Baron-Epel Orna, Levin-Zamir Diane, Cohen Vicki, Elhayany Asher
School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, 199 Aba Khoushy Boulevard, Mount Carmel, Haifa, Israel.
Department of Health Education and Promotion, Clalit Health Services, Israel.
Health Promot Int. 2019 Apr 1;34(2):248-257. doi: 10.1093/heapro/dax078.
The association between health literacy (HL) and health outcomes, including self-perceived health (SPH) has been well documented. Yet the complexity of this association is not yet completely clear. Drawing on the Health Literacy Scale (HLS) study in Israel, we examined the association between HL, Internal Health Locus of Control (IHLOC) and SPH among Jews and Arabs. A face-to-face survey was conducted among 242 Arabs and 358 Jews. The questionnaire measured SPH, IHLOC and two measures of HL: a European HLScale (HLS-EU-16) and the Hebrew/Arabic Health Literacy Test (H/AHLT), based on the Short Test Of Functional Health Literacy in Adults. Analysis included multivariable logistic regressions and bootstrapping to identify mediation effects. Among Jews, IHLOC seems to be a significant mediator between HL and SPH. IHLOC was strongly associated with SPH (OR = 6.13; CI = 3.2, 11.8), while HL was not significantly associated directly with SPH. Similar results were observed when using the H/AHLT as a measure of HL. Among Arabs a different pattern emerges; IHLOC was neither associated with SPH nor was it a mediator of the association between HL and SPH. The two measures of HL seem to have different associations with SPH among Arabs, as only H/AHLT was associated significantly with SPH, and not HLS-EU-16. Thus, those with higher levels of IHLOC assess their health as better than those with low IHLOC only among Jews, and not among Arabs. IHLOC seems to be a significant mediator between HL and SPH among some cultures. Among Arabs, only functional HL seems to be positively associated with SPH.
健康素养（HL）与包括自我感知健康（SPH）在内的健康结果之间的关联已有充分记录。然而，这种关联的复杂性尚未完全明晰。借鉴以色列的健康素养量表（HLS）研究，我们考察了犹太人和阿拉伯人中HL、内在健康控制源（IHLOC）与SPH之间的关联。对242名阿拉伯人和358名犹太人进行了面对面调查。问卷测量了SPH、IHLOC以及两种HL测量指标：欧洲健康素养量表（HLS-EU-16）和基于成人功能性健康素养简短测试的希伯来语/阿拉伯语健康素养测试（H/AHLT）。分析包括多变量逻辑回归和自抽样法以确定中介效应。在犹太人中，IHLOC似乎是HL与SPH之间的重要中介。IHLOC与SPH密切相关（OR = 6.13；CI = 3.2，11.8），而HL与SPH没有直接显著关联。使用H/AHLT作为HL测量指标时也观察到类似结果。在阿拉伯人中出现了不同模式；IHLOC既与SPH无关，也不是HL与SPH关联的中介。在阿拉伯人中，两种HL测量指标与SPH的关联似乎不同，因为只有H/AHLT与SPH显著相关，而HLS-EU-16则不然。因此，只有在犹太人中，具有较高IHLOC水平者对自身健康的评估才优于低IHLOC者，而在阿拉伯人中并非如此。在某些文化中，IHLOC似乎是HL与SPH之间的重要中介。在阿拉伯人中，只有功能性HL似乎与SPH呈正相关。
