Health Literacy survey in Vietnam Research institution: Hanoi School of Public Health Ghep vao slide truoc Presentation by Nguyen Trung Kien, MA, Lecturer Faculty of Social Science, Behavior and Health Education

OUTLINE Introduction Objectives Methods Results Conclusion Further research 1 2 3 4 5 6

INTRODUCTION Several health studies focused on knowledge, attitude and practice or behavior of specific groups of people relate to specific diseases. Lack of Health Literacy studies in Vietnam so far

Literacy in Vietnam and neighbor countries (UNESCO, 2013) Slide ve Literacy nen trinh bay truoc HL Recent years, adult literacy rate in Vietnam has increased gradually (93,4% in 2011; target 94% in 2015) In Malaysia: 93,1% in 2010; target 94,5% in 2015

Objectives This survey aims: To estimate the health literacy of Vietnamese people in some areas of Vietnam To describe the determinants of health literacy among these target pops To describe the consequences of limited health literacy for health behaviors, health risks, self-perceived health status Em phai bam sat muc tieu cua survey tren cac nhom doi tuong de chuan bi presentation – vi day la report ve ket qua survey – khong trinh bay nhu kieu y tuong ve proposal nhu lan truoc toi trinh bay.

Methods Phai co slides mo ta ve method cua survey: theo order + design? + sample size? Sampling? + variables? + data collection? + instrument? + data analysis? Others (if necessary) Dung cac slides tiep theo de sap xep va revise lai cho phu hop

HLS-Asia-Questionnaire Forth and back translation from HLS-EU-Q Discuss and finalize the translation Beside the original 86 questions, another 18 questionnaires were added to reflect the local diversities. HLS – ASIA – Q Demographics (9 questions, added 11 questions) Health Literacy Survey (47 questions) Personal Health Information (15 questions, added 4 questions and 3 sub questions) Social and economics information (7 questions, added 3 questions) Functional health Information (7 questions) Total: 104 questions HLS –EU – Q Health Literacy Survey (47 questions) Personal Health Information (15 questions) Functional health Information (7 questions) Demographics (9 questions) Social and economics information (7 questions) Total: 86 questions To add a brief intro of the HL-EU project and draw the connections, process of development --- how? The ‘transfer’/ ‘translation’process: HL-EU into HLSA

Methods - instrument self-administrated questionnaire Instrument: Questionnaire of HLS-Asia was translated into Vietnamese, and then back translated Face validation with experts Will pre-test with the target participants Data collection: self-administrated questionnaire

Sampling Research sites – Chi Linh town, Hai Duong province & 2 universities in Hanoi Hanoi capital Ward BenTam University of social sciences and humanities & Hanoi school of public health Rural VanAn sampling (multistage) Mountainous LeLoi

Results

Table 1: Socio-demographic characteristics of Hai Duong and 2 Hanoi universities randomly sampled population (n=966) Variables Values n Percentage HL Age Range 15-93   43.71 ± 18.7 15-24 184 19.0 30 25-34 157 16.3 35-44 165 17.1 28 45-54 181 18.7 29 55-64 123 12.7 65 and older 156 16.1 Gender Female 527 54.6 Male 439 45.4 The highest education attainment Junior high school and below 164 17.3 25 Senior high school 681 70.5 University and above 118 12.2 33 Marital status Not in marriage 298 30.8 Ever been married (married, divorced, widowed) 668 69.2 Religious belief Non-specific religion 846 87.6 Religion (Buddhism, Taoism, Christian, Catholics, Islam, Others) 120 12.4 24 Nen chia lam 2 slides cho ro rang vi chu qua be: (1) AGE + GENDER ; (2) the rest

Percentage distribution of Comprehensive HL levels and sub-domains

Determinants of Heath Literacy

Table 2: The association between demographic and socioeconomic of the population and their general health literacy, simple linear regression model Variables β (SE) + p Age -0.047 (0.015) .002 Gender   Female Male -0.264 (0.577) .648 Marital status Ever been married Not in marriage 0.633 (0.638) .321 Location Mountainous Rural 4.724 (0.780) <.001 Ward 8.786 (0.830) University 5.290 (1.647) Religious belief Religion None religion 5.422(0.854) The highest attained education University and above Senior high school -3.485 (0.829) < .001 Junior high school and below -7.976 (1.135) Self-perceived social status 0.240 (0.170) .159 Nen tach bang cho ro rang; chu y neu denominator la quan the nao cho ro rang va de hieu khi present. Chu y meaning cua regression model – the hien xu huong khac biet giua cac nhom cua IV? Noi khac di co moi lien quan voi DV la HL ko?

Table 2: (con’t) Variables β (SE) + p Net income per month Community involvement   Often Sometimes -3.404(1.785) .058 Seldom -4.240 (2.049) .039 Not at all -5.185 (1.917) .007 Net income per month -0.131(0.068) .054 Able to pay for medication Very easy Fairy easy -2.399 (0.360) < .001 Fairy difficult -3.910 (0.399) Very difficult -4.385 (0.622) Afford to see doctor -0.725 (0.363) .046 -1.713 (0.433) -1.251 (0.654) .056 Watching medical TV -0.715 (0.269) .008 Rarely -1.258 (0.287) Never -1.707 (0.294) tuong tu slide truoc + The differences (first category as the reference) were estimated by simple linear regression models

Correlations between several economic factors Spearman’s rho Pay for medication Afford doctor Pay the bills Income 1.00 .800** .312** -.134** Afford to see doctor   .300** .145** Afford to pay bills -.081* **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed. “Able to pay for medication” a good presenter for economic status

Table 3: The association between determinants and general HL, multiple linear regression model Variables β (SE) + p Age -0.003 (0.005) .499 Gender   Female Male 0.194 (0.149) .193 Location Rural Mountainous 0.241 (0.391) .538 Ward -0.244 (0.524) .642 Education University and above Senior high school -0.810 (0.274) .005 Junior high school and below -0.369 (0.217) .089 Nen tach 2 bang cho ro – present chi nen nhan manh den nhung lien quan co y nghia chu y neu denominator la quan the nao cho ro rang va de hieu khi present. Chu y meaning cua regression model – the hien xu huong khac biet giua cac nhom cua IV? Noi khac di co moi lien quan voi DV la HL ko?

Table 3: (cont’d) Variables β (SE) + p Able to pay for medication   Very easy Fairy easy -0.571 (0.244) .019 Fairy difficult -1.066 (0.273) < .001 Very difficult -1.151 (0.386) .003 Receiving medical training Yes No 0.377(0.383) .325 Watching medical TV Often Sometimes -0.695 (0.259) .007 Rarely -1.215 (0.277) Never -1.688 (0.284) + The differences (the first category as the reference) were estimated by multiple linear regression models

Table 4: Consequences of general health literacy, multiple linear regression model Consequences of HL β (SE) + p Health behaviours and risks   Physical activities -1.582(0.259) <.001 Alcohol consumption -4.404(1.813) .015 Smoking -.459(0.464) .322 Health status Self-perceived health 1.741(0.519) .001 Long-term illness -1.489(0.838) .076 Limitation related to health problem 1.631(0.944) .084 Frequency of doctor visits Western medicine doctor -0.943(0.489) .054 Dentists 1.584(0.681) .020 Chinese medicine doctor -1.535(0.761) .044 Waiting time for appointment -.588(.279) .035 0.424(0.427) .321 1.216(0.509) .017 Able to afford to see the doctor -2.647(0.692) Nen tach rieng 2 slides cho ro rang Neu ro denominator (quan the mau – toan bo hay nhom cu the nao) + Coefficient value (when HL change one unit) after adjusted for age, gender, social status, income

Conclusion

Determinations of HL Vietnam Demographics: residency location, religion. Socio-economics Education, financial deprivation, afford to see doctor. Self-perceived health Others watching medical TV program, frequency of doctor visits

Outcomes Health behaviours and risks Physical activities: Unable to do, not at all, few a month, few a week, daily Alcohol consumption: None, light, moderate, excessive, very excessive Self-perceived health, long-term illness, limited activities by health problems Frequency of doctors’ visits Western medicine doctor, Dentist, Chinese medicine doctor Waiting time for appointment Western medicine doctor, Dentist, Chinese medicine doctor

Further research Analyze the data combined with Hai Phong University Have a significant data of Health Literacy in Vietnam (data form the Center and North of )Vietnam Compare with those of neighbor countries in Asia-Pacific region Apply HLS(16) questionnaire

Thank you for your attention! For all