key: cord-0326187-cb67u3d0 authors: Azlan, A.; Hamzah, M. R.; Tham, J. S.; Ayub, S. H.; Ahmad, A. L.; Mohamad, E. M. title: Associations between health literacy and sociodemographic factors: A cross-sectional study in Malaysia utilising the HLS-M-Q18 date: 2021-02-23 journal: nan DOI: 10.1101/2021.02.19.21252088 sha: e74afe9fd33f10b5cfdb99d6f6c9ff991a7f4a6e doc_id: 326187 cord_uid: cb67u3d0 Health literacy is progressively seen as an indicator to describe a nation's health status. To improve health literacy, countries need to address health inequalities by examining different social demographic factors across the population. This assessment is crucial to identify and evaluate strengths and limitations of a country in addressing health issues. By addressing these health inequalities, a country would be better informed to take necessary steps to improve the nation's health literacy. This study examines health literacy levels in Malaysia and analyses socio-demographic factors that are associated with health literacy. A cross-sectional survey was carried out using the HLS-M-Q18 instrument which was validated for the Malaysian population. Multi-stage random sampling strategy was used in this study utilising several sampling techniques including quota sampling, cluster sampling and simple random sampling to allow random data collection. A total of 855 respondents were sampled. Results found significant associations between health literacy and age, health status and health problems. Findings also suggest that lower health literacy levels were found to be associated with the younger generation. The findings of this study have provided baseline data of the health literacy of Malaysians and provide evidence toward potential areas of intervention. Worldwide interest in studying health literacy is increasing as health promoters and 52 practitioners recognise its significance in reducing illness [1] and improving quality of life 53 [2]. The benefits of health literacy extend beyond individual health care to include effective 54 disease prevention in society, as well as improving health promotion in general. Health 55 literacy is a concept that extends beyond health education. It addresses social and 56 environmental factors that influences individual ability to engage with health information to 57 make informed decisions and to utilise health services to benefit them and their surroundings. The objectives of this study are to (1) measure society's health literacy and (2) observe socio-88 demographic factors that are associated with health literacy in Malaysia. In order to improve 89 health inequalities in the community, an assessment of individual health literacy is crucial to 90 identify and evaluate the strengths and limitations in addressing health issues in a diverse 91 society [13] . In order for health care providers and policy makers to respond efficiently, they 92 need to understand the diverse factors that affect health literacy before facilitating access to 93 health information, providing services and devising health intervention that does not 94 discriminate against health literacy limitations [14] . 95 96 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) 18-1320/41882). All respondents were above 18 years old and therefore involved no minors. 110 All respondents also signed a written consent form clearly stating their rights and nature of 111 participation in the study before being asked to answer the questionnaire. The confidentiality 112 of the information and privacy of the respondents were protected throughout the study. 113 114 Recruitment procedure 115 Multi-stage random sampling was used in this study. In detail, there were three stages 116 involved, utilising several sampling techniques (quota sampling, cluster sampling and simple 117 random sampling) to allow random data collection. The three stages are illustrated in Figure 118 The researchers made the decision to prioritise an inclusive Malaysian sample based on 154 ethnicity and urban/rural strata due to constraints in resources. This was to ensure that the 155 smaller groups were adequately represented in the sample. The list of states, ethnicities and 156 urban/rural distribution required for this study are as presented in Table 1 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 23, 2021. ; https://doi.org/10.1101/2021.02.19.21252088 doi: medRxiv preprint The survey instrument was adopted from the HLS-M-Q18 short version of health literacy 174 questionnaire which was validated in a study [12] . The questionnaire contained three main 175 sections: 1) demographics, which surveyed respondents' socio-demographic information, 176 including gender, age, race, marital status and income; 2) personal health information; 3) 18-177 item measure of health literacy. The questionnaire was constructed in the English and Malay 178 languages. A backward-translation approach was used in translating the items between 179 English and Malay, so as to ensure linguistic and conceptual equivalence [22] . Discrepancies 180 between the two versions were rectified, and equivalence of measuring on all items was 181 ensured through consultation with bilingual researchers. 182 183 Personal health information was measured by three items. First, respondents were asked to 184 rate their health condition from "bad" coded as "1" to "good" coded as "2". The second item 185 asked respondents to identify if they suffered from long-term illness: "Do you have any long-186 term illness or health problems? Long-term illness means problems which have lasted, or you 187 expect to last, 6 months or more". Two answer options were provided (1 = No and 1 = Yes, 188 one or more than one). The third item asked respondents to identify their frequency of 189 involvement in physical activities such as lifting and carrying heavy objects, hoeing, . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 23, 2021. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 23, 2021. Respondents who stated their ethnicity as "Malay" used as a reference. 247 d Respondents who stated their health status as "Good" used as a reference. 248 e Respondents who stated their health problem as "No disease" used as a reference. 249 f Respondents who stated their marital status as "Not married" used as a reference 250 g Respondents whose income was below RM3,000 /month used as a reference. 251 h Respondents who stated their daily exercise as " ≤ 2 days a week" used as a reference. 252 253 In terms of age, the findings revealed that there was a significant relationship between age 254 and health literacy. Generation Y participants (aged 23-37) were less likely to be associated 255 with adequate health literacy (expected beta less than 1, C.I = 0.319 -0.946, P= 0.031 < 256 p=0.05). Respondents who had perceived bad health status were less likely to be associated 257 with adequate health literacy (expected beta less than 1, C.I = 0.301 -0.618, P= 0.000 < 258 p=0.05) compared to those who rated their health as good. This indicates that if the level of 259 perceived bad health status increases, the odds of being associated with adequate health 260 literacy will decrease. The association of health problems with the level of health literacy 261 was statistically significant. Respondents who had reported that they have 'One or more than 262 one' were nearly 1.5 more likely to be associated with adequate health literacy compared to 263 those who had no disease (expected beta more than 1, C.I = 1.000 -2.096, P= 0.05 < p=0.05). 264 The logistic regression results also showed that the other characteristics such as gender, race, 265 marital status, income and daily exercise remained not significantly associated with health 266 literacy level. 267 268 The results of our study indicate that Malaysians with one or more diseases were significantly 270 more likely to have higher health literacy levels. The same pattern was observed in a study 271 conducted among university students in Turkey; health literacy was significantly higher in 272 those with chronic conditions [23] . A possible explanation for this is that people with 273 diagnosis of long-term illness(es) were better acquainted with the healthcare system, health 274 advice and information. However, this raises concerns regarding the point at which people 275 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted February 23, 2021. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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