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HOME > J Korean Acad Community Health Nurs > Volume 26(3); 2015 > Article
Original Article
Health Literacy and Health Behavior in Late School-age Children
Byeong-Soon Jang, Dong-Hee Kim
Journal of Korean Academy of Community Health Nursing 2015;26(3):199-208.
DOI: https://doi.org/10.12799/jkachn.2015.26.3.199
Published online: September 30, 2015

College of Nursing, Pusan National University, Yangsan, Korea.

• Received: April 27, 2015   • Revised: August 1, 2015   • Accepted: September 14, 2015

© 2015 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was conducted to analyze the association between health literacy and health behavior and the effect of health literacy on health behavior in late school-age children.
  • Methods
    Data were obtained from 333 participants who were 5th and 6th-grade students sampled from 8 elementary schools in Busan. Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen) and Newest Vital Sign (NVS) was used for assessing linguistic and functional health literacy, and the health promotion behavior score was measured for health behavior.
  • Results
    The percentage of those with limited linguistic and functional health literacy was high (47.1%, 56.8%). Linguistic health literacy (r=.38, p<.001) and functional health literacy (r=.11, p=.048) had a correlation with health behavior. Health behavior was significantly associated with perceived health status (β=1.94, p<.001), number of times of health education (β=0.18, p<.001), academic achievement (p<.001), home literacy environment (β=0.13, p=.016), perception of changes after health education (p=.011), and linguistic health literacy (β=0.23, p<.001).
  • Conclusion
    The results of this study indicate that children with adequate health literacy are more likely to do health behaviors. Therefore, it is important to develop educational strategies to raise children's health literacy level and consequently to induce them to perform more health behaviors in daily life.
Table 1

Characteristics of the Participants (N=333)

Characteristics Categories n (%) M±SD
Grade 5th 165 (49.5)
6th 168 (50.5)
Gender Male 171 (51.4)
Female 162 (48.6)
Self reported achievement High 21 (6.3)
Middle 174 (52.6)
Low 136 (41.1)
No answer 2 (0.6)
Mother's education level ≤High school 55 (25.7)
College 128 (59.8)
≥Graduate 31 (14.5)
Don't know 119 (35.7)
Home literacy environment (books) <10 67 (20.1) 139.3±244.27
≥10 262 (78.7)
Self reportde health status ≤5 32 (10.1) 8.1±1.73
≥6 284 (89.9)
No answer 7 (2.1)
Diagnosed Disease No 295 (88.6)
Yes 38 (11.4)
 Allergic disease 21 (55.3)
 Other disease 17 (44.7)
Admission No 298 (90.0)
Yes 33 (10.0)
No answer 2 (0.6)
Frequency of health education ≤0.5/wk 96 (28.8) 0.7±0.21
>0.6/wk 237 (71.2)
Total 17.7±7.81
Primary source of learning health School 170 (51.2)
Media, Internet 57 (17.2)
Home 37 (11.1)
Books 32 (9.6)
Other 36 (10.8)
No answer 1 (0.3)
Major health information providers Parents 120 (36.1)
Health teacher 103 (31.0)
Doctors 61 (18.4)
Other 48 (14.5)
No answer 1 (0.3)
Interest in health education No interest 5 (1.6)
Usually 60 (18.8)
Interest 255 (79.7)
No answer 13 (3.9)
Perceived benefit for health education No benefit 3 (0.9)
Usually 37 (11.6)
Beneficial 280 (87.5)
No answer 13 (3.9)
Perceived changes after health education Knowledge 151 (46.3)
Attitude 115 (35.3)
Behavior 26 (8.0)
No change 34 (10.4)
No answer 7 (2.1)
Table 2

Health behavior Score and Health Literacy (N=333)

Variables Linguistic health literacy t (p) Functional health literacy F (p)
Limited
(n=157)
Adequate
(n=176)
Likelihood of limited (n=63) Possibility of limited (n=125) Adequate (n=142)
n (%) n (%) n (%) n (%) n (%)
Health literacy score 21.9±13.51 54.5±7.41 -27.68
(<.001)
0.6±0.50 2.6±0.49 4.9±0.81 1,065.63
(<.001)
Health behavior score 117.6±14.33 126.1±12.18 -5.84
(<.001)
119.9±15.07 121.8±13.68 123.2±13.55 1.30
(.275)
daily life and health 4.3±0.53 4.4±0.51 -4.34
(<.001)
4.2±0.55 4.3±0.54 4.4±0.50 1.55
(.214)
disease prevention and health 4.4±0.60 4.6±0.60 -2.85
(.005)
4.4±0.80 4.6±0.04 4.5±0.54 2.52
(.082)
Drug abuse prevention 4.4±0.60 4.6±0.60 -2.85
(.005)
4.4±0.80 4.6±0.04 4.5±0.54 2.52
(.082)
Gender and health 4.0±0.61 4.3±0.62 -4.29
(<.001)
4.1±0.75 4.2±0.62 4.3±0.55 2.41
(.092)
Mental health 4.3±0.77 4.6±0.69 -4.15
(<.001)
4.2±1.01 4.5±0.66 4.6±0.62 6.43
(.002)
Society and health 4.1±0.94 4.5±0.81 -3.85
(<.001)
4.0±1.06 4.3±0.82 4.4±0.88 2.90
(.057)
Injury prevention and first aid 3.9±0.75 4.2±0.76 -3.04
(<.001)
4.0±0.92 4.1±0.75 4.1±0.70 0.31
(.735)
Table 3

Differences in Health Literacy and Health Behavior Score according to Characteristics (N=333)

Characteristics Categories Linguistic health literacy x2 (p) Functional health literacy x2 (p) Health behavior x2 (p)
Limited Adequate Likelihood of limited Possibility of limited Adequate
n (%) n (%) n (%) n (%) n (%) M±SD
Grade 5 75 (45.5) 90 (54.5) 0.38
(.584)
43 (26.2) 55 (33.5) 66 (40.2) 11.23
(.004)
120.2±14.55 -2.52
(.012)
6 82 (48.8) 86 (51.2) 20 (11.9) 71 (42.3) 77 (45.8) 124.1±13.29
Gender Male 69 (48.9) 102 (53.1) 0.57
(.450)
38 (22.4) 63 (37.1) 69 (40.6) 2.67
(.264)
122.9±14.21 1.00
(.317)
Female 72 (51.1) 90 (46.9) 25 (15.4) 63 (38.9) 74 (45.7) 121.4±13.86
Self reported achievement High 56 (39.7) 80 (42.1) 3.42
(.181)
19 (14.0) 43 (31.6) 74 (54.4) 16.11
(.003)
125.9±12.40 19.83
(<.001)
(a>b>c)
Middle 72 (51.3) 102 (53.7) 40 (23.1) 68 (39.3) 65 (37.6) 120.8±13.68
Low 13 (9.2) 8 (4.2) 4 (19.0) 13 (61.9) 4 (19.0) 107.5±13.71
Mother's educational level (N =214) ≤High school 32 (38.6) 23 (17.6) 12.44
(.002)
8 (14.5) 28 (50.9) 19 (34.5) 5.12
(.275)
117.7±15.43 7.56
(.001)
(a, c<b)
Graduate 39 (47.0) 89 (67.9) 14 (10.9) 54 (42.2) 60 (46.9) 126.0±11.77
≥Postgraduate 12 (14.5) 19 (14.5) 7 (22.6) 11 (35.5) 13 (41.9) 124.9±14.67
Home literacy environment <10 39 (27.9) 28 (14.8) 8.44
(.004)
13 (19.7) 29 (43.9) 24 (36.4) 1.82
(.403)
45.7±16.03 -4.55
(<.001)
≥10 101 (72.1) 161 (85.2) 47 (17.9) 96 (36.6) 119 (45.4) 41.0±20.04
Self reported health status ≤5 15 (46.9) 17 (53.1) 0.00
(.986)
6 (18.8) 10 (31.3) 16 (50.0) 0.75
(.686)
112.9±16.38 -3.96
(<.001)
≥6 135 (47.0) 152 (53.0) 54 (18.9) 110 (38.5) 122 (42.7) 123.1±13.44
Diagnosed disease No 123 (42.1) 169 (57.9) 0.03
(.862)
56 (19.2) 111 (38.1) 124 (42.6) 0.54
(.764)
122.7±14.00 -0.96
(.338)
Yes 17 (43.6) 22 (56.4) 7 (17.9) 13 (33.3) 19 (48.7) 124.0±12.94
Admission No 129 (43.3) 169 (56.7) 2.06
(.152)
54 (18.1) 115 (38.6) 129 (43.3) 1.10
(.577)
121.8±14.06 -1.06
(.292)
Yes 10 (30.3) 230 (69.7) 8 (26.0) 10 (46.9) 9 (28.1) 124.5±12.64
Frequency of health education ≤0.5/wk 45 (46.9) 51 (53.1) 0.00
(.950)
27 (28.4) 32 (33.7) 36 (37.9) 7.72
(.021)
119.6±14.05 -2.05
(.041)
>0.5/wk 112 (47.3) 125 (52.7) 36 (15.2) 94 (39.7) 107 (45.1) 123.1±12.72
Perceived change after health education Attitude 47 (34.1) 68 (36.2) 1.04
(.792)
24 (21.1) 48 (42.1) 42 (36.8) 6.67
(.353)
122.9±14.73 5.14
(.001)
(a, b, c>d)
Knowledge 67 (48.6) 84 (44.7) 28 (18.5) 49 (32.5) 74 (49.0) 122.3±13.63
Behavior 9 (6.5) 17 (9.0) 5 (19.2) 10 (38.5) 11 (42.3) 125.6±8.10
No change 15 (10.9) 19 (10.1) 4 (11.8) 17 (50.0) 13 (38.2) 114.4±14.17

Scheffé test.

Table 4

Correlation among Health Literacy and Health Behavior

Variables Health behavior Linguistic health literacy Functional health literacy
r (p) r (p) r (p)
Health behavior 1
Linguistic health literacy (REALM-TEEN) .38 (<.001) 1
Functional health literacy (NVS) .11 (.048) .01 (.874) 1

REALM-TEEN=rapid estimate of adolescent literacy in medicine; NVS=newest vital sign.

Table 5

Hierarchical Multiple Linear Regression of Health Literacy on Health Behavior

Variables Model 1 Model 2
β t p β t p
Self reported health status 1.94 3.73 <.001 0.21 4.18 <.001
Times of health education 0.18 3.56 <.001 0.15 3.03 .003
Self reported achievement (1=high) 0.56 4.96 <.001 0.46 4.30 <.001
Self reported achievement (1=middle) 0.44 3.94 <.001 0.35 3.27 .001
Perceived changes after HE (1=no change) -0.13 -2.55 .011 -0.15 -3.11 .002
Home literacy environment (books) 0.13 2.42 .016
Linguistic health literacy 0.32 6.55 <.001
F (p) 15.15 (<.001) 23.01 (<.001)
R2 .24 (.235) .32 (.319)
Adjusted R2 .22 (.219) .31 (.305)

β=standarized beta; HE=health education; Dummy variables.

This study was supported by Research Institute of Nursing Science, Pusan National University.

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