Sociodemographic characteristics of the participants
As shown in Table 1, of the participants, 2408 (46.3%) were male, and 2797 (53.7%) were female. More than half of the participants (63.7%) lived in urban areas. The average age was 49.1±13.7 years. A total of 141 participants (2.7%) were illiterate, 550 (10.6%) had a primary education, 1431 (27.5%) had a junior school education, 1524 (29.3%) had a high school education, 1417 (27.2%) had a college education, and 142 (2.7%) had a master’s degree or above. Approximately 13.4% of the participants were farmers, and more than 71.0% of the participants had fewer than 3 family members. More than 60% of the participants had an average annual income of no more than 100,000 CNY. Of the participants, 50.1% suffered from chronic diseases, and over 60% reported that they were in excellent or good health.
Table 1 Sociodemographic characteristics and knowledge rate of health literacy in Wuhan, 2018.
Characteristics
|
N (%) a
|
Mean ± SD b
|
> 80% or score c
|
Knowledge rate (%)
|
c2
|
P
|
Area of residence
|
|
|
|
|
|
|
Urban
|
3315 (63.7)
|
44.9±11.3
|
773
|
23.3
|
95.20
|
<0.001
|
Rural
|
1890 (36.3)
|
39.3±11.7
|
231
|
12.2
|
|
|
Gender
|
|
|
|
|
|
|
Male
|
2408 (46.3)
|
42.7±11.8
|
450
|
18.7
|
1.04
|
0.308
|
Female
|
2797 (53.7)
|
43.0±11.7
|
554
|
19.8
|
|
|
Age, years
|
|
|
|
|
|
|
15-24
|
209 (4.0)
|
45.6±11.6
|
65
|
31.1
|
210.58
|
<0.001
|
25-34
|
759 (14.6)
|
46.0±10.7
|
212
|
27.9
|
|
|
35-44
|
853 (16.4)
|
46.2±11.4
|
261
|
30.6
|
|
|
45-54
|
1232 (23.7)
|
41.9±12.0
|
218
|
17.7
|
|
|
55-64
|
1343 (25.8)
|
40.8±11.6
|
154
|
11.5
|
|
|
65-69
|
809 (15.5)
|
40.9±11.5
|
94
|
11.6
|
|
|
Ethnicity
|
|
|
|
|
|
|
Han
|
5168 (99.3)
|
42.9±11.7
|
993
|
19.2
|
2.61
|
0.106
|
Other
|
37 (0.7)
|
45.7±9.6
|
11
|
29.7
|
|
|
Education
|
|
|
|
|
|
|
Illiterate
|
141 (2.7)
|
28.8±12.6
|
7
|
5.0
|
768.04
|
<0.001
|
Primary school
|
550 (10.6)
|
36.0±11.9
|
30
|
5.5
|
|
|
Junior school
|
1431 (27.5)
|
39.1±10.9
|
87
|
6.1
|
|
|
High school
|
1524 (29.3)
|
43.6±9.8
|
235
|
15.4
|
|
|
College
|
1417 (27.2)
|
49.0±10.1
|
567
|
40.0
|
|
|
Master’s degree or above
|
142 (2.7)
|
52.8±10.1
|
78
|
54.9
|
|
|
Occupation
|
|
|
|
|
|
|
Civil servant
|
89 (1.7)
|
49.9±9.4
|
39
|
43.8
|
677.64
|
<0.001
|
Teacher
|
231 (4.4)
|
53.1±9.3
|
130
|
56.3
|
|
|
Medical staff
|
127 (2.4)
|
53.8±8.6
|
71
|
55.9
|
|
|
Other public institution staff
|
608 (11.7)
|
48.1±10.7
|
228
|
37.5
|
|
|
Student
|
110 (2.1)
|
47.7±11.1
|
43
|
39.1
|
|
|
Farmer
|
699 (13.4)
|
35.4±11.3
|
41
|
5.9
|
|
|
Worker
|
684 (13.1)
|
39.8±10.9
|
56
|
8.2
|
|
|
Other enterprise staff
|
815 (15.7)
|
43.8±10.3
|
144
|
17.7
|
|
|
Other
|
1842 (35.4)
|
42.2±11.2
|
252
|
13.7
|
|
|
Number of people in the household
|
|
|
|
|
|
|
1-3
|
3695 (71.0)
|
42.7±11.6
|
680
|
18.4
|
6.45
|
0.040
|
4-6
|
1447 (27.8)
|
43.4±11.9
|
310
|
21.4
|
|
|
³7
|
63 (1.2)
|
41.0±12.5
|
14
|
22.2
|
|
|
Average annual household income, CNY
|
|
|
|
|
|
|
<30,000
|
539 (10.4)
|
37.5±11.6
|
21
|
3.9
|
268.12
|
<0.001
|
30,000-50,000
|
969 (18.6)
|
39.6±11.2
|
87
|
9.0
|
|
|
50,000-100,000
|
1826 (35.1)
|
43.2±11.7
|
367
|
20.1
|
|
|
100,000-300,000
|
1589 (30.5)
|
46.0±11.3
|
478
|
30.1
|
|
|
³300,000
|
282 (5.4)
|
44.9±9.8
|
51
|
18.1
|
|
|
Native population
|
|
|
|
|
|
|
Yes
|
4648 (89.3)
|
43.0±11.7
|
894
|
19.2
|
0.09
|
0.771
|
No
|
557 (10.7)
|
42.3±12.1
|
110
|
19.7
|
|
|
Suffering from chronic diseases e
|
|
|
|
|
|
|
Yes
|
2610 (50.1)
|
41.1±11.5
|
370
|
14.2
|
87.91
|
<0.001
|
No
|
2595 (49.9)
|
44.7±11.7
|
634
|
24.4
|
|
|
Self-reported health status
|
|
|
|
|
|
|
Excellent
|
1138 (21.9)
|
43.2±11.5
|
238
|
20.9
|
9.66
|
0.047
|
Good
|
2203 (42.3)
|
43.6±11.5
|
444
|
20.2
|
|
|
Average
|
1643 (31.6)
|
42.1±11.9
|
288
|
17.5
|
|
|
Relatively poor
|
186 (3.6)
|
40.9±12.6
|
31
|
16.7
|
|
|
Poor
|
35 (0.7)
|
36.6±12.3
|
3
|
8.6
|
|
|
Total
|
5205 (100.0)
|
42.9±11.7
|
1004
|
19.3
|
-
|
-
|
a percentage of all participants; b score of health literacy; c number of participants with a total score higher than 80%; d number of participants with a total score lower than 80%; e Chronic diseases included hypertension, heart disease, cerebrovascular disease (stroke, cerebral infarction, cerebral thrombosis), diabetes, and malignant cancer.
The association between knowledge rate of health literacy level and socio-demographic characteristics
As shown in Table 1, there are specific groups whose knowledge rate of health literacy is considerably below the average level (19.3%): people living in rural areas, in older age groups, with a lower education level, working as a farmer or worker, with less people in the household, with lower household income, suffered from chronic diseases and with poor self-reported health status.
With regard to socio-economic status, higher proportions of limited health literacy are found among people who were between 45 and 54 years old (17.7%), between 55 and 64 years old (11.5%) or older (11.6%); whose self-reported health status was average (17.5%), relatively poor (16.7%) or poor (8.6%); who suffered from chronic diseases (14.2%); whose annual household income was between 30,000 and 50,000 CNY (9.0%) or less than 30,000 CNY (3.9%); who were workers (8.2%) or farmers (5.6%); and whose education level was junior school (6.1%), primary school (5.5%) or illiterate (5.0%). The differences in the above groups were significant.
Average score, knowledge rate of total health literacy and the three aspects and six dimensions of health literacy
The average scores for each health literacy scale are shown in Table 2. The rate of knowledge in the three aspects, KAA, HRS, and BAL, was 33.9%, 33.2% and 17.3%, respectively. Additionally, for the six dimensions, the knowledge rate in descending order was 57.8%, 52.8%, 41.0%, 27.8%, 26.1%, and 19.0% for SAFA, SVH, HI, MC, ID, and CD, respectively.
Table 2 Average points and knowledge of each scale in the three aspects and six dimensions.
Variables a
|
Number of questions
|
Total points
|
80% of total score (%)
|
Mean±SD
|
>80% of score b
|
Knowledge rate (%)
|
Three aspects
|
|
|
|
|
|
|
KAA
|
22
|
28
|
22.4
|
19.1±5.0
|
1767
|
33.9
|
BAL
|
16
|
22
|
17.6
|
13.3±4.5
|
900
|
17.3
|
HRS
|
12
|
16
|
12.8
|
10.5±3.6
|
1728
|
33.2
|
Six dimensions
|
|
|
|
|
|
|
SVH
|
8
|
11
|
8.8
|
7.4±2.5
|
2749
|
52.8
|
ID
|
6
|
7
|
5.6
|
4.6±1.5
|
1356
|
26.1
|
CD
|
9
|
12
|
9.6
|
7.0±2.7
|
988
|
19.0
|
SAFA
|
10
|
14
|
11.2
|
10.5±3.0
|
3008
|
57.8
|
MC
|
11
|
14
|
11.2
|
8.7±2.8
|
1449
|
27.8
|
HI
|
6
|
8
|
6.4
|
4.8±2.1
|
2132
|
41.0
|
Health literacy
|
50
|
66
|
52.8
|
42.9±11.7
|
1004
|
19.3
|
a KAA: Knowledge and attitudes; BAL: Health-related behaviour and lifestyle; HRS: Health-related skills; SVH: Scientific views of health; ID: Infectious diseases; CD: Chronic diseases; SAFA: Safety and first aid; MC: Medical care; HI: Health information.
b number of participants with a total score > 80%.
Multiple logistic regression analysis on risk factors associated with health literacy knowledge rate
The variables with statistical significance in the Chi-square test (Table 1) were examined in the multiple logistic regression. As shown in Table 3, participants living in urban areas (OR=1.31, 95% CI: 1.08, 1.60) were significantly likely to have a higher knowledge rate of health literacy than those living in rural areas. Compared to participants who were illiterate, participants with an education level of high school (OR= 2.27, 95% CI: 1.00, 5.13), college (OR=5.36, 95% CI: 2.35, 12.23) and master’s degree or above (OR= 6.67, 95% CI: 2.70, 16.46) were likely to have a significantly higher knowledge rate of health literacy. Medical staff (OR=2.42, 95% CI: 1.36, 4.32) were likely to have higher health literacy than residents whose occupation was civil servant. As average household income increased, the participants were more likely to have higher health literacy. Participants suffering from chronic disease were associated with lower health literacy. Of these factors, living in an urban area, education level (except primary school and junior school), working as medical staff and having a higher annual household income were positively correlated with health literacy, while being a worker or suffering from chronic diseases were negatively correlated with health literacy.
Table 3 Multiple logistic regression analysis of risk factors associated with health literacy in different socio-demographic characteristics
Parameters
|
B
|
S.E.
|
Wald
|
df
|
P
|
OR
|
OR95%C.I.
|
Area of residence
|
|
|
|
|
|
|
|
Rural
|
ref
|
|
|
|
|
|
|
Urban
|
0.27
|
0.10
|
7.26
|
1
|
0.01
|
1.31
|
(1.08,1.60)
|
Age, years
|
|
|
|
|
|
|
|
65-69
|
ref
|
|
|
|
|
|
|
55-64
|
0.06
|
0.24
|
0.07
|
1
|
0.79
|
1.07
|
(0.67,1.70)
|
45-54
|
0.29
|
0.24
|
1.46
|
1
|
0.23
|
1.34
|
(0.83,2.14)
|
35-44
|
0.01
|
0.24
|
0.00
|
1
|
0.96
|
1.01
|
(0.63,1.63)
|
25-34
|
-0.38
|
0.25
|
2.29
|
1
|
0.13
|
0.69
|
(0.42,1.12)
|
15-24
|
-0.01
|
0.26
|
0.00
|
1
|
0.97
|
0.99
|
(0.59,1.66)
|
Education
|
|
|
|
|
|
|
|
Illiterate
|
ref
|
|
|
|
|
|
|
Primary school
|
0.02
|
0.44
|
0.00
|
1
|
0.96
|
1.02
|
(0.43,2.41)
|
Junior school
|
0.03
|
0.42
|
0.00
|
1
|
0.95
|
1.03
|
(0.45,2.32)
|
High school
|
0.82
|
0.42
|
3.88
|
1
|
0.05
|
2.27
|
(1.00,5.13)
|
College
|
1.68
|
0.42
|
15.97
|
1
|
<0.01
|
5.36
|
(2.35,12.23)
|
Master’s degree or above
|
1.90
|
0.46
|
16.91
|
1
|
<0.01
|
6.67
|
(2.70,16.46)
|
Occupation
|
|
|
|
|
|
|
|
Civil servant
|
ref
|
|
|
|
|
|
|
Teacher
|
0.60
|
0.27
|
5.19
|
1
|
0.02
|
1.83
|
(1.09,3.07)
|
Medical staff
|
0.89
|
0.30
|
9.02
|
1
|
<0.01
|
2.42
|
(1.36,4.32)
|
Other public institution staff
|
0.12
|
0.24
|
0.24
|
1
|
0.62
|
1.13
|
(0.70,1.81)
|
Student
|
0.31
|
0.37
|
0.72
|
1
|
0.40
|
1.37
|
(0.67,2.80)
|
Farmer
|
-0.29
|
0.31
|
0.86
|
1
|
0.36
|
0.75
|
(0.41,1.38)
|
Worker
|
-0.79
|
0.28
|
8.10
|
1
|
<0.01
|
0.46
|
(0.27,0.78)
|
Other enterprise staff
|
-0.72
|
0.25
|
8.58
|
1
|
<0.01
|
0.49
|
(0.30,0.79)
|
Other
|
-0.45
|
0.24
|
3.49
|
1
|
0.06
|
0.64
|
(0.40,1.02)
|
Number of people in the household
|
|
|
|
|
|
|
|
1-3
|
ref
|
|
|
|
|
|
|
4-6
|
-0.04
|
0.09
|
0.19
|
1
|
0.67
|
0.96
|
(0.81,1.15)
|
³7
|
0.37
|
0.35
|
1.11
|
1
|
0.29
|
1.44
|
(0.73,2.86)
|
Average annual household income, CNY
|
|
|
|
|
|
|
|
<30,000
|
ref
|
|
|
|
|
|
|
30,000~50,000
|
0.51
|
0.26
|
3.93
|
1
|
<0.05
|
1.67
|
(1.01,2.76)
|
50,000-100,000
|
1.21
|
0.24
|
25.81
|
1
|
<0.01
|
3.36
|
(2.11,5.37)
|
100,000-300,000
|
1.41
|
0.24
|
34.73
|
1
|
<0.01
|
4.11
|
(2.57,6.57)
|
³300,000
|
0.65
|
0.29
|
5.06
|
1
|
0.02
|
1.91
|
(1.09,3.35)
|
Suffering from chronic diseases a
|
|
|
|
|
|
|
|
Yes
|
ref
|
|
|
|
|
|
|
No
|
0.18
|
0.09
|
4.41
|
1
|
0.04
|
1.20
|
(1.01,1.42)
|
Self-reported health status
|
|
|
|
|
|
|
|
Excellent
|
ref
|
|
|
|
|
|
|
Good
|
0.05
|
0.10
|
0.26
|
1
|
0.61
|
1.05
|
(0.86,1.29)
|
Average
|
0.05
|
0.11
|
0.17
|
1
|
0.68
|
1.05
|
(0.84,1.31)
|
Relatively poor
|
0.20
|
0.24
|
0.66
|
1
|
0.42
|
1.22
|
(0.76,1.96)
|
Poor
|
-0.11
|
0.65
|
0.03
|
1
|
0.87
|
0.90
|
(0.25,3.23)
|
Constant
|
-3.52
|
0.58
|
36.83
|
1
|
<0.01
|
0.03
|
-
|
a Chronic diseases included hypertension, heart disease, cerebrovascular disease (stroke, cerebral infarction, cerebral thrombosis), diabetes, and malignant cancer.