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Original Article
- Health Literacy and Health Behavior in Late School-age Children
- Byeong-Soon Jang, Dong-Hee Kim
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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
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© 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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Abstract
-
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.
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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.
Characteristics of the Participants (N=333)
Health behavior Score and Health Literacy (N=333)
Differences in Health Literacy and Health Behavior Score according to Characteristics (N=333)
Correlation among Health Literacy and Health Behavior
Hierarchical Multiple Linear Regression of Health Literacy on Health Behavior
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Figure & Data
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XML Download| 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) |
| 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) |
| 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 | ||||
| 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 |
| 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) | ||||
†Scheffé test.
REALM-TEEN=rapid estimate of adolescent literacy in medicine; NVS=newest vital sign.
β=standarized beta; HE=health education; †Dummy variables.
Table 1
Table 2
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Table 5
College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
E-mail: office@rcphn.org
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