* ; Health Status ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran. METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages. RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (β^=0.02), illiteracy (β^=0.04), household density per residential unit (β^=1.29), distance between the center of the county and the provincial capital (β^=0.03), and urbanization (β^=0.81). The following other risk factors for TB mortality were identified: diabetes (β^=0.02), human immunodeficiency virus infection (β^=0.04), infection with TB in the most recent 2 years (β^=0.07), injection drug use (β^=0.07), long-term corticosteroid use (β^=0.09), malignant diseases (β^=0.09), chronic kidney disease (β^=0.32), gastrectomy (β^=0.50), chronic malnutrition (β^=0.38), and a body mass index more than 10% under the ideal weight (β^=0.01). However, silicosis had no effect. CONCLUSIONS: The results of this study provide useful information on risk factors for mortality from TB.
Body Mass Index ; Cross-Sectional Studies ; Education, Medical ; Family Characteristics ; Gastrectomy ; HIV ; Humans ; Iran ; Literacy ; Malnutrition ; Models, Statistical ; Mortality ; Public Health ; Renal Insufficiency, Chronic ; Risk Factors ; Silicosis ; Statistics as Topic ; Tuberculosis ; Unemployment ; Urbanization

OBJECTIVES: Tuberculosis (TB) is a global public health problem that causes morbidity and mortality in millions of people per year. The purpose of this study was to examine the relationship of potential risk factors with TB mortality in Iran.METHODS: This cross-sectional study was performed on 9,151 patients with TB from March 2017 to March 2018 in Iran. Data were gathered from all 429 counties of Iran by the Ministry of Health and Medical Education and Statistical Center of Iran. In this study, a generalized estimating equation-based zero-inflated negative binomial model was used to determine the effect of related factors on TB mortality at the community level. For data analysis, R version 3.4.2 was used with the relevant packages.RESULTS: The risk of mortality from TB was found to increase with the unemployment rate (β^=0.02), illiteracy (β^=0.04), household density per residential unit (β^=1.29), distance between the center of the county and the provincial capital (β^=0.03), and urbanization (β^=0.81). The following other risk factors for TB mortality were identified: diabetes (β^=0.02), human immunodeficiency virus infection (β^=0.04), infection with TB in the most recent 2 years (β^=0.07), injection drug use (β^=0.07), long-term corticosteroid use (β^=0.09), malignant diseases (β^=0.09), chronic kidney disease (β^=0.32), gastrectomy (β^=0.50), chronic malnutrition (β^=0.38), and a body mass index more than 10% under the ideal weight (β^=0.01). However, silicosis had no effect.CONCLUSIONS: The results of this study provide useful information on risk factors for mortality from TB.
Body Mass Index ; Cross-Sectional Studies ; Education, Medical ; Family Characteristics ; Gastrectomy ; HIV ; Humans ; Iran ; Literacy ; Malnutrition ; Models, Statistical ; Mortality ; Public Health ; Renal Insufficiency, Chronic ; Risk Factors ; Silicosis ; Statistics as Topic ; Tuberculosis ; Unemployment ; Urbanization

BACKGROUND: This study aimed to examine (1) the patterns of online health information search with respect to seeking and scanning, and (2) how online search, along with eHealth literacy, predicts perceived information usefulness in the context of diet and weight control. METHODS: Online survey was conducted with 299 adults from the consumer panel recruited for the purpose of quality assessment of the Korean National Health Information Portal in 2016. We conducted paired sample t-test and multiple logistic regression to address the research questions. Data analysis was performed using IBM SPSS Statistics ver. 24.0 (IBM Corp., Armonk, NY, USA) and SAS ver. 9.3 (SAS Institute Inc., Cary, NC, USA). RESULTS: Of the respondents, 38.8% were ‘high seek-high scanners,’ 35.8% were ‘low seek-low scanners,’ 13.0% were ‘high seek-low scanners,’ and 12.4% were ‘low seek-high scanners.’ eHealth literacy was a significant, positive predictor of online information scanning (odds ratio [OR], 2.46; 95% confidence interval [CI], 1.41–4.29), but not for online information seeking (OR, 1.75; 95% CI, 1.00–3.05). With respect to perceived usefulness of online information seeking, online seeking (OR, 4.90; 95% CI, 2.19–11.00) and eHealth literacy (OR, 2.30; 95% CI, 1.11–4.75) were significant predictors. Perceived usefulness of online scanning had a significant association with online scanning (OR, 2.38; 95% CI, 1.08–5.22), but not with eHealth literacy. CONCLUSION: To increase the effectiveness of the health policy for online information search and related outcomes in the context of diet and weight control, it is important to develop education programs promoting eHealth literacy.
Adult ; Diet ; Education ; Health Policy ; Humans ; Information Seeking Behavior ; Literacy ; Logistic Models ; Statistics as Topic ; Surveys and Questionnaires ; Telemedicine ; Weight Loss

PURPOSE: The aim of this study was to evaluate a ‘patient empowerment program for schizophrenia (PEPS)’ to improve problem solving ability, quality of life, and mental health literacy for hospitalized patients with schizophrenia. METHODS: The study was a non-equivalent control group non-synchronized design. Study participants were recruited from a psychiatric hospital in Republic of Korea. Of 56 participants, 20 were assigned to the experimental group and 36 to the control group. Data were collected from September, 2017 to January, 2018. Data analyses included chi-squared or Fisher's exact tests, t-tests, and repeated measure ANOVA with SPSS/WIN 21.0 program. RESULTS: After participating PEPS, the experimental group showed a significant increase in quality of life and mental health literacy compared to the control group. However, there were no significant differences in problem solving ability between the two groups. CONCLUSION: Findings show that patients with schizophrenia receive benefits from PEPS in terms of quality of life and mental health literacy. However, further research is necessary to develop clinical strategies to improve their problem solving abilities.
Health Literacy ; Hospitals, Psychiatric ; Humans ; Literacy ; Mental Health ; Power (Psychology) ; Problem Solving ; Psychotherapy ; Quality of Life ; Republic of Korea ; Schizophrenia ; Statistics as Topic

OBJECTIVES: Low birth weight (LBW) is a major public health concern, especially in developing countries, and is frequently related to child morbidity and mortality. This study aimed to identify key determinants that influence the prevalence of LBW in selected developing countries. METHODS: Secondary data analysis was conducted using 10 recent Demography and Health Surveys from developing countries based on the availability of the required information for the years 2010 to 2013. Associations of demographic, socioeconomic, community-based, and individual factors of the mother with LBW in infants were evaluated using multivariate logistic regression analysis. RESULTS: The overall prevalence of LBW in the study countries was 15.9% (range, 9.0 to 35.1%). The following factors were shown to have a significant association with the risk of having an LBW infant in developing countries: maternal age of 35 to 49 years (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.2 to 3.1; p<0.01), inadequate antenatal care (ANC) (aOR, 1.7; 95% CI, 1.1 to 2.8; p<0.01), illiteracy (aOR, 1.5; 95% CI, 1.1 to 2.7; p<0.001), delayed conception (aOR, 1.8; 95% CI, 1.4 to 2.5; p<0.001), low body mass index (aOR, 1.6; 95% CI, 1.2 to 2.1; p<0.001) and being in the poorest socioeconomic stratum (aOR, 1.4; 95% CI, 1.1 to 1.8; p<0.001). CONCLUSIONS: This study demonstrated that delayed conception, advanced maternal age, and inadequate ANC visits had independent effects on the prevalence of LBW. Strategies should be implemented based on these findings with the goal of developing policy options for improving the overall maternal health status in developing countries.
Body Mass Index ; Child ; Demography ; Developing Countries* ; Fertilization ; Global Health ; Health Surveys ; Humans ; Infant ; Infant, Low Birth Weight* ; Infant, Newborn ; Literacy ; Logistic Models ; Maternal Age ; Maternal Health ; Mortality ; Mothers ; Odds Ratio ; Prevalence ; Public Health ; Statistics as Topic

PURPOSE: Following legal reform in 2013, the annual number of asylum seekers entering South Korea has increased from 1,143 in 2012 to 5,711 in 2015. We interviewed six African refugee mothers of young children regarding their health needs and barriers to access maternal child health services. METHODS: We recruited mothers who had visited a clinic for immigrants between July 2013 and August 2015. Participants were African refugee women, aged over 18 years, who had given birth in Korea within the previous 5 years and had come to Korea over a year before recruitment. Interview questions examined participants' experiences in pregnancy and childbirth and concerns regarding their child's health status. Initial data analysis involved all researchers' immersion in the entire collection of transcripts. We then noted recurrent topics and themes and identified similar issues. RESULTS: At the time of giving birth, 5 participants were asylum seekers and one had undocumented status. The following barriers impeded their access to maternal child healthcare: socioeconomic factors (unstable social identity, low economic status, difficulty obtaining health insurance), language barriers (lack of linguistically appropriate health information, limited access to translation services), and cultural barriers (religious and cultural differences). Weak social support also hindered access to healthcare soon after migration; however, social links with the community emerged as a key coping strategy following settlement. CONCLUSION: We identified barriers to maternal and child healthcare and coping strategies among African refugee mothers in Korea. Future research should assess refugees' health status and improve health access and literacy among refugee mothers.
Child ; Communication Barriers ; Delivery of Health Care* ; Emigrants and Immigrants ; Female ; Health Services Accessibility ; Humans ; Immersion ; Infant ; Korea* ; Literacy ; Maternal-Child Health Services ; Mothers* ; Parturition ; Pregnancy ; Refugees* ; Social Identification ; Socioeconomic Factors ; Statistics as Topic

To translate and revise the Medication Literacy Assessment in English (MedLitRxSE-English) and evaluate its validity and reliability.
 Methods: We introduced MedLitRxSE-English from abroad. According to the principles of Brislin and culture adjustment, we revised it as a Chinese edition. Using random sampling method, from Oct, 2014 to Jan, 2015, 461 non-hospitalized patients from the outpatient departments of the top three hospitals in Changsha city were investigated. The reliability and validity of the scale was tested.
 Results: The test-retest reliability of the Chinese version for medication literacy scale was 0.885; the split reliability was 0.840; K-R was 0.820; the correlations between the assessment of medication literacy and the corresponding items were 0.427-0.587; the confirmatory factor analysis revealed overall good fit. Root mean square error of approximation (RMSEA), χ2/df, goodness of fit index (GFI) and comparative fit index (CFI) was 0.08, 3.06, 0.91 and 0.94, respectively. 
 Conclusion: The Chinese version for the assessment of medication literacy is in good reliability and validity, and it can be used to evaluate the medication literacy in our country.
China ; Factor Analysis, Statistical ; Health Literacy ; statistics & numerical data ; Humans ; Language ; Reproducibility of Results ; Surveys and Questionnaires ; standards ; Translating

PURPOSE: The aim of this study is to clarify the level of health literacy, health risk perception and health behavior of Korean elders and to determine the impact of their health literacy and health risk perception on their health behavior. METHODS: A descriptive correlation study was conducted with 188 elders aged 65 or older in senior welfare centers in Busan. Questionnaires were used to measure levels of health literacy, health risk perception, and health behavior. Descriptive statistics, t-test, ANOVA, Kruskal Wallis test, Pearson's correlation, and hierarchical regression were performed. RESULTS: 43.6% of the subjects had low levels of health literacy. There was a negative relation between health literacy and health risk perception, and between health risk perception and health behavior. There was a positive relation between health literacy and health behavior. Health concern, health literacy affected health behavior. Health literacy independently accounted for 24% of health behavior. Health risk perception didn't affect health behavior. CONCLUSION: Many of the Korean elders had low levels of health literacy and health literacy was independently associated with health behavior. These findings show that interventions for improving health literacy are necessary to enhance health behavior of the elderly.
Aged ; Busan ; Health Behavior* ; Health Literacy* ; Health Status ; Humans ; Statistics as Topic ; Surveys and Questionnaires

OBJECTIVETo understand status of health literacy among diabetics and their health management behaviors, and analyze the relationship of health literacy and health management.

METHODSA two-staged cluster randomized sampling method was used to investigate 1 130 diabetics in Beijing, Ningbo and Xiamen from October to November in 2012. All participants should be diagnosed by primary hospital and above and have lived in the community over six months. Diabetic patients who indicated that they had severely impaired vision or cognitive disorder, or had severe physical deterioration, or did not live in the address provided were excluded. A total of 1 130 questionnaires were sent out and 1 083 eligible questionnaires were taken back, accounting for 96.87%. Multivariate logistic regression was adopted to analyze the association between health literacy and health management behaviors and blood glucose level.

RESULTSAmong those participants, 47.7% (517) were men, 52.3% (566) were women, the age was (67.0 ± 9.5). According to diabetes health literacy scores, 73.7% (798/1 083) of them were classified as poor health literacy and 26.1% (283/1 083) as essential health literacy. Health literacy was associated with health management behaviors independently, demonstrating that the probability of utilizing health education, free physical examination, lifestyle guidance, monitoring blood glucose on their own, measuring blood glucose more than once a week and taking hypoglycemic agent regularly among diabetics with essential health literacy were 1.40 (95%CI:1.03-1.91), 1.65 (95%CI: 1.19-2.28), 2.70 (95%CI:1.98-3.69), 2.05 (95%CI:1.34-3.15), 2.56 (95%CI:1.85-3.56) , 1.48 (95%CI:1.07-2.06) times of those in diabetics with poor health literacy (P < 0.05).

CONCLUSIONHealth literacy may affect health management behaviors among diabetics. More activities targeted on diabetics with low health literacy were suggested to improve their' health literacy and their skills about diabetes mellitus management.

Aged ; Blood Glucose Self-Monitoring ; statistics & numerical data ; Diabetes Mellitus ; therapy ; Female ; Health Behavior ; Health Literacy ; statistics & numerical data ; Humans ; Logistic Models ; Male ; Medication Adherence ; statistics & numerical data ; Middle Aged ; Surveys and Questionnaires