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      Relationship between Health Literacy, Health-Related Behaviors and Health Status: A Survey of Elderly Chinese


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          Background: Despite the large volume of research dedicated to health-related behavior change, chronic disease costs continue to rise, thus creating a major public health burden. Health literacy, the ability to seek, understand, and utilize health information, has been identified as an important factor in the course of chronic conditions. Little research has been conducted on the relationship between health literacy and health-related behaviors and health status in elderly Chinese. The aim of this study was to elucidate the relationship between health literacy and health-related behaviors and health status in China. Methods: The subjects enrolled in this study were selected based on a stratified cluster random sampling design. Information involving >4500 older adults in 44 pension institutions in Urumqi, Changji, Karamay, and Shihezi of Xinjiang between September 2011 and June 2012 was collected. The Chinese Citizen Health Literacy Questionnaire (China Health Education Centre, 2008) and a Scale of the General Status were administered and the information was obtained through face-to-face inquiries by investigators. A total of 1452 respondents met the inclusion criteria. A total of 1452 questionnaires were issued and the valid response rate was 96.14% (1396 of 1452). Factors affecting health literacy and the relationship to health literacy were identified by one-way ANOVA and a multiple linear regression model. Results: The average health literacy level of the elderly in nursing homes was relatively low (71.74 ± 28.35 points). There were significant differences in the health literacy score among the factors of age, gender, race, education level, household income, marital conditions, and former occupation ( p < 0.001). The health literacy score was significantly associated with smoking, drinking, physical exercise, and health examination ( p < 0.001). The elderly with higher health literacy scores were significantly less likely to have risky behaviors (smoking, regular drinking, and lack of physical exercise), and in turn significantly more likely to undergo health examinations regularly, report good self-rated health, and significantly more likely to access sufficient health information from multiple sources ( p < 0.001). No differences were noted between the health literacy score and BMI ( p > 0.05). Multiple linear regression analysis showed that the independent influencing factors of health literacy included education level, race, former occupation, household income, age, physical exercise, health examination, smoking, and health information access ( p < 0.001). Conclusions: Health literacy was significantly associated with health-related behaviors in elderly Chinese. Further longitudinal studies are needed to help confirm that improving health literacy in the elderly may be effective in changing health-related behaviors. To reduce risky habits, educational interventions to improve health literacy should be simultaneously conducted in health promotion work.

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          Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California.

          This study estimated health status by low health literacy and limited English proficiency alone and in combination for Latino, Chinese, Korean, Vietnamese, and White respondents in a population-based sample: 48,427 adults from the 2007 California Health Interview Survey, including 3,715 with limited English proficiency. Multivariate logistic models examined self-reported health by health literacy and English proficiency in the full sample and in racial/ethnic subgroups. Overall, 44.9% with limited English proficiency reported low health literacy, versus 13.8% of English speakers. Among the limited English proficient, Chinese respondents had the highest prevalence of low health literacy (68.3%), followed by Latinos (45.3%), Koreans (35.6%), Vietnamese (29.7%), and Whites (18.8%). In the full sample, respondents with both limited English proficiency/low health literacy reported the highest prevalence of poor health (45.1%), followed by limited English proficiency-only (41.1%), low health literacy-only (22.2%), and neither (13.8%), a hierarchy that remained significant in multivariate models. However, subanalyses revealed that limited English proficient Latinos, Vietnamese, and Whites had equal or greater odds of poor health compared with low health literate/limited English proficient respondents. Individuals with both limited English proficiency and low health literacy are at high risk for poor health. Limited English proficiency may carry greater health risk than low health literacy, though important racial/ethnic variations exist.
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            When do older adults turn to the internet for health information? Findings from the Wisconsin Longitudinal Study.

            Understanding how and when patients use nonphysician sources of health information is important to facilitate shared decision making within provider outpatient visits. However, little is known about which older adults seek health information on the internet or when. To determine how patient characteristics are related to seeking health information online and to the timing of these searches in relation to doctor visits. Six thousand two hundred and seventy-nine respondents (aged 63 to 66 years) who completed the 2004 round of phone and mail surveys (70% response) as part of the Wisconsin Longitudinal Study Graduate Sample. Self-reported use of the internet to search for health information and timing of use. One-third of respondents had searched online for information about their own health or health care. Half of these searched for health information unrelated to their last doctor visit, while 1/3 searched after a visit, and 1/6 searched before. Among respondents with internet access at home or work, years of education (odds ratio [OR]=1.09, confidence interval [CI]=1.06 to 1.13) and openness-to-experience (OR=1.26, CI=1.16 to 1.36) were positively associated with searching online for health information irrespective of timing in relation to doctor visits. Compared with those who had never sought health information online, sicker individuals (especially those with cancer, OR=1.51, CI=1.14 to 1.99) were more likely to seek information online after a doctor visit. Attitudinal and personality factors were related to seeking health information online before or unrelated to a visit. There are important differences in the timing of online health information searches by psychological and health characteristics among older adults with internet access.
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              The Internet as a health information source: findings from the 2007 Health Information National Trends Survey and implications for health communication.

              A wealth of health information is available online, but we do not fully understand the implications for health communication. This study examined whether health information seekers who turn to the Internet first differ from those who turn elsewhere. Data from the 2,338 respondents to the mail portion of the National Cancer Institute's Health Information National Trends Survey (HINTS) 2007 who reported looking for health information for themselves were analyzed. Logistic regression was used to examine whether health information seekers turning to the Internet first differed in terms of demographics, information preferences and seeking confidence, and communication with providers from those using other sources. In the final model, Internet users were younger, more educated, higher income, preferred numbers rather than words to describe chance, and think it is very important to get personal medical information electronically. There were no differences in terms of gender, health status, confidence seeking health information, or communication with providers. Health information seekers who turn to the Internet first are different, both in terms of demographics and information preferences. As the use of communication technologies increases, health communicators need to be attentive to the potential for communication inequalities.

                Author and article information

                Role: Academic Editor
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                International Journal of Environmental Research and Public Health
                18 August 2015
                August 2015
                : 12
                : 8
                : 9714-9725
                [1 ]Nursing Department of Medical College, Yangzhou University, Yangzhou 225002, China
                [2 ]Clinical Nursing Department of Nursing College, Xinjiang Medical University; Urumqi 830000, China; E-Mails: 15739078976@ 123456163.com (L.L.); lyf900105@ 123456126.com (Y.-F.L.); gl08290528@ 123456126.com (Y.-L.C.)
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: lyb19950806@ 123456126.com ; Tel.: +86-0514-87978873; Fax: +86-0514-87341733.
                © 2015 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).


                Public health

                health literacy, health-related behaviors, health status, nursing homes, relationship


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