Gender-based Inequalities in Health literacy among an Iranian Kurd Population: Results of a Community Survey

Abstract

Background Health literacy (HL) as a social determinant of health has a determinant role in providing different populations with healthcare services, in an equal manner. Our aim in this study was to investigate the contribution of socio-demographic factors to functional health literacy (FHL) in a population of Iranian adults and identify differences in the contribution of these factors across genders.Methods This community-based cross-sectional study was conducted in 2015 to 2016 in Sanandaj, Iran. Multistage cluster sampling was employed to recruit 1000 people older than 18 (response rate = 89.2%) from 35 urban and 10 rural health care centers through home-based interviews. Test of functional health literacy in adults (TOFHLA) was used to assess FHL. In order to measure inequality in FHL, a concentration index decomposition was used.Results Participants included 869 respondents (57.5% women) with a mean age of 33.68 year. Participants demonstrated an average TOFHLA score of 51.9. Women demonstrated slightly higher TOFHLA scores (52.2 [SD: 0.46]) compared to men (50.7 [SD: 0.4]). However, the concentration index for gender was 10.9% suggesting gender contributed only moderately to TOFHLA scores. Comparatively, 54.3% of TOFHLA differences were attributed to geographic location. Among women, place of residence, monthly income age, education level, being head of household, and contributed to 43%, 32%, 13%,11.5% and 11%, of FHL inequality, respectively. Among men, however, place of residence (45.2%) size of household (15.1%), and monthly income (13.5%) contributed most to inequality in FHL.Conclusions This research suggests sociodemographic characteristics contributed differently to FHL inequality depending on gender. Understanding these differences may assist in identifying and targeting interventions towards men and women with low levels of FHL. Furthermore, work by health policy makers and health promotion specialists to address these contributing social factors may help to alleviate inequalities in health literacy.