Determinants of Health Literacy and Healthy Lifestyle against Metabolic Syndrome among Major Ethnic Groups of Sarawak, Malaysia: A Multi-Group Path Analysis

Abstract

Introduction: Non-communicable diseases like metabolic syndrome can be prevented and controlled by practicing healthy lifestyle. Although health literacy is a critical factor in lifestyle modification to prevent non-communicable diseases and its complications, its role on metabolic syndrome prevention is still understudied. Objective: The main aim of this study was to identify the determinants of health literacy and healthy lifestyle practice against metabolic syndrome among multi-ethnic group of Sarawak based on health literacy skills framework. Methods: Using a stratified multistage sampling, a total of 1006 respondents were recruited to represent the major ethnic groups in Sarawak, Malaysia. Moderator variables, mediator variables and outcome variable (healthy lifestyle practice) were tested using path analysis to examine multiple and interrelated dependence relationships. Multi-group analysis was performed to compare structural models between major ethnic groups in Sarawak, namely Malay/Melanau, Native groups and Chinese. Results: Female respondents and those with higher education status were more likely to have better healthy lifestyle practice. Greater level of health literacy was positively significant with both disease knowledge and healthy lifestyle practice. Participants with good understanding of disease knowledge can directly influence healthy lifestyle. Simultaneously, health literacy and metabolic syndrome knowledge can mediate the relationship between sociodemographic variables, service accessibility, medical and family history with practice of healthy lifestyle. Multi-group path analysis indicated differences in causal pathway leading to healthy lifestyle practice among the ethnic groups. Conclusion: Health programs or interventions to increase health literacy skills and better understanding of metabolic syndrome will improve practice of healthy lifestyle. Culturally sensitive multidimensional approaches are needed to ensure health-related information can be delivered effectively across the state.

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“…Our results showed that of the HL dimensions, the ability to access health information and decision-making were significant predictors of lifestyle and explained approximately 34% of the variance in the model. Our findings are comparable to previous studies of Health literacy in Malaysia, 26 China, 29 and Japan, 30 which emphasized the importance of health literacy towards healthy lifestyle habits. Dominick et al found that the higher the health literacy, the higher physical activity selfefficacy.…”

“…Previous studies reported similar findings. [25][26][27] In addition, Sun et al, reported that education has a positive and direct effect on prior knowledge and health literacy. 28 This should help the policy of focusing on promoting health literacy and integrating the education of knowledge of specific diseases in the school curriculum.…”

Socio-demographic factors and healthy lifestyle behaviours among Malaysian adults: National Health and Morbidity Survey 2019

“…For instance, a study conducted in Taiwan showed that women had healthier dietary practices, a higher level of physical activity, lower rates of smoking and obesity, and maintain a healthy metabolic status compared to men 26 . Another possible factor contributing to more prevalent healthy lifestyle scores in women may be that women care more about their diet 27 . Women consumed more fruit and vegetable than men and less rice and sweetened beverages 28 .…”

“…Previous study suggested that other ethnic groups were more likely than Chinese, Malays and Indians to report being engaged in physical activity. According to a causal model of healthy behaviours among various ethnic groups in Sarawak, Malaysia, the Chinese population were found to possess a better level of healthy literacy, which results in the practice of healthy lifestyle 27 . A systematic review found that Chinese adolescents were associated with higher scores for healthy dietary patterns, which contributed to better diet quality compared to Malays 32 .…”

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“…28 LHL can also lead to a poorer quality of life (QOL). For instance, people with LHL are more likely to adopt an unhealthy lifestyle such as smoking or lack of exercise, which will increase risk of developing chronic diseases 29 and subsequently reduce their QOL. 30 Patients with lower HL are also less likely to use preventive health services, resulting in later diagnosis of cancer.…”