Abstract
ObjectivesTo examine the association between health literacy (HL) and health-related quality of life (HRQoL) among primary and high school students in Nanjing, China.MethodsA 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.ResultsTotally, 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.ConclusionsHL 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.
Highlights
Health-related quality of life (HRQoL), a broad self-perception regarding physical and mental health conditions, is a comprehensive indicator usually used for both clinical and public health purposes to measure individual’s life quality [1,2,3]
Among these very few available studies on the relationship between Health literacy (HL) and HRQoL among school students, participants were limited to those students with a narrow range of age-groups (11–13, 15–19 or 12–15 years old) and the separate results could not be extrapolated to general population of children and adolescents [22,23,24]
The BEACH-Children Study was developed as a cross-sectional survey with three main objectives to investigate: (1) the link between built environment and obesity and physical activity (PA); (2) the association of lifestyle and behaviors with HRQoL; and (3) HL prevalence and its associated characteristics
Summary
Health-related quality of life (HRQoL), a broad self-perception regarding physical and mental health conditions, is a comprehensive indicator usually used for both clinical and public health purposes to measure individual’s life quality [1,2,3]. HRQoL has been examined to be associated with some lifestyle and behaviors among children and adolescents in Western countries and China [4,5,6,7,8,9,10,11]. This implies that lifestyle and behavior intervention may be of help for improving HRQoL among children and. Mainly including health-related knowledge, belief, skills and behaviors, are usually integrated into a scale to assess personal HL level among both adult and adolescent population worldwide [16,17,18,19,20]. Among these very few available studies on the relationship between HL and HRQoL among school students, participants were limited to those students with a narrow range of age-groups (11–13, 15–19 or 12–15 years old) and the separate results could not be extrapolated to general population of children and adolescents [22,23,24]
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