Abstract
Health literacy (HL) is an individual ability as well as a distributed resource available within an individual’s social network. We performed an explorative study assessing the role of HL as the country-level ecological variable in predicting the health disparities among immigrants. Country-level HL data were obtained from the publicly available first European Health Literacy Survey reports. Individual-level data on citizenship, perceived health status, body mass index, smoking habits, physical activity and attendance at breast and cervical cancer screening were extracted from the European Health Interview Survey of Eurostat. Data from both sources were obtained for Austria, Bulgaria, Greece, Poland and Spain. The country-specific odds ratio (OR) for the association between the participants’ citizenship and other individual health-relevant characteristics was pooled into summary OR using random-effects models. Meta-regression was used to explore whether the HL of a country could explain part of the between-countries heterogeneity. Results: For the perceived health status, nutritional status and attendance at cervical cancer screening, the lower was the country-level HL (as ecological variable), the higher were the health inequalities relating to citizenship. The results of our exploratory research suggest that improving the population HL may help mitigate health inequalities between residents and migrants.
Highlights
Health literacy (HL) is gaining critical importance in public health
The study participants differed substantially across countries (p-value < 0.001) in terms of characteristics that were used in subsequent analysis, including the demographics age group and gender, citizenship, educational level and employment status, marital status, degree of urbanisation of their area of residence, health status, anthropometry, lifestyle and, among women, attendance at cancer screening programmes (Table 2)
The proportion of missing values was below 1% for age, gender, citizenship, educational level, employment status, marital status, degree of urbanisation and the presence of underlying illnesses or health problems; between 1% and 5% for physical activity levels and attendance at breast or cervical cancer screening; and above 5% for perceived health status (5.5%), body mass index (9.2%) and smoking habits (6.1%)
Summary
From the original perspective focusing on handling words and numbers in the medical context, the concept has gradually expanded to include more complex abilities relating to information-seeking, decision-making, problem-solving, critical thinking and communication, all of which are crucial in interacting with the health system [1]. Freedman [2] defined public heath literacy as “the degree to which individuals and groups can obtain, process, understand, evaluate, and act information needed to make public health decision that benefit the community”. This is distinct from, yet related to, individual-level HL.
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