The relationship between health literacy and health-related quality of life among school-aged children in regional China

Abstract

Objectives To examine the association between health literacy (HL) and health-related quality of life (HRQoL) among primary and high school students in Nanjing, China. Methods A cross-sectional study was conducted among randomly selected primary (graders 4–6), junior (graders 7–9) and senior (graders 10–12) high school students in 2018 in Nanjing Municipality of China. HRQoL, the outcome variable, was assessed with the validated Chinese version of Child Health Utility 9D (CHU9D) and used as continuous variable, while HL, our independent variable, was measured with the validated Chinese Students’ Health literacy Assessment Scale and treated as categorical variable (“adequate” or “inadequate”) in the analysis. Mixed-effects linear regression models were introduced to calculate mean difference and 95% confidence interval (CI) for examining the association between HL and HRQoL. Results Totally, 4388 of 4498 students completed the survey. Among these responders, the mean score of CHU9D was 0.78 ± 0.17, and the proportion of participants with adequate HL was 85.8% (95% CI = 84.7%, 86.8%). After adjustment for potential confounders and class-level clustering effects, participants who had adequate HL were observed having, on average, an elevated HRQoL score of 0.08 (95% CI = 0.06, 0.11) units compared to their counterparts with inadequate HL. Such a positive HL-HRQoL association was also identified among each stratum of participants’ age, gender and residence. Conclusions HL was positively associated with HRQoL score among primary and high school students in China. It has public health implications that HRQoL may be improved through school-based health literacy intervention among children and adolescents in China.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

“…In 89 relevant papers in HL, studies authored by Chinese scientists are the most prevalent, with 27 studies that surveyed HL levels in various groups of people. They were patients 22 -27 or general public, secondary, 28 -30 high school, 30,31 college students, 32,33 women, 34 12 years old and above, 16,15,35 -43 or older adults. 44 -47 Taiwan had the second-highest number of HL measurement articles, with 16 published papers.…”

Coping with identity threat and health literacy on the quality of life and mental health in students: Structural equation modeling

“…The results of a study in 2022 showed that there is a significant relationship between the level of health literacy and the dimensions of quality of life (physical dimension, psychological dimension, and overall quality of life), so that people with higher health literacy have higher physical and mental quality of life as well as higher health‐related quality of life 36 . It has been shown in a study that people with sufficient health literacy had a higher quality of life, and there is a relationship between health literacy and the physical and mental aspects of quality of life 37 …”

“…36 It has been shown in a study that people with sufficient health literacy had a higher quality of life, and there is a relationship between health literacy and the physical and mental aspects of quality of life. 37 It was shown in a systematic review that health literacy was related to quality of life, and health knowledge, health behavior, health beliefs, and health skills were related to quality of life. There is, however, a need for more studies.…”

Are Health Literacy and Physical Literacy Independent Concepts? A Gender-Stratified Analysis in Medical School Students from Croatia

“…Indeed, in a comprehensive review, it was shown that the individuals with lower HL had poorer global health status, were more likely to express symptoms of depression, and had higher all-cause mortality rates [ 8 ]. In addition, a study on Indonesian adolescents identified that HL was related to health behaviors, including physical activity [ 12 ], while another study recorded that HL was associated with health-related quality of life (i.e., self-perception of mental and physical health conditions) among Chinese schoolchildren [ 13 ]. Moreover, low levels of HL were linked to increased body weight and obesity [ 14 , 15 ] and poor nutritional habits, including increased sugar, fat, and salt intake in children and adolescents [ 16 ].…”