| BackgroundThe prevalence and mortality of chronic diseases in China showed a rising trend, currently, which has become an important public health problem that threatens to public health. It is necessary to maintain and promote public health by enhancing the level of public health concept and health literacy, strengthening self-health management level, and transformation of the bad mode of life and behavior. Health literacy has become one of the important indexes to evaluate the public health quality in some countries. Health literacy study in abroad starts early, in which connotation and evaluation studies are relative mature. In Sorensen’s research, there are12health literacy models and17different concepts of health literacy. In health literacy assessment researches, there are35different health literacy assessment methods, in which the Test of Functional Health Literacy in Adults(TOFHLA),the Rapid Estimate of Adult Literacy in Medicine (REALM) and the latest measurement tools of Newest Vital signs (NVS) are commonly used. It is because of short time for evaluation that the REALM and NVS are welcomed by users. It was in2005that our country introduced Health literacy concept and we did research since2007. The Health Administration Department of China carried out health literacy survey of public and evaluated66items in whole country in2008and2009,2012and2013respectively. The survey content in2008included health concept, basic health knowledge, healthy lifestyle and behavior, and basic skills, a total of79items, and we increased the proportion of tobacco control program after2012, in which cover103items totally, and the evaluation time was more than20minutes. The different regions of our country carry out monitoring and evaluation research based on national questionnaire for reference, which includes too much assessment content.The related research usually is a direct copy from foreign measurement method, without considering the China’s culture and economy, so it’s hard in the popularization and application. Therefore, we should draw lessons from the foreign thought of rapid assessment of health literacy, combining the reality of health education and health literacy in our country, and developing scientific and effective rapid assessment tool of health literacy in our country, which considerate public health and clinical medicine, individual and the group characteristics, and organic combination of health literacy and health status, health management together. It will become the common assessment tools, and facilitates comparison between different regions and different countries in different evaluation time for health literacy.Scientific assessment is an important foundation for carrying out an effective intervention and the main basis to select the appropriate intervention techniques. There are important significances to explore the appropriate health education intervention ways which are suitable for whole population based on the urban public health management. We takes a lot of health literacy education at current, which was mainly comprehensive way to disseminate health literacy knowledge, such as TV, newspapers, radio, Internet, brochures, posters, billboards, speaking tour, tour, knowledge contests, and promotional activities in our country. However, the text massage form for large-scale population education intervention has not been reported now. It is widely accepted that short massage cover a large number of audience, high viewing rate, management flexibility, lower cost, highly targeted, and re-disseminated characteristics. Thus it has been used in Health education and behavioral interventions in special populations in domestic and abroad, such as High blood pressure, diabetes, maternal, kidney disease. The Low health literacy lead to the low health service utilization, delayed diagnosis, less understanding of the medical condition and treatment, self-health management skills shortage, poor health, and high mortality rate, so we should seek an more effective method of low health literacy intervention. The effective entry points of improving health are public intervention and improve self-management skills of health. As far as we know, there is no research about the combination of Health literacy, health management and health status in China.In summary, it is necessary to carry out health literacy, health management, health status-related research and to build health literacy rapid assessment tool, which can be used to effectively carry out the scientific assessment of health literacy. In addition, targeted and effective intervention measures should be adopted to improve health literacy, health management and health status.ObjectiveThis study intends to explore a practical, scientific, and easy to operate for public rapid assessment of health literacy combined with short message intervention system, which can link the rapid assessment of health literacy with self-health management, eventually to promote the public health literacy and health status. It would provide an important decision basis for improving and completing the urban public health literacy education intervention and public health management.MethodsOur research methods include literature retrieval, interdisciplinary method, panel discussion, Delphi expert consultation, cross-sectional survey, and quasi experimental research, etc.First, we study the backgrounds by literature retrieval which covered the connotation, evaluation and correlation of the health literacy, health management and health status, then we grasp the progress and current problems in home and abroad. We should put forward the innovative research ideas and research content combined with existing problem of health education in Shenzhen city, which will provide the basis for the new connotation of health literacy research in the future.Second, we analyze the data of public health literacy from cross-sectional survey in Shenzhen, which were collected by household surveys way (according to the stage sampling survey, we selected32communities with6,413residents in Shenzhen, effective rate of the questionnaire was98.66%). We did in-depth analysis of public health literacy, health management, health status, and their influencing factors, which provide the reality basis for constructing the practice and real effective rapid assessment system of health literacy.Third, the new connotation and the new model of health literacy were proposed by interdisciplinary research which is helpful to the development of health education work. We construct health literacy evaluation index system of rapid assessment system mainly based on Delphi expert consultation method by consulting24experts, and combining the reality of Shenzhen city.Finally, a quasi-experimental study was carried out and3205people participate in message intervention. The aim is to verify the stability and practicability of the health literacy evaluation index system, and also to verify the effectiveness of the intervention with short message to enhance public health literacy and healthy level.The SPSS21.0software was used for descriptive statistics, test of variance, t test, chi-square test, Logistic regression, hierarchical cluster analysis, correlation analysis and other statistical analysis.Results1. Access the current situation of the public health literacy based on the original health literacy assessment system and the standards of health literacy in Shenzhen city(1) The level of the public health literacy in Shenzhen city was not high. The percent of having health literacy was6.28%, with the level of overall health literacy knowledge59.86%, the level of health behavior66.94%, and the level of health literacy skills59.32%. After Logistic regression analysis,age(OR=1.09), gender(OR=1.79),household registration(OR=)0.67,the degree of culture(OR=1.76), family(OR=0.75), health management(OR=1.67) are considered as the influence factors of the public health literacy in Shenzhen.(2) The public health consciousness in Shenzhen is not high. Only30.91percent of citizens in Shenzhen consider life and behavior factors as the most important affect factors of health, which is lower than60%reported by WHO, and there are statistical differences between our report and WHO (X2=38.36, P<0.001). By Logistic regression analysis, The household registration of Shenzhen(OR=1.23), high cultural degree(OR=0.78), high personal income(OR=1.12), no smoking(OR=1.16), check-up once per year(OR=1.25), exercise more2-3times per week(OR?=1.25), well status of self-reported health(OR=1.18), none prevalence in two weeks(OR=0.83) are positive influence factors. The evaluation of life and behavior factors account for high proportion to affect health, while marital status (divorced and widowed)(OR=0.78), high medical costs(OR=0.96) are negative factors.(3) The proportion of public self-health-management in Shenzhen is not high. Only29.47%of the citizens of Shenzhen have the basic self-health-management. By the binomial Logistic regression analysis, age(OR=1.22), female(OR=1.20), high-education level(OR=1.24), high personal income(OR=1.07), large family population(OR=1.23), household registration of Shenzhen(OR=1.13), suffering from chronic diseases(OR=1.22) are the influence factors of self-health-management.(4) The conditions of public health assessment in Shenzhen need to be improved. Only62.42%of the public have good self-health-evaluation, in which age(OR=0.75), gender(OR=0.70), marriage(OR=0.87), personal income(OR=1.19), washing your hands before eating and after toilet(OR=1.25), brushing your teeth every day(OR=1.10), sleep seven to eight hours per day(OR=1.10), using antibiotics by the prescription(OR=1.36), few pressure(OR=1.58) are the impact factors.(5) The prevalence in two weeks, chronic diseases, and the hospitalization are related to health literacy and health behavior. By Logistic regression analysis, the influence factors of prevalence in two weeks are age(OR=0.81), household register(OR=1.41), marriage(OR=0.83), education level(OR=0.92), personal income(OR=1.19), family population(OR=0.93), no smoking(OR=1.34), brushing your teeth every day(OR=1.16), sleep seven to eight hours per day(OR=1.23), using antibiotics by the prescription(OR=1.35), A medical check-up every year(OR=1.21), few pressure(OR=1.48). The influence factors for chronic diseases are age(OR=0.49), household register(OR=1.39), personal income(OR=1.17), family population(OR=0.95), no drinking(OR=0.81), opening a window ventilated(OR=0.80), brushing your teeth every day(OR=1.39), sleep seven to eight hours per day(OR=1.14), using antibiotics by the prescription(OR=1.26), a medical check-up every year(OR=0.84), and few pressure(OR=1.56). The influence factors of hospitalization are gender(OR=0.61), household registration(OR=1.36), marriage(OR=0.64), culture degree(OR=1.15), the family population(OR=0.92), no smoking(OR=1.66), washing hand be for eating and after toilet(OR=1.40), use antibiotics according to the prescription(OR=1.34), and few pressure(OR=1.24).2.Construction of the new health literacy model and the index system of the health literacy evaluation system(1) The new health literacy model based on the comprehensive research in domestic and abroad, and combined with the reality of health education work in Shenzhen city, we put forward the new connotation of health literacy. That means " a kind of ability and process that can be used to obtain health knowledge, optimizing the self-health-management, promoting and forming some health behaviors and health skills, so as to improve the health situation". At the same time, we put forward the three-dimension model "health knowledge-health behavior-health skills" from the narrow view and a four-dimension model "health knowledge-health behavior-health skills-health level" from generalized view. To determine health literacy level, we refer to foreign health literacy standards S-TOFHLA, and use60%and75%values of the total score as cut off, so health literacy levels can be divided into three levels, such as low health literacy, high health literacy and marginal health literacy.(2) Construction rapid evaluation system of health literacy.According to the principle of systemic, conciseness, agility and sustainability, the Delphi method was used in this study, combined with hierarchical cluster analysis and the influencing factors of the health literacy to construct a rapid evaluation system of health literacy. The authority level of24experts who participated in the consultation is0.87, with the positive coefficient of two consultations100%, coordination coefficient Kendall’s W0.41, so the experts’ opinions were reliable and credible. According to the results of consultation, hierarchical clustering analysis,and the influence factors of health literacy, there are20items used to be the key evaluation index for three-dimensional rapid assessment system of health literacy, including the eight knowledge accomplishment and behavior literacy, four skills literacy, which weights are40%,40%and20%respectively. There are also20items in four-dimensional rapid assessment system of health literacy, including seven knowledge accomplishment and behavior literacy, four skills literacy, and two health levels, which weights are35%,35%,20%and10%respectively. The reliability between three-dimensional rapid assessment system and the old is0.89,and the four-dimensional rapid assessment system is0.86.(3) The evaluation time for rapid assessment system of health literacy was5.9minutes on average, which is faster than the original assessment time (13.2minutes).3.Evaluating of messages intervention effects with rapid evaluation system of health literacy(1) Changes of the health literacy levelThere are about60messages to every person used to publish for intervention in one year. The mean of three dimensions of health literacy in intervention group is64.67, which is higher than the value before intervention (mean=63.11,t=24.95, P <0.001).The mean of four dimensions of health literacy before intervention is66.42, which is lower than the value after intervention (mean=67.76, t=34.65, P<0.001) The health literacy levels of three dimensions four dimensions increase1.56and1.34respectively.(2) The change of Self-health management and health statusThere are statistical differences in the prevalence of chronic diseases between intervention group and control group. The prevalence of chronic diseases was under control and the proportion of self-health management in intervention group increased7.76%. Moreover, messages intervention had a great positive effects in marginal health literacy group and high health literacy group. The proportion of self-health management increased10.92percent and the prevalence of chronic diseases decreased from15.76percent to12.39percent in marginal health literacy group. Meanwhile, in high health literacy group, the proportion of self-health management increased from24.98percent to31.16percent. The prevalence of chronic diseases decreased from16.02percent to9.49percent in Marginal health literacy group, in contrast the prevalence of chronic diseases increased from14.32percent to18.32percent in low health literacy group.(3) Per capita effectiveness of three-dimension and four-dimension health literacy were0.54and0.38by messages intervention respectively.Conclusion1.Health literacy was related to health management and health status closely and there is a great significance to do the further research on health literacy study. The level of public health literacy in Shenzhen was lower and according to the current evaluationcriteria in domestic, the proportion of Health literacy is only6.28percent. Our study suggested that the level of Public Health literacy was associated with health management and health status, and it was influenced by many factors.2.We put forward the three-dimension model of health knowledge-health behaviors-health skills" model and the four-dimension model of health knowledge-health behaviors-health skills-health level based on the previous research all over the world and the practice of heath education, it will play an important role in the promotion of daily work, doing help in the screening of people with low level of health literacy, and doing comparison between different regions.3.The rapid assessment system of health literacy has great potential practical value and reliability which is worthy of promotion and application.The construction of rapid assessment system was simple and convenient with mean assessment time5.9minutes, which was7.3minutes faster than the old one which needs13.2minutes. It is simple and easy to assess the health literacy by the hundred percentage point system. The health literacy can be divided into three types: low level, marginal level and high level with the cut-off value of60and75, by which is appropriate for assessing the health literacy not only for individuals but also for populations.4.Health messages are effective interventions not only for improving health literacy but also for economic and practical values. Compared with control group, the level of health literacy of public in intervention group improved1.56and1.34for three-dimension health literacy and four-dimension health literacy after the messages intervention. The cost-effectiveness of message intervention was0.54and0.38per person. So message intervention to improve the public health literacy is practical, economical and effective. |
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