Institute of Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, D-10117 Berlin, Germany.
Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, D-10117 Berlin, Germany.
Eur J Public Health. 2023 Aug 1;33(4):561-567. doi: 10.1093/eurpub/ckad070.
Health literacy is gaining importance as it concerns the ability of individuals to encounter the complex demands of health in modern societies. Little is known about the environmental associations of health literacy in high-income countries. This study aims to (i) analyse urban-rural differences in health literacy and further (ii) investigate the interrelations of associated factors.
Based on secondary analyses using a population-based survey of individuals aged 35 years and older from Berlin, Germany, and the surrounding rural area. Health literacy, sociodemographic factors (gender, age, educational level, marital status, income), environmental factors (urban/rural) and health behaviour (physical activity) were assessed with questionnaires. T-tests, Analyses of Variance and multiple regression with interaction terms have been applied.
In total, 1822 participants (51.2% female and 56.8% living in an urban region) took part in this study. Health literacy was significantly higher in rural regions (mean = 35.73, SD = 7.56) than in urban regions (mean = 34.10, SD = 8.07). Multiple multivariate regressions showed that living in urban regions, being older, having vocational or basic education, having mid or low income, being widowed, having moderate or low levels of physical activity were significantly negatively associated with health literacy. Incorporating interaction terms showed significance that being older is positively associated with urban regions.
We found higher levels of health literacy in rural regions and also demonstrated that multiple associated factors of health literacy work congruously. Thus, the environment, associated factors and their interplay must be considered in future urban-rural health literacy research.
健康素养越来越受到重视，因为它关系到个人在现代社会中应对复杂健康需求的能力。在高收入国家，人们对健康素养的环境关联知之甚少。本研究旨在：（i）分析健康素养的城乡差异，进一步（ii）调查相关因素的相互关系。
本研究基于对德国柏林及其周边农村地区年龄在 35 岁及以上的人群进行的一项基于人群的调查的二次分析。健康素养、社会人口因素（性别、年龄、教育水平、婚姻状况、收入）、环境因素（城市/农村）和健康行为（体育活动）通过问卷调查进行评估。采用 t 检验、方差分析和具有交互项的多元回归进行分析。
共有 1822 名参与者（51.2%为女性，56.8%居住在城市地区）参与了这项研究。农村地区的健康素养明显高于城市地区（均值=35.73，标准差=7.56）（均值=34.10，标准差=8.07）。多元回归分析表明，居住在城市地区、年龄较大、接受职业或基础教育、收入中等或较低、丧偶、体育活动水平中等或较低与健康素养显著负相关。纳入交互项表明，年龄较大与城市地区呈正相关。
我们发现农村地区的健康素养水平较高，同时还表明健康素养的多个相关因素协同作用。因此，在未来的城乡健康素养研究中，必须考虑环境、相关因素及其相互作用。
