Health literacy and health outcomes in China’s floating population: mediating effects of health service

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Abstract

Background

The floating population in China consists primarily of internal immigrants and represents a typical health vulnerable group. Poor health literacy has recently become an obstacle in the accessibility and utilization of health services for the vulnerable population, leading to adverse health outcomes. This study aimed to examine whether health literacy affected health outcomes in China’s floating population and whether health service utilization had a mediating effect between health literacy and health outcomes.

Method

The current study utilized a cross-sectional stratified, multistage, proportional to scale (PPS) study in Zhejiang Province, China, in November and December 2019. In total, 657 valid self-reported questionnaires were recovered and used for data collection. Questionnaires included questions regarding sociodemographic characteristics, health literacy, health outcomes, and health service utilization. Confirmatory factor analysis was used to test questionnaire validity; descriptive statistics were used to understand the demographic characteristics of the floating population; and structural equation modeling was used to determine whether health service utilization mediated health literacy and health outcomes.

Results

We report positive correlations between health literacy, health service utilization, and health outcomes. Mediation analysis demonstrated that health service utilization had partial mediating effects between health literacy and health outcomes. In the relationship between health literacy and health outcomes, the indirect effects of health service utilization accounted for 6.6–8.7% of the total effects.

Conclusion

Complete health literacy, through health care literacy and health promotion literacy, affects the mobile population’s initiative to use health services, which, in turn, affects health outcomes. Thus, improving the health literacy of the floating population will help to improve health outcomes. Furthermore, health service providers should enhance the diversity of health service supply to ensure that the floating population has the external resources to improve personal health literacy.

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The impact of patient and public involvement on UK NHS health care: a systematic review.

Carole Mockford, Frances Griffiths, Sophie Staniszewska … (2012)

Patient and public involvement (PPI) has become an integral part of health care with its emphasis on including and empowering individuals and communities in the shaping of health and social care services. The aims of this study were to identify the impact of PPI on UK National Health Service (NHS) healthcare services and to identify the economic cost. It also examined how PPI is being defined, theorized and conceptualized, and how the impact of PPI is captured or measured. Seventeen key online databases and websites were searched, e.g. Medline and the King's Fund. UK studies from 1997 to 2009 which included service user involvement in NHS healthcare services. Date extraction Key themes were identified and a narrative analysis was undertaken. The review indicates that PPI has a range of impacts on healthcare services. There is little evidence of any economic analysis of the costs involved. A key limitation of the PPI evidence base is the poor quality of reporting impact. Few studies define PPI, there is little theoretical underpinning or conceptualization reported, there is an absence of robust measurement of impact and descriptive evidence lacked detail. There is a need for significant development of the PPI evidence base particularly around guidance for the reporting of user activity and impact. The evidence base needs to be significantly strengthened to ensure the full impact of involving service users in NHS healthcare services is fully understood.

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Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries

Tuyen Duong, Altyn ARINGAZINA, Gaukhar Baisunova … (2016)

Background Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries. Methods A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013–2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis. Results The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from <0.001 to 0.011) and perceived social status (P from <0.001 to 0.016), with evidence of known-group validity. Conclusions The HLS-EU-Q47 was a satisfactory and comprehensive health literacy survey tool for use in Asia.

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Low literacy impairs comprehension of prescription drug warning labels.

Ramon Durazo-Arvizu, P F Bass, Michael Wolf … (2006)

Adverse events resulting from medication error are a serious concern. Patients' literacy and their ability to understand medication information are increasingly seen as a safety issue. To examine whether adult patients receiving primary care services at a public hospital clinic were able to correctly interpret commonly used prescription medication warning labels. In-person structured interviews with literacy assessment. Public hospital, primary care clinic. A total of 251 adult patients waiting for an appointment at the Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) Primary Care Clinic. Correct interpretation, as determined by expert panel review of patients' verbatim responses, for each of 8 commonly used prescription medication warning labels. Approximately one-third of patients (n=74) were reading at or below the 6th-grade level (low literacy). Patient comprehension of warning labels was associated with one's literacy level. Multistep instructions proved difficult for patients across all literacy levels. After controlling for relevant potential confounding variables, patients with low literacy were 3.4 times less likely to interpret prescription medication warning labels correctly (95% confidence interval: 2.3 to 4.9). Patients with low literacy had difficulty understanding prescription medication warning labels. Patients of all literacy levels had better understanding of warning labels that contained single-step versus multiple-step instructions. Warning labels should be developed with consumer participation, especially with lower literate populations, to ensure comprehension of short, concise messages created with familiar words and recognizable icons.

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Author and article information

Contributors

Hai-YanYu: yuhaiyanfei@163.com

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 8 April 2021

Publication date PMC-release: 8 April 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 691

Affiliations

[1 ]GRID grid.268099.c, ISNI 0000 0001 0348 3990, 7B304, School of Public Health Management, , Wenzhou Medical University, ; Chashan Town, Ouhai District, Wenzhou City, China

[2 ]Shaoxing College of Arts and Sciences, 508 Huancheng West Road, Shaoxing, China

Article

Publisher ID: 10662

DOI: 10.1186/s12889-021-10662-7

PMC ID: 8030651

PubMed ID: 33832480

SO-VID: 3d0afabc-9e3f-4dc9-802c-3a3180052ade

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 4 June 2020

Date accepted : 21 March 2021

Funding

Funded by: National Social Science Fund of China

Award ID: (no.17BZZ054).

Custom metadata

ScienceOpen disciplines: Public health

Keywords: floating population,health literacy,health outcomes,health services

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ScienceOpen disciplines: Public health

Keywords: floating population, health literacy, health outcomes, health services

Health literacy and health outcomes in China’s floating population: mediating effects of health service

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Most cited references 45

The impact of patient and public involvement on UK NHS health care: a systematic review.

Measuring health literacy in Asia: Validation of the HLS-EU-Q47 survey tool in six Asian countries

Low literacy impairs comprehension of prescription drug warning labels.

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