Rikard R V, Thompson Maxine S, McKinney Julie, Beauchamp Alison
Department of Media & Information, Michigan State University, 409 Comm Arts, 404 Wilson Road, East Lansing, MI, 48824, USA.
Department of Sociology & Anthropology, North Carolina State University, Raleigh, NC, USA.
BMC Public Health. 2016 Sep 13;16(1):975. doi: 10.1186/s12889-016-3621-9.
In the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources) contribute to understanding disparities in health literacy.
We analyze data on respondents 18 years of age and older (N = 14,592) from the 2003 National Assessment of Adult Literacy (NAAL) restricted access data set. A series of weighted Ordinary Least Squares (OLS) regression models estimate the association between respondent's demographic characteristics, socioeconomic status (SES), relational social class, social resources and an Item Response Theory (IRT) based health literacy measure.
Our findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use) are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels.
Relational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering) are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.
在美国，健康素养方面的差异与健康结果方面的差异并行。我们的研究有助于理解各种社会不平等指标（即客观社会阶层、关系性社会阶层和社会资源）如何促进对健康素养差异的理解。
我们分析了来自2003年成人识字能力全国评估（NAAL）受限访问数据集的18岁及以上受访者的数据（N = 14,592）。一系列加权普通最小二乘法（OLS）回归模型估计了受访者的人口统计学特征、社会经济地位（SES）、关系性社会阶层、社会资源与基于项目反应理论（IRT）的健康素养测量之间的关联。
我们的研究结果与先前关于健康素养的社会和社会经济决定因素的研究一致。然而，我们的研究结果揭示了关系性社会地位对于理解美国健康素养差异的重要性。社会地位的客观指标是健康素养持续且有力的指标。关系性社会地位的测量，如公民参与（即投票、志愿服务和使用图书馆），在扣除客观资源后与较高的健康素养水平相关。包括说英语和婚姻状况在内的社会资源与较高的健康素养水平相关。
社会阶层的关系性指标与健康素养相关，独立于客观社会阶层指标。公民素养（如投票和志愿服务）是健康素养的预测因素，并为健康干预提供了机会。我们的研究结果支持健康素养是一种社会建构的观点，并表明需要制定一个理论驱动的健康素养概念定义，其中包括公民素养成分。
