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      Health literacy is associated with health behaviour and self-reported health: A large population-based study in individuals with cardiovascular disease

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          Abstract

          Background

          Health literacy may constitute a modifiable determinant of health behaviour and affect cardiovascular disease prevention. This study investigates the associations between health literacy and health behaviour as well as health status.

          Design

          A cross-sectional study on a population-based sample of people with acute myocardial infarction, angina pectoris or stroke ( N = 3116).

          Methods

          Health literacy was assessed using two dimensions from the Health Literacy Questionnaire: ‘understanding health information’ and ‘engaging with healthcare providers’. Health behaviour included physical activity, dietary habits, smoking, alcohol consumption and body mass index. Health status was examined using Short Form Health Survey 12 version 2 (four-week recall) (physical and mental components). We used regression analyses to examine the associations.

          Results

          ‘Understanding health information’ was inversely associated with physical inactivity (odds ratio (OR) 0.48 (0.39;0.59), unhealthy diet (OR 0.64 (0.47;0.88)), underweight (OR 0.43 (0.21;0.89)) and obesity (OR 0.79 (0.63;0.99)). ‘Engaging with healthcare providers’ was inversely associated with physical inactivity (OR 0.64 (0.53;0.77)), less than healthy diet (OR 0.79 (0.64;0.96)) and daily smoking (OR 0.81 (0.66;1.0)). An increase in ‘understanding health information’ as well as ‘engaging with healthcare providers’ was associated with an increase in both physical and mental health status.

          Conclusions

          The findings suggest that aspects of health literacy are associated with health status and health behaviour in cardiovascular patients and should be considered in interventions regarding cardiovascular disease prevention.

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          Most cited references48

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          Health literacy and public health: A systematic review and integration of definitions and models

          Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.
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            Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

            D Nutbeam (2000)
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              The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ)

              Background Health literacy has become an increasingly important concept in public health. We sought to develop a comprehensive measure of health literacy capable of diagnosing health literacy needs across individuals and organisations by utilizing perspectives from the general population, patients, practitioners and policymakers. Methods Using a validity-driven approach we undertook grounded consultations (workshops and interviews) to identify broad conceptually distinct domains. Questionnaire items were developed directly from the consultation data following a strict process aiming to capture the full range of experiences of people currently engaged in healthcare through to people in the general population. Psychometric analyses included confirmatory factor analysis (CFA) and item response theory. Cognitive interviews were used to ensure questions were understood as intended. Items were initially tested in a calibration sample from community health, home care and hospital settings (N=634) and then in a replication sample (N=405) comprising recent emergency department attendees. Results Initially 91 items were generated across 6 scales with agree/disagree response options and 5 scales with difficulty in undertaking tasks response options. Cognitive testing revealed that most items were well understood and only some minor re-wording was required. Psychometric testing of the calibration sample identified 34 poorly performing or conceptually redundant items and they were removed resulting in 10 scales. These were then tested in a replication sample and refined to yield 9 final scales comprising 44 items. A 9-factor CFA model was fitted to these items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ 2 WLSMV(866 d.f.) = 2927, p<0.000, CFI = 0.936, TLI = 0.930, RMSEA = 0.076, and WRMR = 1.698. Final scales included: Feeling understood and supported by healthcare providers; Having sufficient information to manage my health; Actively managing my health; Social support for health; Appraisal of health information; Ability to actively engage with healthcare providers; Navigating the healthcare system; Ability to find good health information; and Understand health information well enough to know what to do. Conclusions The HLQ covers 9 conceptually distinct areas of health literacy to assess the needs and challenges of a wide range of people and organisations. Given the validity-driven approach, the HLQ is likely to be useful in surveys, intervention evaluation, and studies of the needs and capabilities of individuals.
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                Author and article information

                Journal
                Eur J Prev Cardiol
                Eur J Prev Cardiol
                CPR
                spcpr
                European Journal of Preventive Cardiology
                SAGE Publications (Sage UK: London, England )
                2047-4873
                2047-4881
                31 August 2017
                November 2017
                : 24
                : 17
                : 1880-1888
                Affiliations
                [1 ]Section for Health Promotion and Health Services, Department of Public Health, Aarhus University, Denmark
                [2 ]DEFACTUM, Central Denmark Region, Denmark
                [3 ]Section for General Practice, Department of Public Health, Aarhus University, Denmark
                [4 ]Institute for Health and Society, Newcastle University, UK
                [5 ]Steno Diabetes Centre Copenhagen, Health Promotion Research, Denmark
                Author notes
                [*]Anna Aaby, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark. Email: aaby@ 123456ph.au.dk
                Article
                10.1177_2047487317729538
                10.1177/2047487317729538
                5680908
                28854822
                faf36732-a749-4586-bdf9-c7c7893d1893
                © The European Society of Cardiology 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 1 June 2017
                : 12 August 2017
                Categories
                Prevention
                Full Research Paper

                health literacy,cardiovascular disease,health behaviour,health status,health survey

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