Fernandez Dena M, Larson Janet L, Zikmund-Fisher Brian J
Department of Internal Medicine, Division of General Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-2029, USA.
Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA.
BMC Public Health. 2016 Jul 19;16:596. doi: 10.1186/s12889-016-3267-7.
While the association between inadequate health literacy and adverse health outcomes has been well documented, less is known about the impact of health literacy on health perceptions, such as perceptions of control over health, and preventive health behaviors.
We identified a subsample of participants (N = 707) from the Health and Retirement Study (HRS), a nationally representative sample of older adults, who participated in health literacy testing. Self-reported health literacy was measured with a literacy screening question, and objective health literacy with a summed score of items from the Test of Functional Health Literacy. We compared answers on these items to those related to participation in health behaviors such as cancer screening, exercise, and tobacco use, as well as self-referencing health beliefs.
In logistic regression models adjusted for gender, education, race, and age, participants with adequate self-reported health literacy (compared to poorer levels of health literacy) had greater odds of participation in mammography within the last 2 years (Odds ratio [OR] = 2.215, p = 0.01) and participation in moderate exercise two or more times per week (OR = 1.512, p = 0.03). Participants with adequate objective health literacy had reduced odds of participation in monthly breast self-exams (OR = 0.369, p = 0.004) and reduced odds of current tobacco use (OR = 0.456, p = 0.03). In adjusted linear regression analyses, self-reported health literacy made a small but significant contribution to explaining perceived control of health (β 0.151, p = <0.001) and perceived social standing (β 0.112, p = 0.002).
In a subsample of older adult participants of the HRS, measures of health literacy were positively related to several health promoting behaviors and health-related beliefs and non-use of breast self-exams, a screening behavior of questionable benefit. These relationships varied however, between self-reported and objectively-measured health literacy. Further investigation into the specific mechanisms that lead higher literacy people to pursue health promoting actions appears clearly warranted.
虽然健康素养不足与不良健康结果之间的关联已有充分记录，但对于健康素养对健康认知（如对健康的控制感）和预防性健康行为的影响，人们了解较少。
我们从健康与退休研究（HRS）中确定了一个参与者子样本（N = 707），HRS是一个具有全国代表性的老年人样本，这些参与者参加了健康素养测试。自我报告的健康素养通过一个识字筛查问题来衡量，客观健康素养则通过功能健康素养测试项目的总分来衡量。我们将这些项目的答案与那些与参与癌症筛查、锻炼和吸烟等健康行为以及自我参照健康信念相关的答案进行了比较。
在对性别、教育程度、种族和年龄进行调整的逻辑回归模型中，自我报告健康素养充足的参与者（与健康素养水平较低者相比）在过去两年内进行乳房X光检查的几率更高（优势比[OR]=2.215，p = 0.01），且每周进行两次或更多次适度锻炼的几率更高（OR = 1.512，p = 0.03）。客观健康素养充足的参与者进行每月乳房自我检查的几率降低（OR = 0.369，p = 0.004），当前吸烟的几率降低（OR = 0.456，p = 0.03）。在调整后的线性回归分析中，自我报告的健康素养对解释健康控制感（β = 0.151，p = <0.001）和社会地位感知（β = 0.112，p = 0.002）有微小但显著的贡献。
在HRS的老年参与者子样本中，健康素养指标与几种健康促进行为、与健康相关的信念以及不进行乳房自我检查（一种益处存疑的筛查行为）呈正相关。然而，这些关系在自我报告的健康素养和客观测量的健康素养之间有所不同。显然有必要进一步研究导致高素养人群采取健康促进行动的具体机制。
