Sentell Tetine, Zhang Wei, Davis James, Baker Kathleen Kromer, Braun Kathryn L
Office of Public Health Studies, University of Hawai'i at Manoa, 1960 East-West Road, Biomed D104-G, Honolulu, HI, 96821, USA,
J Gen Intern Med. 2014 Feb;29(2):298-304. doi: 10.1007/s11606-013-2638-3. Epub 2013 Oct 5.
Individual health literacy is an established predictor of individual health outcomes. Community-level health literacy may also impact individual health, yet limited research has simultaneously considered the influence of individual and community health literacy on individual health.
The study goal was to determine if community health literacy had an independent relationship with individual self-reported health beyond individual health literacy.
We used data from the 2008 and 2010 Hawai'i Health Survey, a representative statewide telephone survey. Multilevel models predicted individual self-reported health by both individual and community health literacy, controlling for relevant individual-level (education, race/ethnicity, gender, poverty, insurance status, age, and marital status) and community-level variables (community poverty and community education).
The sample included 11,779 individuals within 37 communities.
Individual health literacy was defined by validated self-reported measurement. Communities were defined by zip code combinations. Community health literacy was defined as the percentage of individuals within a community reporting low health literacy. Census data by ZIP Code Tabulation Areas provided community-level variables.
In descriptive results, 18.2 % self-reported low health literacy, and 14.7 % reported self-reported poor health. Community-level low health literacy ranged from 5.37 % to 35.99 %. In final, multilevel models, both individual (OR: 2.00; 95 % CI: 1.63-2.44) and community low health literacy (OR: 1.02; 95 % CI: 1.00-1.03) were significantly positively associated with self-reported poor health status. Each percentage increase of average low health literacy within a community was associated with an approximately 2 % increase in poor self-reported health for individuals in that community. Also associated with poorer health were lower educational attainment, older age, poverty, and non-White race.
Both individual and community health literacy are significant, distinct correlates of individual general health status. Primary care providers and facilities should consider and address health literacy at both community and individual levels.
个体健康素养是个体健康状况的既定预测指标。社区层面的健康素养也可能影响个体健康，但同时考虑个体和社区健康素养对个体健康影响的研究有限。
本研究的目标是确定社区健康素养与个体自我报告的健康状况之间是否存在独立于个体健康素养的关系。
我们使用了2008年和2010年夏威夷健康调查的数据，这是一项具有全州代表性的电话调查。多水平模型通过个体和社区健康素养预测个体自我报告的健康状况，同时控制相关的个体层面变量（教育程度、种族/民族、性别、贫困、保险状况、年龄和婚姻状况）和社区层面变量（社区贫困和社区教育）。
样本包括37个社区内的11779名个体。
个体健康素养通过经过验证的自我报告测量来定义。社区由邮政编码组合定义。社区健康素养定义为社区内报告低健康素养的个体百分比。邮政编码分区的人口普查数据提供了社区层面的变量。
在描述性结果中，18.2%的人自我报告健康素养低，14.7%的人报告自我健康状况差。社区层面的低健康素养范围为5.37%至35.99%。在最终的多水平模型中，个体（比值比：2.00；95%置信区间：1.63 - 2.44）和社区低健康素养（比值比：1.02；95%置信区间：1.00 - 1.03）均与自我报告的健康状况差显著正相关。社区内平均低健康素养每增加一个百分点，该社区个体自我报告的健康状况差的比例就会增加约2%。教育程度较低、年龄较大、贫困和非白人种族也与较差健康状况相关。
个体和社区健康素养都是个体总体健康状况的重要且不同的相关因素。初级保健提供者和机构应在社区和个体层面考虑并解决健康素养问题。
