Abstract
BackgroundWe examined the relationship between health literacy (HL) and health-related quality of life (HRQoL) as well as relationship differentials by ethnicity among rural women from a Chinese poor minority area.MethodsWe conducted in-person interviews with 913 rural women aged 23 – 57 (57.5% Hui minorities/42.5% Han ethnicity) enrolled in the Ningxia Women Health Project, gathering data on EQ-5D, self-designed HL, socio-demographic characteristics, and chronic diseases. The extent of impairments in the five dimensions of the EQ-5D was used to measure HRQoL. Factor analysis yielded a single HL factor, which was used as a dichotomous variable in multivariate log-binomial regression models that examined the adjusted association of HL with HRQoL.ResultsNearly half of the women had no formal education. The most prevalent impairments were pain/discomfort and anxiety/depression (42.42% and 32.09%, respectively). The Hui minorities had 1.65 times higher rates of low HL (defined as less than mean of the factor score for HL) and 1.22 and 1.25 times for pain/discomfort and anxiety/depression impairments, respectively. Low HL was associated with poor HRQoL, with a 23% increase in the prevalence of pain/discomfort impairments after adjusting for socio-demographics. This association was significant in the Hui group (PR=1.30, 95% CI=1.06-1.58) but not for the Han group (PR=0.99, 95% CI=0.76-1.30). HL-stratified analysis revealed modification for ethnic disparities in HRQoL; for pain/discomfort impairments, high HL-PR=0.88 (95% CI=0.71-1.08), low HL-PR=1.24 (95% CI = 1.01-1.52); for anxiety/depression impairments, high HL-PR=0.98 (95% CI=0.73-1.32), low HL-PR=1.44 (95% CI = 1.05-1.98).ConclusionsLow HL is associated with poor HRQoL across the entire sample and the association may be modified by ethnicity. Similarly, ethnic disparities in HRQoL may be modified by HL, larger in low HL group. Health services should address HL in vulnerable minority women to improve their HRQoL.
Highlights
We examined the relationship between health literacy (HL) and health-related quality of life (HRQoL) as well as relationship differentials by ethnicity among rural women from a Chinese poor minority area
The participants were young and physically healthy women, so a ceiling effect may contribute to lower prevalence of mobility, selfcare and usual activities across Han and Hui women based on the strong negative association of HRQoL and physical health with age [30]
Our study provides some valuable insights into the complex association between HL and ethnic disparities in HRQoL in a poor minority area of China
Summary
We examined the relationship between health literacy (HL) and health-related quality of life (HRQoL) as well as relationship differentials by ethnicity among rural women from a Chinese poor minority area. Low HL is consistently associated with poor health outcomes, such as global health status, mortality, hospitalization and preventive health care use [7], but data on its relationship with HRQoL are insufficient and equivocal [5,7,8,9,10,11]. Another study using EQ-5D to measure HRQoL showed no significant relationship between HL and HRQoL among patients with rheumatic diseases [12] Despite these mixed findings, theoretical models provide three potential pathways that link low HL to health disparities: 1) decreased accessibility and use of medical care because individuals with low HL may have difficulty navigating the health care system, 2) increased stress burden by increasing the challenges of daily life and health system navigation and illness self-management, and 3) decreased self-efficacy, i.e. We believe that enhancing HL could reduce health disparities
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