Adolescent Health Literacy in Beijing and Melbourne: A Cross-Cultural Comparison

Abstract

While adolescent health literacy has gained momentum, it is under-researched from a cross-cultural perspective. This study aims to compare health literacy among two cultural groups of secondary students in Beijing and Melbourne. A cross-sectional study was conducted with 770 students from five secondary schools in Beijing and Melbourne. A self-administered questionnaire was designed to collect information on health literacy (the eight-item health literacy assessment tool (HLAT-8), the Newest Vital Sign (NVS) and the 47-item Health Literacy Survey (HLS-47)), its antecedents and health outcomes. Overall, students’ health literacy in Melbourne (n = 120) was higher than that in Beijing (n = 650): 28.25 ± 6.00 versus 26.37 ± 5.89 (HLAT-8); and 4.13 ± 1.73 versus 3.65 ± 1.64 (NVS). The proportion of students with low health literacy varied by instruments, representing 23.7–32.2% in Melbourne and 29.0%–45.5% in Beijing. In both cultural groups, students’ self-efficacy, social support, and perceptions of school environment were associated with their health literacy, which in turn predicted their health behaviours, patient-provider communication and health status. Given the nature of our study design and small samples, a cautious conclusion would be that adolescent health literacy is sensitive to the broad cultural context and might be an interactive outcome influenced by an individual’s health skills and the social environment. Particularly, creating a supportive school environment is critical to develop adolescent health literacy that would eventually contribute to better health outcomes.

A Comparative Study on Adolescents’ Health Literacy in Europe: Findings from the HBSC Study

“…When these findings are linked to the findings showing clear differences in HL between and within countries, one can identify a definite public health and health promotion issue in the extremes of low and high HL encountered. Similar findings on the association between HL and self-rated health have been reported previously [13], also among adult populations [7,19].…”

“…A previous study of Finnish adolescents showed that HL explained 10% of the variation, and more than gender, FAS school achievement, educational orientation, or age, which together with HL explained 12% [4]. Few other studies have shown findings of a similar size range [13,14] even if a study on adult samples reported stronger effects [37]. In any case, bearing in mind also that self-rated health is a robust predictor of mortality [38], it can be suggested that any factor that contributes to a decrease in health disparities is important, including HL.…”

“…Nationally conducted studies have shown that higher HL is more common among various categories, including girls [10], children from more affluent families [10][11][12], those with higher school achievement [10,12], and those with the motivation to learn health issues [11]. Furthermore, higher HL has been associated with better self-rated health [13,14]. There are clear public health issues involved in understanding how differences in self-rated health operate, as either a subjective indicator of general health, or as a robust measure of it [15,16].…”

Interdisciplinary Perspectives on Health Literacy Research Around the World: More Important Than Ever in a Time of COVID-19

“…Several articles consider the critical importance of tailoring by community, culture, and need, including several that provide an international comparison. In "Adolescent Health Literacy in Beijing and Melbourne: A Cross-Cultural Comparison", Guo and colleagues [83] consider adolescent health literacy from a cross-cultural perspective. In "Factors that Influence the Former Soviet Union Immigrants", Kostareva et al [84] consider the unique health literacy needs of those from a specific cultural context in whatever country they arrive.…”

“…We have research from Europe (e.g., Lithuania, Germany, Austria, Denmark, Sweden), North America (e.g., USA, Canada), and Asia (e.g., Vietnam, Taiwan) along with research from Africa (Ghana), which is understudied in health literacy. We also consider cross country comparisons-comparing Beijing and Melbourne in the study by Guo and colleagues [83] and the health literacy of former Soviet Union immigrants across the globe in the study by Kostareva et al [84].…”