Understanding the risk factors for infectious diseases, their prevention, and control, among residents of Zhejiang Province

Abstract

Objective: To investigate the understanding of infectious diseases, their prevention, and control, and the factors influencing this literacy among urban and rural residents of Zhejiang Province. Methods: In November- December 2014, a multistage stratified cluster sampling questionnaire was administered at study sites in eight districts of Zhejiang province: Hangzhou city Gongshu district, Hangzhou city Chun'an county, Wenzhou city Cangnan county, Dongyang city, Jiaxing city Jiashan county, Zhoushan city Putuo district, Linhai city, Lishui city Jinyun county. The inclusion criteria were: 15-60 years old, living locally for more than six continuous months, and no mental illness. The exclusion criteria were: foreigner residing locally, resident of Hong Kong, Macau, or Taiwan, or unable to communicate through speech or writing. In this study, 4 091 questionnaires were distributed, and 4 020 valid questionnaires were returned(98.26%). Health literacy regarding infectious diseases was measured at five levels: knowledge, skills, behaviors, access to information, and understanding of the prevention of infectious diseases. A total score was calculated for each questionnaire, and a total score of ≥80 was deemed to indicate an understanding of the prevention of infectious diseases. A χ2 test was used to compare the levels of health literacy in different populations with single-factor analyses, and a multivariate unconditional logistic regression model was used to analyze the factors affecting infectious diseases prevention and treatment literacy levels. Results: Of the 4 020 respondents(aged(43.84 ± 10.28)years), 1 964 were male(48.86%)and 2 056 were female(51.14%). In the total surveyed population, 15.17%(n=610)understood the prevention of infectious diseases, 294 were male(14.97%)and 316 were female(15.37%)(χ2=2.48, P=0.115). When the participants in the different age groups were analyzed, 23.11%, 20.29%, 13.27%, and 11.04% of those aged 18- 29(n=116), 30- 39(n= 166), 40- 49(n=178), and ≥50 years(n=150), respectively, understood infectious disease prevention(χ2= 63.16, P<0.001). When the participants were analyzed according to education, 46.01%, 24.86%, 12.03%, 5.27%, or 2.39% of those educated at university(n=167), at high school/vocational school/college(n=175), at middle school(n=215), at elementary school(n=46), or who were illiterate/slightly literate(n=7), respectively, understood infectious disease prevention(χ2=436.67, P<0.001). Among the urban(n=336)and rural participants(n=274), 18.98% and 12.18% understood infectious disease prevention, respectively(χ2= 35.57, P<0.001), so the urban residents had better health literacy than rural residents(OR=1.28, 95% CI= 1.06- 1.54), and those aged 18- 29 or 30- 39 years had even better health literacy than the rural residents(OR=1.39, 95%CI=1.01-1.91). When the health literacy levels of migrant workers were compared with those of agency/institutional personnel, business people, unemployed, and retirees, the OR(95% CI)values were 2.52(1.82-3.49), 1.69(1.24-2.30), 2.99(1.65-5.39), and 2.43(1.59-3.72), respectively. When the illiterate/slightly literate were compared with those educated at university, high school/vocational school/secondary school, and junior high school, the OR(95%CI)values were 35.11(15.73-78.36), 13.31(6.11-28.99), and 5.37(2.48-11.62), respectively. Conclusion: Limited levels of health literacy are common among the residents of Zhejiang Province. Lower education level, older age, and rural residence were predictors of low health literacy in this study.