Research On Health Literacy And Metabolic Syndrome Of Cadres Above Division-level In South War Zone

BackgroundBeing the nucleus of army, the health state about cadres above division-level makes us worry about it. The morbidity of chronic non-communicable diseases about this group is high, especially the morbidity of cardiovascular and cerebrovascular diseases. Currently, health education and health promotion are the most effective and economical ways of chronic disease. Health literacy has caught great attentions of relative organization and institution around the world for its significance to health education and health promation. It plays an active role in self-health management skill, and transformation of the bad mode of life and behavior.The breakthrough point of most study on health outcomes is chronic diseases in public health direction. However, there are many different kinds of chronic diseases, such as cardiovascular disease, cancer and lumbocrural pain, etc. The prevalence of different kinds of chronic diseases, risk factors and prevention focus are different. The main kind of chronic diseases about cadres above division-level were cardiovascular disease. Metabolic syndrome and its four main components(obesity, dyslipidemia, hypertension, and diabetes mellitus or sugar regulation damaged) is one of the chronic diseases and is closed with cardiovascular disease.ObjectiveThis study intends to provide theoretical base and evidence for researches by descriptive review and systematic assessment of pertinent literature, investigating health literacy and metabolic syndrome on cadres above division-level in south war zone respectively, analyzing research results of health literacy and chronic disease qualitatively, and offer practical experience for health education and chronic disease prevention to cadres above division-level.MethodsOur research methods include descriptive literature review, systematic assessment, questionnaire survey, prevalence survey, cluster sampling, statistical analysis and analytic induction, etc.Firstly, we descriptively review pertinent literature of health literacy and metabolic syndrome, sort out its connotation, definition and dimension, assessment method, relative theory, conception of metabolic syndrome and characteristics of epidemiology and master the research trend in China and other countries to support further study on the correlation between health literacy and metabolic syndrome.Secondly, with the method of system evaluation, Chinese adult prevalence of metabolic syndrome was analysed, together with the metabolic syndrome rate of different gender, different age groups, male /female at different ages, different year of study and different areas.Thirdly, our study adopts a cross-sectional observational study and chooses two questionnaires on health literacy, one is from perspective of health public, and the other is from clinic perspective. 633 cadres above division-level from 5 provinces in south war zone are invited to finish these two kinds of questionnaires. Meanwhile, we also check relative results of health examination of cadres of that year to judge their applicability analyze current situation of health literacy and metabolic syndrome of participants and explore the influence factors and relationship of health literacy and metabolic syndrome.To verify and improve the quantitative study, we discuss the differences on cognition of chronic diseades and life style between different levels of cadres and explain the health literacy to metabolic syndrome by qualitative research, interview and semi-fixed questionnaire.Stata 13 software is used for evaluation, Epidata 3.1 for logging data and verification, SPSS 19.0 for descriptive statistics, tests of variance, chi-square test, Logistic regression and Atlas. ti 5.0 for analyzing research result.ResultsSystematic assessment on morbidity of adult metabolic syndrome base on IDF criteria.1. Retrieved result. From July 2005 to June 2015, there were 129 theses found by computer and manually, which covered 646773 adults.2. Random effects model was used for data consolidation, prevalence of adult based on IDF criteria was 22.2%(95% CI: 20.7%-23.7%).3. Random effects model was used for meta-analysis of different subgroups. The prevalence of male was 21.1%(95% CI: 19.5%-22.7%), prevalence of women was 21.8%(95% CI: 19.8%-23.7%). Prevalence in different age group were: for ≥20-30 year old 6.9%(95% CI: 5.6%-8.2%), for ≥30-40 year old 12.7%(95% CI: 9.9%-15.5%), for ≥40-50 year old 22.2%(95% CI: 19.0%-25.4%), for ≥50-60 year old 30.3%(95% CI: 26.4%-34.3%), for ≥60-70 year old 35.8%(95% CI: 30.8%-40.8%) and for for ≥70 year old 38.7%(95% CI: 34.4%-43.1%). Difference between prevalence in different ages of male and female showed that except for ≥50-60 years old age, the rest of the five ages(≥ 20-30 years old, ≥30-40 years old, ≥40-50 years old, ≥60-70 years, ≥70 years) had statistical significance.Prevalence in different study years were: for 2000 prevalence rate 12.7%(12.1%-13.3%), for 2002 prevalence rate 13.1%(9.2%-16.9%), for 2003 prevalence rate 14.8%(9.8%-19.8%), for 2004 prevalence rate 26.7%(20.0%-33.3%), for 2005 prevalence rate 24.7%(18.3%- 31.2%), for 2006 prevalence rate 26.0%(22.2%-29.8%), for 2007 prevalence rate 23.6%(20.4%-26.9%), for 2008 prevalence rate 25%(19.1%-30.9%), for 2009 prevalence rate 20.1%(16.2%-24.0%), for 2010 prevalence rate 18.8%(14.5%-23.1%), for 2011 prevalence rate 23.8%(15.8%-31.7%), for 2012 prevalence rate 20.3%(19.2%-21.4%) and for 2013 prevalence rate 28.5%(27.7%-29.3%).Prevalence in different region was: for south 19.1%(17.5%-20.8%) and north 25.5%(23.1%-28.0%).4. Sensitivity analysis. The sensitivity analysis for Chinese adult prevalence of metabolic syndrome, the metabolic syndrome rate of different gender, different age groups, male /female at different ages, different year of study and different areas, one research was deleted each time in order to observe the effect on the combined effect. The result showed after excluding one study, the remaining studies were uniformly distributed in the total combined both sides of the effect size, which had little effect on the total combined value.For the difference of different gender and different age with different gender, the result of sensitivity analysis showed that the remaining studies were uniformly distributed in the total combined both sides of the effect size, which have little effect on the total combined value.5. Publication bias analysis. Except the total prevalence rate and male prevalence rate, other subgroup existed no publication bias.6. Meta- regression analysis. Univariate meta-regression analysis showed that area can affect heterogeneous size. And multivariate analysis showed that area and study year can explain some heterogeneity.Survey result on health literacy of cadres above division-level in south war zone1. With multi stage stratified cluster sampling method, a total of 714 samples was selected and finally 633 questionnaires were completed. The effective rate was 88.6%2. Health Literacy Questionnaire of Chinese Residents is chose to be the assessment form of public health and Health Literacy Questionnaire of Chronic Patients of clinical evaluation. The results show that the rates of 633 cadres with high health literacy are 51.82% and 100% in the two scales respectively.3. The survey results of Health Literacy Questionnaire of Chinese Residents on cadres above division-level are as follows. The possessing rate of health literacy is 51.82%, basic knowledge and belief is 54.81%, healthy life style is 1.48% and basic skill is 98.52%. That is to say, the possessing rate of basic knowledge and belief and skill is obviously higher than the first survey on health literacy of Chinese residents(p<0.05) while healthy life style is obviously lower(p<0.05).4. Univariate analysis shows that different age, gender, education degree, family history of participants can influent their health literacy greatly. Logistic regression analysis presents that women compared with men, high health literacy OR(95%CI) was 3.426(1.881-6.242). Age OR(95%CI) was 0.839(0.796-0.885). In marriage compared with unmarried(unmarried, widowed and divorced), high health literacy OR(95%CI) was 2.463(0.170-0.973). Having a family history compared no family history, high health literacy OR(95%CI) was 0.565(0.400-0.800).Logistic regression analysis presents that women compared with men, high basic knowledge and belief OR(95%CI) was 0.446(0.267-0.744). Age OR(95%CI) was 0.944(0.903-0.987). Having a family history compared with no family history, high basic knowledge and belief OR(95%CI) was 0.610(0.439-0.847). We did not found any variable can influent life style of these cadres. The high basic skill of age OR(95%CI) was 0.829(0.717-0.960).Current situation of metabolic syndrome1. There are 89 general participants, 349 high risk participant and 195 patients of metabolic syndrome which account for 14.10%, 55.13% and 30.77% respectively. Overweight and central obesity(52.71%) is the most common index of high risk group and elevation of blood pressure(70.83%) is the major constituent of metabolic syndrome group.There are 3 people are abnormal in 4 components(1.54%), 64 in 3(32.82%) and 128 in 2(65.64%) in metabolic syndrome group.There are 17 people are abnormal in 3 components(4.87%), 163 in 2(46.70%) and 169 in 1(48.42%) in high risk group.2. The univariate analysis shows that gender, education degree, family history can influent health literacy greatly of cadres above division-level(p<0.05).Logistic regression analysis presents that high basic knowledge and belief compared with low basic knowledge and belief, the MS OR(95%CI) was 0.228(0.144-0.359). High health literacy compared with low health literacy, the MS OR(95%CI) was 0.524(0.323-0.850). Female compared with male, the Ms OR(95%CI) was 0.408(0.204-0.818). The Ms of age OR was 1.060(1.005-1.118). In marriage compared with unmarried(unmarried, widowed and divorced), the Ms OR(95%CI) was 0.354(0.145-0.866). Having a family history compared no family history, the Ms OR(95%CI) was 1.495(1.015-2.200). Bachelor degree or above compared with junior college or bachelor degree, the Ms OR(95%CI) was 0.495(0.329-0.746).Logistic regression analysis presents that high basic knowledge and belief compared with low basic knowledge and belief, the high risk population OR(95%CI) was 0.018(0.005-0.070). Female compared with male, the high risk population OR(95%CI) was 0.108(0.041-0.285).Qualitative research results on metabolic syndrome and chronic disease1. Health literacy influents the accessing, tackling and understanding of chronic disease information. The results show that participants with higher health literacy and lower health literacy present different attention on chronic disease. Participants wit h higher health literacy tend to pay more attention to chronic disease and have better understanding of risk factors, while participants with lower health literacy tend to pay less attention, lack of or only have abstract understanding of chronic disease. It is also different in their way of getting information and understanding degree. Continuous comparisons and analyses illustrate that health literacy may affect cadres above division-level on their process of accessing, tackling and understanding of chronic disease information.2. Health literacy influents life style. Researches show that participants with higher health literacy and lower health literacy have various understanding of diet, exercise, smoking and drinking. That is to say, reasonable diet, fitting exercise and abstinence of smoking and drinking are important for prevention of chronic disease. Besides that, participants with higher health literacy can figure out concrete measures and execute strictly.Conclusion1. In the recent 10 years, the prevalence of metabolic syndrome in adults is high, which is a major health problem in adults. According to the risk factors of metabolic syndrome, the specific intervention can reduce the prevalence rate of metabolic syndrome, and promote the health status of the population.2. Health Literacy Questionnaire of Chinese Residents is more suitable for our participants, and it needs a deeper research on assessment method. The factors which influent the health literacy of cadres are various. Health intervention related with different age, gender is conducted to improve their health literacy and especially their life style. Meanwhile, the health literacy of soldiers and officers require enhancement to maintain the development of the army.3. The situation of metabolic syndrome of cadres above division-level is not optimistic and it will even hinder the development of military construction. Cadres in south war zone have similar age structure, diet habit and life style. In order to have a better understanding of the complex of risk factor and provide support and reference for career character and life habit, we suggest a group intervention according to living habit. Those cadres with lower health literacy, of middle and elder age, with bachelor degree below and male with family history of chronic disease should be given priority interventions. Therefore, the intervention can decrease morbidity of metabolic syndrome and promote their health.4. Cadres with different health literacy have different understanding of chronic disease, life style and acquiring and tackling related information. Cadres with lower health literacy are more likely to have difficulties in comprehension while those with higher health literacy tend to have a more concrete and comprehensive understanding of health life style and obtain a more healthy living habit. After deep analysis on the reaction between health literacy and metabolic syndrome, it is easy to see that higher health literacy is good to decreasing the morbidity of metabolic syndrome and improving the health of cadres above division-level.Cadres above division-level are embodied with higher education experience, receptivity, learning ability and self-esteem. Thus, on one hand, carrying out health education, propaganda and training for cadres is easier to achieve result. These activities can promote their basic knowledge, skill and belief and improve their life style and the overall health literacy. On the other hand, as cadres above division-level are nucleus of military and national construction, promoting health of in-service cadres above division-level by enhancing their health literacy on chronic disease, which regard metabolic syndrome as key point, is crucial to the steady development of the army, even to our country.