The Association Between Health Literacy,Self-efficacy And Health Status Among Residents In Qingdao,China

Objective: Health literacy is regarded as a key determinant of individual health status.The improvement of health literacy is not only a vital part of the people’s needs for a better life,but also a comprehensive strategic requirement for economic and social development in China.Previous studies have found that health literacy is closely related to health status.Specifically,insufficient health literacy can lead to decline of quality of life,poor prognosis of cancer,worse control and management of chronic disease,etc.Some psychosocial factors such as selfefficacy can also have a positive impact on health status.The physiological,psychological and social functions and health status and overall health status of individuals with high selfefficacy are better than those with low self-efficacy.Besides,previous studies have shown that self-efficacy is not only affected by health literacy,but also related to individual health status.Based on the above theory,the research used self-reported chronic disease and self-assessed health status as the evaluation indicators of health status,discuss the association between health literacy,self-efficacy and health status,and explore the mechanism of self-efficacy in the association between health literacy and health status.Methods: Based on The Chinese Citizen Health Literacy Questionnaire(2019),the study added the contents of self-efficacy scale and self-rated health status scale,and investigated the non-collective residents aged 15-69 years in 10 districts in Qingdao,China according to the multi-stage stratified random sampling.The questionnaire consists of demographic characteristics,health literacy,self-efficacy scale and self-rated health status scale.The health literacy includes three dimensions: basic knowledge and concept literacy,healthy lifestyle and behavior literacy,and health skill literacy.Based on the Chinese version of the general selfefficacy scale,the core questions suitable for measuring the self-efficacy of this study were compiled to evaluate the self-efficacy of residents.The self-rated health status scale was measured by Euro Qol-visual analogue scale.The health literacy,chronic diseases and selfrated health status were analyzed by univariate analysis.Multivariate logistic regression analysis was adopted to explore the relationship health literacy,three dimensions of health literacy and self-reported chronic diseases.BP neural network was adopted to rank the importance of various factors affecting self-reported chronic diseases among residents.Spearman correlation was adopted to analyze the association between health literacy,three dimensions of health literacy,self-efficacy and self-rated health status.In this study,we used health literacy score and three dimensions of health literacy score as independent variable,self-efficacy as the mediator,self-rated health status as dependent variable,fitting multiple linear regression model to analyze the mediating effect of self-efficacy on health literacy and self-rated health status.All models were adjusted for the potential confounders: urban or rural residence,gender,age,education,annual family income,smoking,drinking and physical exercise.Results: A total of 6,385 non-collective residents aged 15-69 years were investigated in Qingdao,with a mean age of 49.14±13.18 years,of which 51.07% were men.The results showed that the overall level of health literacy was 19.78%,of which the basic knowledge and concept literacy level was 32.55%,the healthy lifestyle and behavior literacy level was 22.62%,and the health skill literacy level was 25.50%.In the analysis of the relationship between health literacy,self-efficacy and self-reported chronic disease,the prevalence of chronic disease was18.37%.Logistic regression analysis showed that overall health literacy,basic knowledge and concept literacy,and health skill literacy were related to self-reported chronic disease,and were the protective factors of self-reported chronic disease.BP neural network model showed that self-efficacy ranks second in the importance ranking of various factors affecting the prevalence of self-reported chronic disease.In the analysis of health literacy,self-efficacy and self-rated health status,the results found that the average score of self-rated health status was85.99±11.60.The bivariate correlation matrix displayed that overall health literacy and three dimensions of health literacy were positively correlated with self-efficacy and self-reported health status.The mediation analysis showed that self-efficacy mediated the associated between overall health literacy,three dimensions of health literacy and self-rated health status,and the mediating effect of self-efficacy were 0.018(95% CI: 0.013~0.023,P<0.001),0.038(95% CI: 0.027~0.049,P<0.001),0.035(95% CI: 0.023~0.048,P<0.001),0.069(95% CI:0.052~0.087,P<0.001),accounting for 34.62%,29.69%,41.18%,33.33% of the total effect,respectively.Conclusions:(1)There was a negative correlation between health literacy and self-reported chronic diseases.(2)There was a positive correlation between health literacy and self-rated health status.(3)Self-efficacy plays an important role in suffering from chronic disease among residents.(4)Self-efficacy mediates the association between health literacy and self-rated health status.Health literacy can improve residents’ health status by enhancing individual selfefficacy.