@2024 Afarand., IRAN

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ISSN: 2383-2150    Journal of Education and Community Health 2018;5(1):42-48

Background
Health literacy is a set of skills that enables a person to read, hear, analyze, decide and apply these skills in health issues and is not merely achieved through the studying or reading for years [1].
Previous Studies
... [2-6]. As women's education is crucial in promoting the health of children and families, women are identified as the primary group for emphasizing increased health literacy [7]. ... [8]. According to some of the limited relevant studies health literacy levels is unacceptable. Banihashemi et al., in a survey study done in five cities and five villages in the provinces of Bushehr, Mazandaran, Kermanshah, Qazvin and Tehran, have evaluated 1,086 subjects aged 18 and over in their homes. Based on the results, 28.1% of the subjects had adequate health literacy, 15.3% had borderline health literacy and 56.6% had inadequate health literacy [9]. Tol et al. also conducted a study to assess the awareness and health literacy in women with type 2 diabetes and the relationship between health literacy and awareness. They reported that diabetic women who participated in the study had inadequate awareness and had borderline health literacy, which confirmed the need for education in order to improve awareness and health literacy [10]. .... [11]. The results of the study by Afshari et al. on adults in Tuyserkan showed inadequate health literacy in the subjects[12].
Aim(s)
The aim of the present study was to determine health literacy level among the women referring to the healthcare centers in Zanjan, Iran.
Research type
This research is a descriptive-analytical (cross-sectional) study.
Research society, place and time
This study was conducted on women referring to the healthcare centers of Zanjan in 2016
Sampling method and number
Based on previous studies [11] and using a formula, 323 subjects were selected. Samples were selected from 11 healthcare centers in Zanjan city by stratified random sampling. Accordingly, the number of families and the population covered by Zanjan healthcare centers was calculated and the number for each center was determined from the sample size of the study to assign the proportional samples. Subsequently, in each healthcare center, the samples were selected among women referring to healthcare services by simple random sampling. The inclusion criteria included reading and writing literacy, a health record for health care at the healthcare center, and the consent to participate in the study. Exclusion criteria also included underlying disorders and no consent to continue to cooperate with the research team.
Used devices&materials
The participation of all subjects in the study was voluntary and with informed consent was obtained, and all women were assured about the confidentiality of information and data would be analyzed in general. Data collection tools included a Persian version of Short Test of Functional Health Literacy in Adults (STOFHLA). STOFHLA is comprised of two sections: reading and evaluation. The former assesses the respondent's ability to read actual health-related texts. This section consists of three texts, including upper gastrointestinal imprinting instructions, the patient’s rights and responsibilities in the insurance policy forms, and a standard form of hospital consent, which are set as 50 questions followed by four alternatives. In the evaluation section, the cards containing an explanation of some of the medications, appointments, financial assistance and an example of the blood glucose test were given to the patient, and then the questions (17 questions) were asked and the response were recorded. The subjects were given 10 minutes for answering the reading section and 20 minutes for evaluation section then even the incomplete questionnaires were collected. Each questions in the reading section scored one (a total of 50 points). 17 questions in the evaluation section were also scored 50 by application of a coefficient (by multiplying the score of each question by 2.941) and the total score of the questionnaire considered 100. Based on the cut off points of 59 and 74, the health literacy of the subjects was classified into three inadequate (0-59), borderline (60-74) and adequate (above 75) levels. Demographic characteristics of the participants (academic levels and occupation) were also collected through interviews. Data was analyzed by SPSS 21 using descriptive statistics and Chi-square, one-way ANOVA and Pearson correlation tests.
Findings by Text
The mean age of participants was 30.0±5.4 years and most of the subjects (28.9%) were in the age group of 25-29 years. In addition, most of the subjects had university education (39%) and also most of them (87.3%) were housewives (Table 1). The frequency of health literacy levels is shown in Table 2. The average overall health literacy was 71.56±17.8 out of 100, and more than half of the participants in the study (55.1%) had adequate health literacy. There was a significant correlation between the age and the reading dimension of health literacy (r =-0.131, p<0.05). There was a positive and significant correlation between reading and evaluation dimensions of health literacy (r=0.373, p<0.01; Table 3). There was a significant relationship between the level of overall health literacy and reading and evaluation dimensions of health literacy, and the level of education and occupation variables (p<0.001; Table 4).
Main comparison to the similar studies
The results showed that about half of the subjects (55.1%) had adequate health literacy, which is consistent with the results of Ganbari et al. study, in which health literacy of 45.4% of the subjects was reported at the adequate level [11]. In this regard, in Tavousi et al. study, 56% of the participants had an adequate level of health literacy, which is consistent with the results of the present study [13]. ... [14]. However, in the study by Banihashemi & Amirkhani only 28.1% of the subjects had adequate health literacy, which is not consistent with the findings of the present study [9]. ... [15, 16]. In the present study, there was a reverse correlation between the age of women and reading dimension of health literacy; as by aging it was reduced. In this regard, Ganbari et al. have reported a significant relationship between age and health literacy [11]. Another finding of the present study showed that there was a significant relationship between educational level and health literacy. In other words, by an increase in the educational level of the studied women, their level of health literacy increased. In this regard, according to the Ganbari et al. study, studying showed the highest association with health literacy [11]. Khosravi et al. also emphasized on the relationship between the health literacy of patients referring to the hospitals in Bushehr city [17]. ... [18-22]. The findings of this study showed that there was a significant relationship between occupation and health literacy and the level of health literacy of employed people is higher than housewives; however this relationship has not been reported in Ganbari et al. study, which can be due to the less employed subjects [11]. This study also indicated that there was no meaningful relationship between health literacy and economic status. The results of Ganbari et al. research have shown a poor relationship between health literacy and income levels, which is consistent with this study [11].
Suggestions
Due to the low level of health literacy in Iran compared with developed countries, designing and implementing educational interventions to improve the health literacy of this crucial and influential population in society is strongly recommended.
Limitations
The findings of this study can not be generalized to all women, since only women who have been referred to the studied health centers were studied.
Conclusions
Women referring to the healthcare centers have borderline health literacy. As health literacy is an important factor in understanding health messages and recommendations of health care providers, it is essential for health staff to use effective methods to transfer data for these individuals. People need to be able to understand and use the information they are given in healthcare centers to make appropriate decisions for health issues.
Acknowledgments
The authors are grateful to the authorities and professors of the School of Health, all the women who collaborated in this study as well as the staff of the healthcare centers in Zanjan.
Conflict of interest
None declared.
Ethical Permissions
This study was approved by the Ethics Committee of the Shahid Beheshti University of Medical Sciences (Ethics code: IR.SBMU.PHNS.1395.136).
Funding Sources
This article is extracted from Master of public health thesis of the Shahid Beheshti University of Medical Sciences.

TABLES and CHARTS

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