1. HEALTH LITERACY ASSESSMENT IN PAKISTAN Preliminary Results DR. SHAHZAD ALI KHAN MBBS, MBA, MPH, FRSPH, PhD HEAD OF THE DEPARTMENT OF HEALTH MANAGEMENT HEALTH SERVICES ACADEMY, ISLAMABAD PAKISTAN shahzad@hsa.edu.pk

2. HEALTH SYSTEM IN PAKISTAN Pakistan has 200 Million population; with 24% below the poverty line; 67% population Rural; 33% Urban Mixed Health Systems with Large Public Sector and even larger Private Sector, There Double burden of diseases; Communicable disease: 44%; NCDs: 56% Three major biases in Pakistan Health Systems: 1.Pro-Curative; 2.Pro-Urban 3.Pro-Rich (over 80% OOPS)

3. 48% men and 8% women: smoke 65% of urban and 79% rural population take less than one serving of fruit a day; 90% of Pakistan’s population consumes less than two servings of vegetables/day. In leisure domain, 90% population is: Inactive. 28.4% urban, 23.3% rural population: Overweight 20% population15-40Yrs have Hypercholestrolaemia 25% over 18 Yrs Age have High blood pressure About 10% population has Diabetes Approx. 6% have Hep-c; and 4% have Hep-B Diarrhoea prevalence in children is 21% Anemia in Pregnant women is 40% 5 th Largest number of TB cases in the world Third largest maternal death in the world Highest number of Polio Cases in the World (203 to date) LIFESTYLE RISK FACTORS: HIGH IN PAKISTAN

4. HEALTH LITERACY ASSESSMENT IN PAKISTAN

5. HEALTH LITERACY ASSESSMENT Researchers were involved from different central and regional level Institutions –Health Services Academy, Islamabad –Pakistan Institute of Medical Sciences, Islamabad –Punjab Social Security Hospital –Insight Research, Pakistan – Provincial Health Departments

6. PROPORTIONATE PROBABILITY SAMPLING INVOLVING ALL FOUR PROVINCES Proportionate Probability Sampling; Two Staged First Stage: Urban Blocks In cities And Villages In Rural Areas Second Stage: Interviews Of Selected individuals 15ys ++ HLS-Asia Tool Used After Translation Into Urdu First, the piloting was done for self administered basis; but it was realized that personal Interviews to be Done Individually By Data Collection Team Long Time To Complete Interview; There is a Need To Make It Concise There Were Problems Of Understanding In Some Questions

7. RESULTS Analysis under process !!! These are just preliminary findings 994 FORMS COMPLETED; –Punjab: 52% –Khyber Pakhtunkhwa: 24% –Sindh: 14% –Balochistan10% Male Female Ratio: 62:38 All respondents were Muslims Mean Age: 33Yrs; Majority respondents between 25-40Yrs; Majority (83%) were Married; Education status: 32% Senior School; 33% College; and 24% Masters level education senior high school to university

8. RESULTS 97% had no medical related training Over 73% reported no chronic disease in the family 66% reported Never watched medical related TV program Similarly 65% reported Never using internet for medical related information Although 55% have had some educational courses; 83% reported never having any health/medical related course Many (48%) were using Public Transportation;

9. RESULTS Majority of respondents Find it “Fairly Difficult” –Find information related to Symptoms:90%“Fairly Difficult” –Find information related to Doctors: 91% “Fairly Difficult” –Understand medical Emergency: 89% “Fairly Difficult” 40% find it Fairly Easy; and 38% Very Easy to understand what doctors say 90% Find it “Fairly Difficult” to understand information in the Leaflets of medicine 40% find it Fairly Easy and another 20% find it Very Easy to Understand what to do in Emergency 33% find it Fairly Easy and another 42% find it Very Easy to Understand doctor/pharmacist prescription

10. RESULTS 40% find it Very Easy; 28% find it Fairly Easy to judge information from doctors 89% find it Fairly Difficult to judge advantages and disadvantages of treatments 37% find it Very Easy and another 20% find it Fairly Easy to judge information from doctors 89% find it Fairly Difficult to Judge information about illness in media 28% find it Very Easy and another 44% find it Fairly Easy to use information from doctors 31% find it Very Easy and 42% find it Fairly Easy to follow prescription of medicine

11. RESULTS 24% find it Very Easy and 44% find it Fairly Easy to call an Ambulance while other 32% find it difficult. 29% find it Very Easy and 43% find it Fairly Easy to follow instructions given 34% find it Very Easy and 36% find it Fairly Easy to find information about healthy behaviours 90% find difficulty getting information related to mental health 21% find it Very Easy and 35% find it Fairly Easy to find information about need of vaccines and screenings 91% find difficulty getting information related to weight, blood pressure control and cholesterol

12. RESULTS Only 22% find it Very Easy and 45% find it Fairly Easy to find understand health warnings and other 33% find it difficult. 20% find it Very Easy and 34% find it Fairly Easy to understand why get vaccinations 25% find it Very Easy and 44% find it Fairly Easy to judge reliable warnings 28% find it Very Easy and 45% find it Fairly Easy to judge when to go to a doctor 30% find it Very Easy and 38% find it Fairly Easy to find information about healthy lifestyle 27% find it Very Easy and 38% find it Fairly Easy to find activities for mental health 89% find difficulty in efforts to promote health at work 89% find difficulty understanding information on food pack

13. RESULTS 85% reported never chewing betel;84% reported not smoking 81% reported not doing exercise (physical activity) 77% reported availability of family member for doctor visit 98% reported having NO Insurance Majority had to contact emergency service in the last 2 years Majority had to visit doctors in last 12 months Time taken in consultation ranged from less that 5 to about 15 minutes in most cases Few raised a question during last doctor appointment 29% rated their health Very Good; 37% as Good; 25% as Fair while 5% rated as bad or very bad Over half of the respondents reported having high level in society; while other half as low level in society

14. WAY FORWARD Undertake detailed Analysis of the data Continue process of data collection given that there are now many organizational partners in Pakistan willing to contribute Do the surveys in Clusters, Strata, subgroups and analyze responses in different groups Train health providers in HL and highlight its role in inerventions of health promotion Publish the findings on regular basis