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Aim: Our aim was to assess the independent association between blood glucose level and health literacy (HL) adjusting for many socio-demographic characteristics and body mass index (BMI) in an adult population in Albania, a transitional country in the South Eastern Europe. Methods: A cross-sectional study was carried out in Tirana in 2012-2014 including a population-based sample of 1,154 individuals aged ≥18 years (57% women; mean age: 45.5 ± 16.4 years; response rate: 88.6%). HL was assessed by use of HLS-EU-Q instrument. Blood glucose level was measured in a fasting state by use of rapid finger stick method. Information on socio-demographic characteristics was collected, and BMI was calculated based on measurement of height and weight in all participants. General Linear Model (GLM) and binary logistic regression were used to assess the independent association of blood glucose level and HL adjusting for all socio-demographic factors and BMI. Results: One-third of participants had pre-diabetes (100-125.9 mg/dl) and further 11% had diabetes (≥126 mg/dl) based on the measured blood glucose level. In fully-adjusted GLM, mean blood glucose level was significantly lower among individuals with excellent HL compared with their counterparts with inadequate HL (99.3 vs. 106.0, respectively). Furthermore, the odds for the presence of diabetes in the group of study participants whose HL was "inadequate" were 2.6 times higher (95% CI = 1.3-5.4) compared to those whose HL was "excellent." Conclusion: We obtained evidence of a strong and significant inverse relationship between measured blood glucose level and HL, independent of many socio-demographic characteristics and measured BMI in a population-based study in a country of the Western Balkans.
Aim: Our aim was to assess the independent association between blood glucose level and health literacy (HL) adjusting for many socio-demographic characteristics and body mass index (BMI) in an adult population in Albania, a transitional country in the South Eastern Europe. Methods: A cross-sectional study was carried out in Tirana in 2012-2014 including a population-based sample of 1,154 individuals aged ≥18 years (57% women; mean age: 45.5 ± 16.4 years; response rate: 88.6%). HL was assessed by use of HLS-EU-Q instrument. Blood glucose level was measured in a fasting state by use of rapid finger stick method. Information on socio-demographic characteristics was collected, and BMI was calculated based on measurement of height and weight in all participants. General Linear Model (GLM) and binary logistic regression were used to assess the independent association of blood glucose level and HL adjusting for all socio-demographic factors and BMI. Results: One-third of participants had pre-diabetes (100-125.9 mg/dl) and further 11% had diabetes (≥126 mg/dl) based on the measured blood glucose level. In fully-adjusted GLM, mean blood glucose level was significantly lower among individuals with excellent HL compared with their counterparts with inadequate HL (99.3 vs. 106.0, respectively). Furthermore, the odds for the presence of diabetes in the group of study participants whose HL was "inadequate" were 2.6 times higher (95% CI = 1.3-5.4) compared to those whose HL was "excellent." Conclusion: We obtained evidence of a strong and significant inverse relationship between measured blood glucose level and HL, independent of many socio-demographic characteristics and measured BMI in a population-based study in a country of the Western Balkans.
BACKGROUND Introduction Health literacy (HL) refers to the people’s ability to find, understand and use health information in order to make appropriate health decisions [1], in an increasingly complex health care system [2]. Despite the many types and definitions of health literacy (for example, one recent systematic review identified more than 250 different health literacy definitions) [3], virtually all experts and studies agree that poor HL is a risk factor for sub-optimal health; on the other hand, health literacy is largely considered a modifiable risk factor thus opening new perspectives to address illness and disease (3). Many determinants of HL have been identified, including demographic (age, gender, education level, socio-economic status, etc.), as well as other psychosocial and cultural factors (4). The level of individual HL at a specific time and place is determined by many factors; indeed, scientific evidence shows that there is a strong link between literacy, education, health literacy and health status (5). In this context, health literacy might be the result of a life-long process, being built incrementally as one ages, learns (formally and informally) and interacts with the environment and other people. On the other hand, the consequences of poor health literacy are very diverse, at the individual and community level, and range from higher mortality and morbidity rates, higher engagement in risky health behaviors, lower health care service utilization at all levels and lower participation in screening programs (4). Health literacy is everybody’s business because we all, at some point in our lives, will need to find, understand and use health information and services (6). It is obvious that HL is important for every individual and, consequently, groups of society. This is even more critical for health professionals and especially for the young generation of students that will become the health professionals of tomorrow. This is because in order to be able to educate patients and inform them about health risk factors, health behaviors and their related benefits, first young professionals need to be health literate themselves (7). Balmer and colleagues argue that “the health literacy responsiveness of health organizations interacts with the health literacy of patients and their health outcomes”; in this context, a health organization first needs to have a health literate workforce in order to create health services that support the development of HL among service users (patients) [8]. As a consequence, it is important for academic institutions that train future health professionals to be aware of the health literacy level of their students, since the later will be an additional factor for building, supporting and developing the health literacy of the population as well [8]. In this context, we carried out a health literacy survey among undergraduate students of the Faculty of Nursing in Albania aiming to determine the actual HL literacy level among nursing students and the associated factors. OBJECTIVE Objective: The aim of this study was to assess the HL level of nursing students in order to shed light on this under-researched topic in Albanian settings. METHODS Methods Study population A cross-sectional survey was carried out among students of the Faculty of Medical Technical Sciences (Faculty of Nursing) in Tirana, Albania, during 22-29 June, 2022. The Faculty of Nursing is part of the University of Medicine, a publicly funded academic institution preparing the next generations of health professionals in Albania. The nursing students were recruited during the exams’ season. More specifically, all nursing students of all branches (nursing, midwifery, physiotherapy, and laboratory technician), of the first and second year of study, giving the exam on various subjects, were invited to participate in this study once they had finished their exam. Out of 247 students giving their exams on selected days and invited to participate, 53 students declined to do so because they didn’t have time. We didn’t collect any basic socio-demographic information about the non-participating students. Ultimately, 193 students participated in the survey yielding a response rate of 78.1% (193/247). Data collection The international full version of the HLS-EU-Q instrument (9) validated in the Albanian language (10) was used to assess the health literacy level of the participants. In line with the recommendations, the HLS-EU-Q instrument was administered face-to-face, using paper and pencil. Apart from HL questions, the questionnaire included the section of basic socio-demographic information requiring the respondents to report their age, gender, branch of study, employment status, marital status, social status and economic status. Before the interview, each participating student was explained in detail the purpose of the survey; subsequently, they were invited to read and sign an informed consent form. All participating students signed this form. This study was approved by the Committee of Bio-Medical Ethics of the Faculty of Medicine. Statistical analysis The HLS-EU-Q instrument contains a total of 47 items, each one rated on a Liker scale with 4 levels (very easy, fairly easy, fairly difficult, and very difficult) [9]. The HL items’ coding was reversed in order for higher scores to indicate better health literacy; a general health literacy index was calculated, summing up all 47 items, and standardized on a scale ranging from 0 to 50, in line with instrument developers’ recommendation (9). General health literacy was categorized into the following categories: inadequate health literacy (score 0-25), problematic health literacy (>25-33), sufficient health literacy (>33-42) and excellent health literacy (>42-50) [9]. The chi-square test was used to assess the distribution of HL levels by basic socio-demographic and health behavior variables. For our purposes, inadequate and problematic health literacy was collapsed into one single category denoting limited HL, versus sufficient and excellent HL that denotes appropriate HL. This newly created variable was used in binary logistic regression models to assess the association of limited HL with independent socio-demographic variables. Two models of binary logistic regression were employed: first, crude (unadjusted) odds ratios (ORs) were reported (Model 1 in binary regression analysis); subsequently, we controlled for the potential confounding effects of gender, age, branch of study, social and economic status of the students (Model 2 in binary regression analysis). All associations with a p-value <0.05 were regarded as statistically significant. The analysis was carried out using the Statistical Package for Social Sciences (SPSS) software, version 15. RESULTS Results The average HL score was 37.2, ranging from 16.7 to 50.0. Less than one in twenty students had inadequate HL, about one in five students had problematic HL, more than half (51.3%) had sufficient HL and about one in four students had excellent HL (Table 1). Table1. Distribution of general health literacy score among study participants Variable Value General health literacy score Mean Standard deviation Median Interquartile Range Minimum Maximum 37.20 6.69 37.59 33.33 – 41.84 16.70 50.0 General health literacy level [n (%)]* Inadequate Problematic Sufficient Excellent 9 (4.7) 38 (19.7) 99 (51.3) 47 (24.4) *Discrepancies in the totals are due to the missing values. The overwhelming majority of participants were female (93.8%), more than half were in the first year of study (20 years old), and more than 90% were studying in the nursing branch (nursing and midwifery). More than four in five students were not working (only studying) at the time of the survey, about 98% were single, about 90% had middle social class and about half had average economic status (Table 2). The prevalence of inadequate and problematic HL was significantly higher among boys and students with low social and economic status, whereas no significant differences were noted with regard to the remaining socio-demographic factors (Table 2). Table 2. Distribution of health literacy levels by socio-demographic characteristics ofstudy participants Variable Total Health literacy P Inadequate Problematic Sufficient Excellent Gender Male Female 12 (6.2)* 181 (93.8) 3 (25.0) * 6 (3.3) 3 (25.0) 35 (19.3) 4 (33.3) 95 (52.5) 2 (16.7) 45 (24.9) 0.005† Age-group 20 years old 21 years old 112 (58.0) 81 (42.0) 3 (2.7) 6 (7.4) 24 (21.4) 14 (17.3) 58 (51.8) 41 (50.6) 27 (24.1) 20 (24.7) 0.443 Branch of study Nursing Midwives Physiotherapy Lab. technician 97 (50.3) 79 (40.9) 7 (3.6) 10 (5.2) 4 (4.1) 5 (6.3) 0 (0.0) 0 (0.0) 17 (17.5) 17 (21.5) 0 (0.0) 4 (40.0) 51 52.6() 37 (46.8) 5 (71.4) 6 (60.6) 25 (25.8) 20 (25.3) 2 (28.6) 0 (0.0) 0.456 Employment status Working student Not working student 26 (13.5) 167 (86.5) 2 (7.7) 7 (4.2) 3 (11.5) 35 (21.0) 15 (57.7) 84 (50.3) 6 (23.1) 41 (24.6) 0.601 Marital status Not married‡ Married 189 (97.9) 4 (2.1) 9 (4.8) 0 (0.0) 38 (20.1) 0 (0.0) 97 (51.3) 2 (50.0) 45 (23.8) 2 (50.0) 0.552 Social status Low Middle High 6 (3.1) 173 (89.6) 14 (7.3) 3 (50.0) 6 (3.5) 0 (0.0) 1 (16.7) 35 (20.2) 2 (14.3) 2 (33.3) 92 (53.2) 5 (35.7) 0 (0.0) 40 (23.1) 7 (50.0) <0.001 Economic status Very bad/bad Average Good/very good 3 (1.6) 95 (49.2) 95 (49.2) 1 (33.3) 4 (4.2) 4 (4.2) 1 (33.3) 23 (24.2) 14 (14.7) 1 (33.3) 53 (55.8) 45 (47.4) 0 (0.0) 15 (15.8) 32 (33.7) 0.016 * Absolute numbers and percentages in parentheses (row percentages for the health literacy categories, but column percentages for the totals). Discrepancies in the total numbers are due to the missing values. † P-values from the chi-square test. ‡ Single, divorced and widowed. Table 3 shows the socio-demographic factors associated with inadequate/problematic general health literacy. In multivariable adjusted analysis (Model 2), the only demographic factor that statistically increased the likelihood of inadequate/problematic HL was male gender with male students being 8.13 times more likely to report inadequate/problematic HL compared to female students (Table 4). The associations with the remaining socio-demographic factors were not significant. Nevertheless, there was a tendency for the likelihood of limited HL to be decidedly higher among students with low social status (OR=6.28 vs. high social status students) and students with bad economic status (OR=3.59 vs. good/very good economic status students). Table 3. The association of inadequate/problematic general health literacy with basic socio-demographic factors – ORs from Binary Logistic Regression Variable Model 1 * Model 2 ** OR (95%CI) P-value OR (95%CI) P-value Gender Male Female 3.42 (1.01-11.16) 1.00 (Reference) 0.042 8.13 (1.68-39.39) 1.00 (Reference) 0.009 Age-group 20 years old 21 years old 1.00 (Reference) 1.03 (0.53-2.01) 0.926 1.00 (Reference) 1.11 (0.50-2.46) 0.805 Branch of study Nursing Midwives Physiotherapy Lab. Technician 1.00 (Reference) 1.40 (0.70-2.78) - (-) 2.41 (0.62-9.35) 0.562 (3) ⁋ Reference 0.342 - 0.202 1.00 (Reference) 1.62 (0.73-3.60) - (-) 2.77 (0.62-12.36) 0.507 (3) Reference 0.235 - 0.181 Employment status Working student Not working student 1.00 (Reference) 1.41 (0.50-3.98) 0.515 1.00 (Reference) 1.57 (0.50-4.94) 0.438 Social status Low Middle High 12.00 (1.25-115.4) 1.86 (0.40-8.67) 1.00 (Reference) 0.073 (2) 0.031 0.427 Reference 6.28 (0.49-80.79) 1.74 (0.34-8.86) 1.00 (Reference) 0.361 (2) 0.159 0.507 Reference Economic status Good/very good Average Very bad/bad 1.00 (Reference) 1.70 (0.86-3.35) 8.56 (0.74-99.61) 0.102 (2) 0.127 0.087 Reference 1.00 (Reference) 1.69 (0.80-3.56) 3.59 (0.16-80.97) 0.309 (2) 0.169 0.421 Reference * Model 1: Crude (unadjusted) ORs, from univariate analysis. ** Model 2: Multivariable adjusted ORs, controlled for gender, age, branch of study, social and economic status. ⁋ Overall P-value and degrees of freedom (in parenthesis). CONCLUSIONS Conclusion Our findings might support policy-makers and education professionals to design and implement gender-specific interventions in order to reduce the gender gap in health literacy among nursing students in Albania. On a broader perspective, such targeted interventions need to be implemented in lower education levels and extra school environments as well, taking into account the socio-demographic determinants of health literacy. CLINICALTRIAL N/A
BACKGROUND Health literacy (HL) refers to people’s ability to find, understand, and use health information in order to make appropriate health decisions. Health literacy among students is important so that tomorrow’s health professionals can deliver high-quality health care and enhance patient education and communication. OBJECTIVE In this context, the aim of this study was to assess the HL level of Faculty of Medical Technical Sciences (FMTS) students in order to shed light on this underresearched topic in Albanian settings. METHODS A cross-sectional study involving 193 FMTS students of various study branches (nursing, midwifery, physiotherapy, and laboratory technician) was carried out during June 22-29, 2022, on the premises of the FMTS Faculty in Tirana, Albania. The international European Health Literacy Survey Questionnaire (HLS-EU-Q) standardized questionnaire, validated in Albanian, was used to collect information about FMTS students’ general HL through a face-to-face interview. Basic sociodemographic information was collected as well. Binary logistic regression was used to assess the factors associated with inadequate, problematic, or limited HL. RESULTS The mean level of general HL was 37.2 (on a scale from 0 [minimum HL] to 50 [maximal HL]). About one-quarter of FMTS students had inadequate (9/193, 4.7%) or problematic (38/193, 19.7%) HL, 51.3% (99/193) had sufficient HL, and 24.4% (47/193) had excellent HL. The prevalence of limited HL (inadequate and problematic HL) was higher among male than female students (6/12, 50% vs 41/181, 22.6%, respectively) and those with lower social and economic status. Upon adjusting for confounding effects, the only factor significantly increasing the likelihood of limited HL was male gender (odds ratio 8.13, 95% CI 1.68-39.39). Findings suggested that low social and economic status also increased the likelihood of limited HL, but such associations did not reach statistical significance. CONCLUSIONS To our knowledge, this is the first study exploring the level of HL and its associated factors among FMTS students in Albania. The prevalence of limited HL was relatively high among FMTS students. There is a need for targeted interventions to increase the HL of nursing and midwifery students, such as the inclusion of HL subjects in the nursing curriculum.
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