1. Health Literacy among Urban Residents in Klang Valley, Malaysia
Tin Tin Su 1, Emma Mohamad 2, Hazreen A Majid 1
1. Centre for Population Health (CePH)
Faculty of Medicine
University of Malaya
2. School of Media and Communication Studies
Universiti Kebangsaan Malaysia

2. Content Health Literacy among Low-income Urban Residents
Cancer Awareness & Anticipated Delay in Help Seeking
Practice of reading food labelling
Awareness of own health status
II. Exploring Health Literacy by using (HLS-Asia-Q) among urban residents in Klang Valley

3. I. Health Literacy Among low- Urban Residents
“PARTNER” Participatory Action Research Through Negotiation & Empowerment of Residents A cross sectional survey was carried out in four community housing projects in Kuala Lumpur during The majority of residents belong to low income groups.

4. The survey recruited a population-representative sample by simple random sampling.
833 households were selected. Total participants for questionnaire survey were 3722
2,360 adults (at least 18 years old) from selected households were invited for medical screening
From invitees, 1,192 (50.5%) participated in medical screening

5. Cancer awareness and anticipated delay in help seeking
The awareness of cancer symptoms, anticipated delay and barriers in health seeking were accessed by using the validated Cancer Awareness Measure (CAM) questionnaire.
The CAM questionnaire was developed by Cancer Research UK, University College London, Kings College London and Oxford University in 2007–08.

6. Socio demographic characteristics of adult participants
Age: 39.8 year (SD 16.4)
Gender: Male (47.1%)
Majority are Malay (82.4%)
Income: 57% of households’ monthly income
< RM 2,000/month

7. Awareness of cancer signs and symptoms
Assessed by prompted and unprompted questions
(unprompted) there are many warning signs and symptoms of cancer. Please name as many as you can think of:……………….
(prompted) Do you think an unexplained lump or swelling could be a sign of cancer?
……persistent unexplained pain , persistent cough or hoarseness(changes in voice) ………….

8. Awareness of warning signs and symptoms
Unprompted (Recall)
(%)
Prompted (Recognition)
Yes No
Don’t Know
Unexplained Lump or Swelling
18.4
61.0
20.6
62.0
23.6
14.5
Persistent Unexplained Pain
9.5
69.9
56.3
26.5
17.2
Unexplained Bleeding
7.1
72.2
20.7
52.2
29.8
18.0
Persistent Cough or Hoarseness (Changes in Voice)
1.1
78.3
39.1
37.8
23.1
Persistent Change in Bowel or Bladder
0.3
79.1
33.2
40.0
26.9
Persistent Difficulty Swallowing
0.1
79.3
37.7
37.9
24.4
Changing in Appearance of a Mole
34.6
42.2
23.2
Soar that Does not Heal
36.7
47.0
16.3
Unexplained Weight Loss
1.9
77.6
20.5
44.6
33.4
22.0
22.1% has 0 knowledge on warning sign and symptoms

9. Anticipated delay in seeking care
If you had a symptom that you thought might be a sign of cancer, how soon would you contact a doctor to make an appointment to discuss it?
589 (25%) of the participants had anticipated delay (>2 week) in help seeking

10. Components of Help-Seeking Barriers (n=2360)
Yes (%)
No (%)
Don’t Know (%)
Emotional Barriers
Too Embarrassed
14.5
77.3
8.3
Too Scared
26.5
65.0
8.5
Worried What Doctor Will Find
21.7
69.8
8.6
Service Barriers
Worried about Wasting Doctor’s Time
5.0
86.4
Difficult to Talk with Doctor
8.9
82.5
Difficult to Make an Appointment
11.2
80.3
Practical Barriers
Too Busy
14.7
76.7
Many Things to Worry About
11.5
58.5
30.0
Difficult to Arrange Transport
8.1
83.4

11. Logistic Regression :Predicting Delay in Help-Seeking controlling socio-demographic characteristics
Adjusted OR (CI)
Prob.
Symptom Knowledge
0.80 (0.77, 0.84)
<0.000
Emotional Barriers
None
Reference
At Least One
2.20 (1.71, 2.83)
Service Barriers  
1.26 (0.92, 1.73)
0.144
Practical Barriers
0.95 (0.70, 1.28)
0.739

12. Practice of Reading Food Labelling
Reading and Understanding Food Label (N=1624)
HHH
Spouse of HHH
Reading food label/nutritional information
67%
75%
Understanding food label
53%
59%

13. Types of Food label read (multiple response)

14. Awareness of own health status
Known Hypertension (HPT) : Hypertension diagnosed by doctor or medical staff
Among 18 years and above
Frequency
Percent
HPT_Not diagnosed
2153
89.6
HPT_Diagnosed
250
10.4
Total
2403
100.00
*Prevalence of known Hypertension
NHMS 4 (2011) : 12.8 %

15. Participants with high BP Known HPT Unknown (undiagnosed)HPT
Finding from medical screening
PPR
Participants with high BP
Known HPT
Unknown (undiagnosed)HPT
Kerinchi
182
46 (25%)
136 (75%)
Seri Cempaka 58
11 (19%)
47 (81%)
Pantai Ria 87
25 (29%)
62 (71%)
Seri Pantai
15 (17%)
72 (83%)

16. Known Diabetic (DM) : Diabetes which had been confirmed by any medical personnel
Among 18 years and above
Frequency
Percent
DM Not Diagnosed
2207
91.8
DM_Diagnosed
196
8.2
Total
2403
100.00
*Prevalence of known diabetes
NHMS 4 (2011) : 7.2 %

17. Results from medical screening
Mean
Std. Deviation
Random Blood Sugar
6.51
3.70
Random Blood Sugar
Male
Female
Frequency
Percent
<5.6
263
368
631
52.9
198
266
464
38.9
>11 39 51 90
7.6
Missing 7
0.6
Total
1192
100
Prevalence of DM (both known and unknown) in NHMS IV: 15.2%

18. Conclusions
Health Literacy among low income-urban population are quite low
(symptoms awareness, reliance for taking care own health)
Individuals with adequate degree of health literacy are able to take responsibility of their own health, as well as their families and surrounding communities.
Health promotion campaigns are essential for low income population to improve their health literacy.
This effort could reduce help-seeking barriers and promote early diagnosis of diseases.

19. Current status of health literacy study in Malaysia
No national or population representative data on general health literacy
Available data focused on either particular study population and/or specific disease – mostly show poor health literacy
This presents a huge potential and benefit for GHL study to be conducted nationwide in Malaysia

20. II. Exploring Health Literacy by using (HLS-Asia-Q) among residents in Klang Valley
600 participants from Klang Valley (Kuala Lumpur & Selangor)
Purposive Quota Sampling: 200 for each ethnicity (Malay, Chinese and Indian)
The questionnaire was translated to Malay (national language)
The demographic part (19 questions) and health literacy component (47 items)

21. Components of questionnaire on Health Literacy
Access Information for
Health Care, Disease Prevention, Health Promotion
Understand Information for
Appraise Information for
Apply Information for
3 to 5 questions under each domain and answers can be scored as 1-4, very difficult , fairly difficult, fairly easy, very easy

22. Access Information for Understand Information for
Health Care
Disease Prevention
Health Promotion
Total score 16 20 12
Mean
11.5
11.95
14.45
11.57 9
11.85
Median 15
Percent of respondents ≤ 50th percentile score
(low health literacy)
9.8%
7.17%
7.83%
7.5%
8.67%
7.33%

23. Appraise Information for
Apply Information for
Health Care
Disease Prevention
Health Promotion
Total score 16 20 12
Mean score
11.09
14.12
8.97
12.07
8.58
11.87
Median score 11 14 9
Percent of respondents ≤ 50th percentile score
(low health literacy)
12.33%
11%
7.33%
4.16%
11.16%
9.17%

24. On going study: Parental health literacy and health status of adolescents
1) To measure health literacy among parents of Malaysian adolescents
2) To identify the association of parental health literacy and life style behavior such as smoking, alcohol drinking, diet and physical activity among adolescents
3) To assess the correlates of parental health literacy and body composition indices such as body mass index, body fat percentage, waist circumference, among Malaysian adolescents
4) To identify the association of parental health literacy and cardiovascular risk factors such as cardiorespiratory fitness, blood pressure, blood glucose and lipid level among Malaysian adolescents

25. Sample size: 1500 school children from 15 schools (urban 10; rural 5)
Study Area: Central and North Zone of Peninsular Malaysia
Study Population: School Children of Form 1, aged 13
Study Design: Prospective cohort study of school children
Sampling: Stratified random sampling
States
WPKL
Selangor
Perak
Urban
Rural
Total # of Schools 96
187 74
114
124
Total # of Sample Schools 3 4 2
Sample size: school children from 15 schools (urban 10; rural 5)
7/3/2013

26. MyHEARTs Study: Adolescent Cohort
2012
MyH I
13yr
N = 1361
2014
MyH II
15 yr
N = 1247
2016
MyH III
17 yr
2026
MyH 2026
27y
930 old, 344 new
7/3/2013

27. Thank you