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

Abstract

Background Health literacy, as a social determinant of health, has a decisive 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. Test of functional health literacy in adults (TOFHLA) was used to assess FHL. In order to measure inequality in FHL, concentration index decomposition was used. Results In total, 869 respondents (response rate: 86.9%) with a mean age (standard deviation; SD) of 33.68 (13.0) completed TOFHLA questionnaire. More than half of participants were women (57.5%). 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 and being head of household 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 Although gender was not the strongest contributing factor for FHL inequalities, poor FHL was mostly concentrated among men. Different factors were attributed to FHL inequality by gender, as discussed inside. Understanding these differences may assist in identifying and targeting interventions towards men and women with low levels of FHL. Our findings shed light the critical role of social determinants of health (SDH) in promoting the health literacy of populations, particularly in developing countries like Iran.