Presentation by: Huynh Ba Phuong Linh 1 Health literacy and associated factors among adults in Thuy Xuan precinct, Hue city, Vietnam Authors: Huynh Ba Phuong Linh* , Vo Van Thang**, *Lien Chieu district medical center, Danang city, Vietnam **Faculty of Public Health, Hue UMP, Vietnam Presentation by: Huynh Ba Phuong Linh

OUTLINE 1 2 3 4 5 6 2 Introduction Objectives Methodology Results Conclusion 6 Recommendations

Introduction 3 Health and social policies are being developed that highlight health literacy (HL) as a key determinant of a person’s ability to optimally manage their health and of a health system’s ability to ensure equitable access to, and use of, services1. One study estimates the cost of limited health literacy to the Nation’s economy to be between $106 and $236 billion USD annually. When one accounts for the future costs that result from current actions (or lack of action), the real present day cost of limited health literacy might be closer to $1.6–3.6 trillion USD2. In both developing and developed countries, health and social policies are being developed that highlight health literacy (HL) as a key determinant of a person’s ability to optimally manage their health and of a health system’s ability to ensure equitable access to, and use of, services United Nations Economic and Social Council: Health literacy and the Millennium Development Goals: United Nations Economic and Social Council (ECOSOC) regional meeting background paper. J Health Commun 2010, 15(Suppl 2):211-223 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy

Introduction 4 Increased mortality Poorer knowledge Lower use of preventive healthcare services Hospitalization Difficulty communicating with health professionals Poor adherence to prescribed medications Low health literacy Low health literacy has been reported to be associated with1: In both developing and developed countries, health and social policies are being developed that highlight health literacy (HL) as a key determinant of a person’s ability to optimally manage their health and of a health system’s ability to ensure equitable access to, and use of, services 1. Richard H Osborne et al. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health 2013, 13:658

Introduction 5 Therefore, HL has gained considerable attention globally in the recent years1. Nevertheless, data on HL in the population is limited for Vietnam. 1. Peter Chang, Health literacy, Asia, and its health future(2016)

Objectives 6 To investigate the health literacy levels among adults in Thuy Xuan precinct, Hue city, Vietnam. To assess the association between potential factors and health literacy among adults in Thuy Xuan precinct, Hue city, Vietnam.

Methodology - Study design: cross-sectional survey 7 - Study design: cross-sectional survey - Random sampling: 633 participants aged 18 and older (were assessed for HL via a face to face interview) - Study was conducted in Thuy Xuan precinct, Hue city from October, 2015 to January, 2016. - HL was measured using questionaire of HL survey in Asia (HL-Asia-Q), which was modified from the HL survey in Europe questionaire (HL-EU-Q). - We used lineare regression to identify factors significantly associated with general-HL (GEN-HL).

Demographic Characteristics Results 8 Table 1. Demographic Characteristics (n=633) Demographic Characteristics n % Gender Male 277 43.8 Female 356 56.2 Age 18-24 70 11.1 25-34 170 26.9 35-44 111 17.5 45-54 55-64 96 15.2 >64 75 11.8 BMI <18,5 18,5-22,9 401 63.4 ≥ 23 121 19.1 Legal marital status Not married 107 16.9 Married 495 78.2 Separated/ Divorced/ Widowed 31 4.9

Demographic Characteristics Results 9 Table 1. Demographic Characteristic (n=633) Demographic Characteristics n % Religious belief Yes 447 70.6 No 186 29.4 The highest attained education Pre-primary education 23 3.6 Primary education 155 24.5 Secondary education 153 24.2 Senior high education 140 22.1 University/college of higher 162 25.6

Health Literacy Indices Results 10 Table 2: Mean and Std. Deviation(SD) of HL Indices Health Literacy Indices Mean ± SD General Health Literacy 28.78 ± 8.69 Health Care_HL 30.30 ± 8.13 Disease Prevention_HL 27.69 ± 10.03 Health Promotion_HL 28.29 ± 9.57 Gen-HL index ( Report on Health Literacy in Eight EU Member States, 2012): Total sample: 33.8 ± 8.0 Ranges from 30.5 ± 9.2 (Bulgaria) to 37.1 ± 6.4 (Netherland)

Figure 1: Percentage distribution of general HL levels and sub-domains Results 11 Figure 1: Percentage distribution of general HL levels and sub-domains Health promotion Health care General HL

Personal Health Information Results 12 Table 3: Personal Health Information Personal Health Information n % Health Self- statement Very bad/bad 67 10.6 Fair 432 68.2 Good/very good 134 21.2 Long-term illness or health problem Yes 97 15.3 No 536 84.7 Health problems limited the activities (last 6 months) Limited 156 24.6 Not limited 477 75.4 12

Personal Health Information Results 13 Table 3: Personal Health Information (n=633) Personal Health Information n % Health insurance cost Required 144 22.7 Voluntary 356 56.2 Support from Government 44 7.0 None 89 14.1 Periodic health examination Yes 367 58.0 No 266 42.0 13

Personal Health Information Results 14 Table 3: Personal Health Information (n=633) Personal Health Information n % Smoking Yes 143 22.6 No 490 77.4 Drinking alcohol 257 40.6 376 59.4 Exercise 302 47.7 331 52.3 Community activities 220 34.8 413 65.2 14

Social and Economic Information Results 15 Table 4: Social and Economic Information (n=633) Social and Economic Information n % Main status of employment Employed 583 92.1 Retirement, unemployed, permanently disabled or homemaker 50 7.9 Receiving medical training Yes 55 8.7 No 578 91.3 Able to pay for medication Easy 488 77.1 Difficult 145 22.9 Afford to see doctor 512 80.9 121 19.1

Social and Economic Information Results 16 Table 4: Social and Economic Information (n=633) Social and Economic Information n % Net income per month Poor 11 1.7 Nearly poor 5 0.8 Fairly, wealth 617 97.5 Comparing health to other with similar age and gender Worse than other 106 16.7 Average 359 56.7 Better than other 168 26.5 Importance of health Health weighs more than job/work 427 67.5 Other idea 206 32.5

University/college of higher Results 17 Table 5: Associated factors of Health literacy: Multiple linear regression analysis Odds ratio (OR) 95% CI p The highest attained education Lower secondary * - Senior high education 2.88 1.68-4.94 0.000 University/college of higher 1.63 0.84-3.16 0.147 Get medical-related information on the Internet Rarely, never* Often, sometimes 1.90 1.14-3.17 0.014 Hue, Indonesia (2015)

Results 18 Table 5: Associated factors of Health literacy: Multiple linear regression analysis Odds ratio (OR) 95% CI p Health insurance cost None* - Required 0.45 0.20-1.01 0.052 Support from Government 0.21 0.06-0.77 0.018 Voluntary 0.53 0.28-1.02 0.059 Periodic health examination No Yes* 2.07 1.32-3.24 0.001 Exercise No * Yes 1.65 1.09-2.51 0.019 Vietnam, Taiwan (2015)

Results 19 Table 5: Associated factors of Health literacy: Multiple linear regression analysis Odds ratio (OR) 95% CI p Able to pay for medication Difficult* - Easy 3.20 1.32-7.75 0.010 Importance of health Other idea* Health weighs more than job/work 1.92 1.19-3.10 0.008 Hue (2015): 1.29

Conclusion 20 The proportions of limited HL were high in health care, disease prevention and health promotion, especially in health promotion. Findings of this study can be considered for local-level measurement comparisons of HL in Vietnam.

Conclusion Associated factors of HL Vietnam 20 Associated factors of HL Vietnam Demographic Characteristics: The highest attained education, Get medical-related information on the Internet. Personal Health Information: Health insurance cost, Periodic health examination, Exercise Social and Economic Information: Able to pay for medication, Importance of health

RECOMMENDATIONS 43 Enhance both the quality and quantity of programs about health education and communication, especially the content of health promotion. Introduction address trusted web sites widely to provide information and answer questions about the health for every people. Expanding research on health literacy in Vietnam.

THANK YOU VERY MUCH FOR YOUR ATTENTION 44 THANK YOU VERY MUCH FOR YOUR ATTENTION For all