Document Type : Original Article
Authors
- . Saeed Karimi
- . Mahmoud Keyvanara 1
- . Mohsen Hosseini 2
- . Marzie Jafarian Jazi 3
- . Elahe Khorasani 3
1 Department of Health Services Management, Social Determinate of Health Research Center
2 Department of Biostatistics and Epidemiology, School of Health,
3 Department of Health Services Management, School of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Today, much attention has been paid to the patient role as the central factor in the
management of their own health. It is focused on the issue that the patient has a more critical role
compared with the health-care provider in controlling the patient own health. defines health literacy
as the degree to which individuals have the capacity to obtain, process, and understand basic health
information and services needed to make appropriate health decisions. Objective: The objective of
this study was to determine health literacy, health status, healthcare utilization and the relationship
between them in 18 - 64 years old people in Isfahan. Structure and Design: This study was a
descriptive analytical survey, which was conducted on 300 subjects of 18-64 years old in Isfahan
with Multi-stage sampling method proportional to selected sample size. Materials and Methods:
For collecting the data, questionnaire adapted from CHAP (Consumer Assessment of Healthcare
Providers and Systems) health literacy questionnaire was used. Health status was measured based
on an assessment of the physical and mental health over the past 6 months by 5° Likert scale. Data
analysis was performed by using SPSS 18, descriptive statistics, Chi-square test and multivariate
analysis of variance. Results: There was no significant correlation between health literacy, health
status and healthcare utilization. Utilization was less in the urban area No. 6 of the city. In the
bachelor’s degree group, the health status was lower than the other groups in these cases: Older
ages, married, women, large family size, undergraduates, and urban area No. 14. Conclusions:
Due to the average prevalence of health literacy in 18-64 years old individuals in Isfahan and lowhealthcare utilization, the followings are recommended: Necessity of more attention to the issue
of health literacy, improving the physician-patient relationship and community awareness, whether
through health promotion programs or media for the optimum use of available resources.
Keywords
in North Carolina. North Carolina: North Carolina department
of health and human services: The North Carolina Institute of
Medicine; 2007.
2. Tsai TI, Shoou-Yih D. Lee,Yi-Wen Tsai, Ken N. Kuo. Methodology
and validation of health literacy scale development in Taiwan. The
George Washington University. J Health Commun 2009; p. 1-26
3. Report on the Council of Scientific Affairs, Ad Hoc Committee
on Health Literacy for the Council on Scientific Affairs. American
Medical Association; 1999.
4. Tehrani Bani-Hashemi A, et al. Health Literacy in five provinces of
the country and its influencing factors. J Med Educ Develop Center
1386;4:1-9.
5. Kickbusch I, Wait S, Daniela M. Navigating health: The role of health
literacy. European Public Health Centre. Gastein Health Declaration.
2005. p. 1-22.
6. Montazeri A, Goshtasebi A, Vahdaninia M. Educational inequalities
in self-reported health in a general Iranian population. BMC Res
Notes 2008;1:50.
7. Healthy People 2010 Objectives: Draft for Public Comment.
Washington, DC: Public Health Service. U.S. Department of Health
and Human Service; 1998.
8. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of
functional health literacy to patients› knowledge of their chronic
disease. A study of patients with hypertension and diabetes. Arch
Intern Med 1998;158:166-72.
9. Baker DW, Parker RM, Williams MV, Clark WS, Nurss J. The
relationship of patient reading ability to self-reported health and
use of health services. Am J Public Health 1997;87:1027-30.
10. Report on the Council of Scientific Affairs. Ad Hoc Committee
on Health Literacy for the Council on Scientific Affairs, American
Medical Association, JAMA, Feb 10, 1999.
11. Gazmararian JA, Baker DW, Williams MV, Parker RM, Scott TL, Green
DC, et al. Health literacy among Medicare enrollees in a managed
care organization. JAMA 1999;281:545-51.
12. Health interview surveys: Towards international harmonization of
methods and instruments. WHO Regional Publications, European
Series. Netherlands, Copenhagen: WHO Regional Office for Europe.
World Health Organization, Statistics; 1996.
13. Manderbacka K, Kåreholt I, Martikainen P, Lundberg O. The effect
of point of reference on the association between self-rated health
and mortality. Soc Sci Med 2003;56:1447-52.
14. Rubin DL, Parmer J, Freimuth V, Kaley T, Okundaye M. Associations
between older adults› spoken interactive health literacy and selected
health care and health communication outcomes. J Health Commun
2011;16:191-204.
15. Raeisi M, Mostafavi F, Hasanzade A, Sharifirad GR. The
relationship between health literacy, health status and healthy
behaviors among elderly in Isfahan. Iran J Health Syst Res
2011;4:469-80.
16. About the CAHPS Item Set for Addressing Health Literacy CAHPS
Clinician & Group Survey and Reporting. 2009. p. 1-8.
17. Ebadifardazar F, Rezapour A, Abbasibroujeni P, Safari H,
Moeeninaeeni M. Utilization of health care services in the state of
Isfahan. Hospital J 1390;10:1-10.
18. Cho YI, Lee SY, Arozullah AM, Crittenden KS. Effects of health
literacy on health status and health service utilization amongst the
elderly. Soc Sci Med 2008;66:1809-16.
19. Arozullah AM, Lee SY, Khan T, Kurup S, Ryan J, Bonner M, et al. The
roles of low literacy and social support in predicting the preventability
of hospital admission. J Gen Intern Med 2006;21:140-5.
20. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM,
Green D, et al. Health literacy and use of outpatient physician
services by Medicare managed care enrollees. J Gen Intern Med
2004;19:215-20.
21. Baker DW, Gazmararian JA, Williams MV, Scott T, Parker RM,
Green D, et al. Functional health literacy and the risk of hospital
admission among Medicare managed care enrollees. Am J Public
Health 2002;92:1278-83.
22. Walker J, Pepa C, Gerard PS. Assessing the health literacy levels
of patients using selected hospital services. Clin Nurse Spec
2010;24:7-31.
23. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low
health literacy and health outcomes: An updated systematic review.
Ann Intern Med 2011;155:97-107.
24. Nielsen-Bohlman L, Panzer AM ,Kindig DA. Health literacy: A
prescription to end confusion. Institute of Medicine of the National
Academies. 500 Fifth St. NW, Washington: National Academies
Press; 2004. p. 1-2.
25. Lee SY, Tsai TI, Tsai YW, Kuo KN. Health literacy, health status, and
healthcare utilization of Taiwanese adults: Results from a national
survey. BMC Public Health 2010;10:614.
26. Hardie NA, Kyanko K, Busch S, Losasso AT, Levin RA. Health literacy
and health care spending and utilization in a consumer-driven health
plan. J Health Commun 2011;16:308-21.
27. Guerra CE, Shea JA. Health literacy and perceived health status in
Latinos and African Americans. Ethn Dis 2007;17:305-12.
28. Jovic-Vranes A, Bjegovic-Mikanovic V, Marinkovic J. Functional
health literacy among primary health-care patients: Data from the
Belgrade pilot study. J Public Health (Oxf) 2009;31:490-5.
29. Tokuda Y, Doba N, Butler JP, Paasche-Orlow MK. Health literacy and
physical and psychological wellbeing in Japanese adults. Patient
Educ Couns 2009;75:411-7.
30. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of
America’s Adults. Results From the 2003 National Assessment of
Adult Literacy.
31. Wolf MS, Gazmararian JA, Baker DW. Health literacy and
functional health status among older adults. Arch Intern Med
2005;165:1946-52.
32. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A,
Crotty K, et al. Health literacy interventions and outcomes: An
updated systematic review. Evid Rep Technol Assess (Full Rep)
2011;11:1-232.
)