Document Type : Original Article

Authors

1 Department of Health Education and Promotion, Faculty of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran

2 Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

3 Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran

Abstract

BACKGROUND AND PURPOSE: The World Health Organization has identified health literacy (HL)
as one of the most important determinants of people’s health. Therefore, this research aimed to
investigate the status of HL and its predictors.
MATERIALS AND METHODS: This research was a cross-sectional study that was performed on 600
adults in Bijar County, Iran. Cluster sampling was used to select the samples. Data were collected
using the questionnaire of HL for Iranian adults. Data were analyzed using one-way analysis of
variance, Student’s t-test, and multiple linear regression in SPSS 21.
RESULTS: The mean score of HL was 3.6 out of 5; 69% and 29% of the samples had a moderateto-high health status, respectively. Among the dimensions of HL, the highest and the lowest means
were perception (3.94) and evaluation (3.21), respectively. Based on the multiple regression results,
the variables (gender – B = −0.142, confidence interval [CI]: −0.409 to −0.011, P = 0.39; education
level – B = 0.391, CI: 0.149–0.287, P = 0.00; and income level – B = 0.203, CI: 0.00–0.00, P = 0.01)
were significantly positively associated with HL.
CONCLUSION: The results of this study can be applied to educational interventions through media
and radio-television to increase public awareness. Education is also strongly recommended in terms
of demographic variables and characteristics to promote HL in the society.

Keywords

1. Greenhalgh T. Health literacy: Towards system level solutions.
BMJ 2015;350:h1026.
2. World Health Organization. Health Literacy: The Solid Facts.
WHO Regional Office for Europe: World Health Organization;
2013.
3. Hosking SM, Pasco JA, Hyde NK, Williams LJ, Brennan-Olsen SL.
Recommendations for dietary calcium intake and bone health: The
role of health literacy. J Nutr Food Sci 2016;6:1-3.
4. Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies
into the 21st century. Health Promot Int 2000;15:259-67.
5. Barton AJ, Allen PE, Boyle DK, Loan LA, Stichler JF, Parnell TA.
Health literacy: Essential for a culture of health. J Contin Educ
Nurs 2018;49:73-8.
6. 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.
7. 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;155:1-941.
8. Jacobs RJ, Lou JQ, Ownby RL, Caballero J. A systematic review
of eHealth interventions to improve health literacy. Health
Informatics J 2016;22:81-98.
9. Diviani N, van den Putte B, Giani S, van Weert JC. Low health
literacy and evaluation of online health information: A systematic
review of the literature. J Med Internet Res 2015;17:e112.
10. Evangelista LS, Rasmusson KD, Laramee AS, Barr J, Ammon SE,
Dunbar S, et al. Health literacy and the patient with heart failure–
implications for patient care and research: A consensus statement
of the Heart Failure Society of America. J Card Fail 2010;16:9.
11. Vogt D, Schaeffer D, Messer M, Berens EM, Hurrelmann K. Health
literacy in old age: Results of a German cross-sectional study.
Health Promot Int 2018;33:739-47.
12. Mitchell SE, Sadikova E, Jack BW, Paasche-Orlow MK. Health
literacy and 30-day postdischarge hospital utilization. J Health
Commun 2012;17 Suppl 3:325-3813.
13. Tehrani H, Rahmani M, Jafari A. Health literacy and Its
relationship with general health of women referring to health
care centers. J Health Lit 2018;3:191-8.
14. Reisi M, Javadzade SH, Mostafavi F, Sharifirad G, Radjati F,
Hasanzade A. Relationship between health literacy, health status,
and healthy behaviors among older adults in Isfahan, Iran. J Educ
Health Promot 2012;1:31.
15. Haghdoost AA, Karamouzian M, Jamshidi E, Sharifi H,
Rakhshani F, Mashayekhi N, et al. Health literacy among Iranian
adults: Findings from a nationwide population-based survey in
2015. East Mediterr Health J 2019;25:828-36.
16. Caylan A, Yayla K, Oztora S, Dagdeviren HN. Assessing health
literacy, the factors affecting it and their relation to some health
behaviors among adults. Biomedical Research 2017;28:6803-7.
17. Martin LT, Ruder T, Escarce JJ, Ghosh-Dastidar B, Sherman D,
Elliott M, et al. Developing predictive models of health literacy.
J Gen Intern Med 2009;24:1211-6.
18. Shokrollahi B, Zandieh M. Estimation of genetic parameters for
body weights of Kurdish sheep in various ages using multivariate
animal models. Afr J Biotechnol. 2012;11:2119-23.
19. Banihashemi SA, Amirkhani MA. Health literacy and the
influencing factors: A study in five provinces of Iran. Strides Dev
Med Educ 2007;1:1-9.
20. Ali M, Tavousi M, Rakhshani F, Azin SA, Jahangiri K, Ebadi M,
et al. Health literacy for Iranian adults (HELIA): Development and
psychometric properties. Payeshj 2014:13:589-99. doi: 10.5812/
ircmj.17(5)2015.25831.
21. Ghanbari S, Majlessi F, Ghaffari M, Mahmoodi Majdabadi M.
Evaluation of health literacy of pregnant women in urban health
centers of Shahid Beheshti Medical University. Daneshvar
2012;19:1-12.
22. Tavousi M, Mehrizi A, Solimanian A, Sarbandi F, Ardestani M,
Hashemi A, et al. Health literacy in Iran: Findings from a national
study. Payesh (Health Monit) 2016;15:95-102.
23. Ghaffari M, Hatami H, Rakhshandrrou S, Shoghli A, Heidari A.
Health literacy among women referring to healthcare centers of
Zanjan City, Iran: A cross-sectional study T. Hamadan Univer
Med Sci 2018;5:42-8.
24. Roberts M, Callahan L, O’Leary C. Social media: A path to health
literacy. Stud Health Technol Inform 2017;240:464-75.
25. Rosenbaum JE, Johnson BK, Deane AE. Health literacy and digital
media use: Assessing the health literacy skills instrument – Short
form and its correlates among African American college students.
Digit Health 2018;4:1-8.
26. Peyman N, Samiee Roudi K. Investigating the status of health
literacy among health providers of rural area. J Health Lit
2016;1:46-52.
27. Khoshravesh S, Moeini B, Rezapur-Shahkolai F, Taheri-Kharameh
Z, Bandehelahi K. Health literacy of employees of Hamadan
University of medical sciences and related demographic factors.
J Educ Community Health 2018;5:19-26.
28. Afshari M, Khazaei S, Bahrami M, Merati H. Investigating adult
health literacy in Tuyserkan city. J Educ Community Health
2014;1:48-55.
29. Golboni F, Nadrian H, Najafi S, Shirzadi S, Mahmoodi H.
Urban–rural differences in health literacy and its determinants
in Iran: A community-based study. Aust J Rural Health 2018;26:
98-105. doi: 10.1111/ajr.12378.
30. Pashaeypoor S, Salemi N, Ansari M. The relationship between
health literacy and the use of social networking in administrative
staff of Tehran University of Medical Sciences. Iran J Nurs Res
2018;13:67-73.
31. Peterson PN, Shetterly SM, Clarke CL, Bekelman DB, Chan PS,
Allen LA, et al. Health literacy and outcomes among patients with
heart failure. JAMA 2011;305:1695-701.
32. Faruqi N, Stocks N, Spooner C, El Haddad N, Harris MF. Research
protocol: Management of obesity in patients with low health
literacy in primary health care. BMC Obes 2015;2:5.
33. Mahmoodi H, Dalvand S, Ghanei Gheshlagh RK. A systematic
review and meta-analysis of health literacy in the Iranian
population: Findings and implications. Shiraz E Medical J
2019;20:e811.
34. Khosravi A, Ahmadzadeh KH. Investigating health literacy Level
of patients referred to Bushehr hospitals and recognizing its
effective factors. Iran South Med J 2016;18:1245-53.
35. Noblin AM, Wan TT, Fottler M. The impact of health literacy on
a patient’s decision to adopt a personal health record. Perspect
Health Inf Manag 2012;9:1-3.
36. Yazdani-Bakhsh R, Javanbakht M, Sadeghi M, Mashayekhi A,
Ghaderi H, Rabiei K. Comparison of health-related quality of life
after percutaneous coronary intervention and coronary artery
bypass surgery. ARYA Atheroscler 2016;12:124-31.
37. Zareban I, Izadirad H. Evaluation of health literacy, health status
and health services utilization in women in Baluchistan region of
Iran. J Health Lit 2016;1:71-82.
38. Panahi R, Osmani F, Sahraei M, Ebrahimi S, Shamsizadeh
Nehadghashti M, Javanmardi E. Relationship of health literacy
and quality of life in adults residing in Karaj, Iran. J Educ
Community Health 2018;4:13-9.
39. World Health Organization. Shanghai declaration on promoting
health in the 2030 Agenda for Sustainable Development. Health
Promot Int 2017;32:7-8.