Application Of Structural Equation Model On Occupational Population Based Health Literacy And Its Relationship With Chronic Diseases

BackgroundIn August 2016,the National Health and Wellness Congress established the guidelines for health in China's new era,that is,focusing on the grassroots level;using reform and innovation as the driving force;given priority to prevention,with equal emphasis on traditional Chinese and western medicine;and integrating health into all policies,for the benefit of all people.The health literacy of the occupational population is an important part of practicing the all-round protection and improving people's health policy,and it is also the focus of public health research.In order to build a healthy city,improve the health literacy and health status of the occupational population,this study takes occupational population of Wuhan city as an example for the relevant research and exploration.ObjectivesIn order to build a healthy city,improve the health literacy level of the population in an all-round way,we conduct health literacy and chronic disease epidemiological surveys among occupational groups from the perspective of the occupational population in Wuhan city.This study aims: firstly,to understand the current status and influencing factors of occupational population health literacy and chronic diseases;secondly,to analyze the structural validity of occupational health literacy measurement questionnaire;thirdly,to explore the quantitative relationship between health literacy and chronic diseases as an evaluation of the application of structural equation models in the research of occupational health literacy.Methods1 Bibliometric analysisThe bibliometric method was used to analyze the literature quantity,time of publication,number of authors,and vocabulary number of health literacy research,so as to explore the current status of domestic and global health literacy research.The global health literacy literature of this study comes from the core collection of Web of Science,and the Chinese literature comes from China National Knowledge Internet(CNKI).The literature search is based on the topic of “health literacy”,the search time is limited to year “2003~2018”,and all documents are retrieved.The number of documents,time of publication,number of authors,and the number of vocabulary of health literacy research was analyzed and to draw research hotsopt maps,and observe the development process of the characteristics and development direction of the field.Analysis of the research process of health literacy by scholars in each period is helpful to indirectly study the mainstream topic in the field of health literacy research.2 Cross-sectional studyThe multi-stage stratified cluster random sampling method was used to select respondents in Wuhan,and the health literacy,behavior and health information of occupational groups were collected through face-to-face questionnaire survey.The questionnaire used the National Residents' Health Literacy Monitoring Questionnaire and the self-made health related indicators questionnaire.Civil servants,teachers,medical personnel,personnel of other public institutions,workers and other enterprise personnel were selected as the objects of analysis.Descriptive statistical analysis methods,single factor and multi-factor statistical analysis methods were used to analyze the current status and influencing factors of health literacy of occupational population in Wuhan.3 Discussion on the methodology of health literacy research based on structural equation modelThe structural equation model is used to analyze the fitness(structural validity)of the residents' health literacy questionnaire applied to the occupational population health literacy evaluation,so as to provide methodology for evaluating the structural validity of the health literacy questionnaire;In addition,by fitting the structural equation models of health literacy,sociodemographic characteristics,behavior and chronic diseases,we find the factors affecting the health of occupational groups,and provide feasible methods for improving the health of occupational groups.Results1 Through bibliometric analysis of health literacy,we found that: the research objects of health literacy often focus on “residents”,“youth” and “college students”,and the research on health literacy of occupational groups has long been neglected;in addition,the research methods of health literacy are single,and most of them are researches on the influencing factors through regression analysis.Finally,the relationship between health literacy and health outcomes is still inconclusive.2 The overall health literacy rate of occupational groups in Wuhan is 13.13%.Specifically,the three aspects of literacy rate of the basic knowledge and concept,healthy lifestyle and behavior,health skills are 23.45%,12.32% and 22.42% respectively.Among the professional population,the basic knowledge and concept literacy have the highest rate,followed by health skills and healthy lifestyle and behavioral literacy.The six types of health problems measured by health literacy were: the literacy rate of safety and first aid is 47.42%,followed by the scientific health concept literacy rate 43.88%,the literacy rate of health information 23.82%,the infectious disease prevention and control literacy 17.92%,and the literacy rate of basic medical care 13.13%.The literacy rate of chronic disease prevention and control was the lowest,with a rate of only 11.14%.The scientific health concept and the knowledge of safety and first aid of the occupational population have higher scores,which means the knowledge is good.While the chronic disease prevention,basic medical knowledge,infectious disease prevention and control scores are low,lacking of relevant knowledge.Age,education,occupation type and family size of the occupational group have significant impact on the overall health literacy.Among the occupational groups,people with age ?60 had lower health literacy than other age groups,and health literacy rate was decrease in turn among age group ?29(OR=4.583),30~39(OR=3.925)and 40~49(OR=3.676).The higher the level of education,the higher the health literacy rate(OR=1.549).Teachers and medical staff have higher health literacy(OR=2.302;OR=3.984)compared to corporate staff.Family size is also one of the factors affecting health literacy,the larger family size,the higher health literacy rate(OR=1.536).3 The current smoking rate of occupational groups in Wuhan is 25.80%,of which the male smoking rate is 36.40%,which is higher than the female smoking rate of 11.40%.The proportion of occupational groups participating in physical exercise is 79.20%,which is mainly based on mild physical exercise once or twice a week.In 2016,the employee medical examination rate was only 46.00%.The prevalence of chronic diseases among occupational population in Wuhan is 18.44%.The main diseases are hypertension,heart disease,cerebrovascular disease,diabetes,malignant tumors and so on.Among people with chronic diseases,hypertension accounted for the highest proportion,reaching 46.80%,followed by diabetes(18.40%),the third is heart disease,(11.60%).There were 224 people with only one type of chronic disease,accounting for 89.60%,16 with two type of chronic diseases,accounting for 6.40%,and 10 with three or more,accounting for 4.00%.The occupational population in Wuhan has a positive positive attitude towards their health,with only 7.52% of them think of their health as poor.4 The fitness of the health literacy questionnaire and the survey data of the occupational population were evaluated by the confirmatory factor analysis method.The results showed that the error variance of each parameter estimation value was positive,and the value ranged from 0.013 to 0.755,with statistically significant(P<0.05).The overall fit of the model reached the overall adaptation criteria(CFI=0.921,TLI=0.911,RMSEA=0.065)and the model was acceptable.It can be considered that the resident health literacy monitoring questionnaire was suitable for measuring the health literacy of occupational groups and had good structural validity.However,the questionnaire showed a lower load in “osteoporosis”,“the efficacy of health products”,“nutrition of fruits and vegetables”,“normal body temperature”,“pregnancy test times”,“treatment of fever symptoms”,“treatment of adverse drug reactions”,and the optimization of the occupational population health literacy measurement questionnaire should be considered from these aspects.5 This study constructed a structural equation model between health literacy,sociodemographic characteristics,behavior and chronic disease.The results showed that the model fit well(GFI>0.95,CFI>0.95,TLI>0.95,RMSEA<0.05).The sociodemographic characteristics have a significant impact on health literacy,with a direct impact effect of 0.242;the sociodemographic characteristics also has a significant effect on behavior,with a total effect of 0.110(direct effect is 0.079,indirect effect is 0.031);the sociodemographic characteristics also have an impact on health,with a total effect of 0.223(direct and indirect effects are 0.187 and 0.036,respectively).Health literacy has a significant direct impact on behavior,with a path coefficient of 0.125;also,health literacy has a significant direct impact on health,with a path coefficient of 0.168.Behavior has no direct or indirect impact on health.6 Compared with other methods,the structural equation model can not only clearly analyze the load of observation indicators of social demographic characteristics,health literacy and behavior,but also can estimate and test the structural relationship between health literacy,behavior and chronic diseases,as well as the causal relationship.Conclusions1 The overall health literacy rate of occupational groups in Wuhan was seriously insufficient,which is lower than reports in other regions of China.In terms of different dimensions,the healthy lifestyle and behavioral literacy rate was the lowest,followed by the health skills literacy.In terms of health problems,the main health problems faced by the Wuhan occupational population were chronic disease prevention and control,basic medical care,infectious disease prevention and control,etc.2 The prevalence of chronic diseases among occupational population was 18.44%,and the main types of chronic diseases were hypertension,diabetes,heart disease,cerebrovascular disease and malignant tumors.However,the occupational population had a more positive attitude towards their health,indicating that the psychology of the professional population was positive.However,about 7.52% of employees thought that their health was poor.Attention to health and psychological intervention of this group should bepaid to prevent the occurrence of adverse consequences.3 The health literacy data of the occupational population was consistent with the theoretical model.It can be considered that the resident health literacy monitoring questionnaire was suitable for measuring the health literacy of occupational groups and had good structural validity.However,some items of the questionnaire showed a lower load,which suggest that the optimization of the occupational population health literacy measurement questionnaire is required.4 Structural equation model analysis found that sociodemographic characteristics not only have a direct impact on chronic disease,but also have an indirect effect on chronic diseases through health literacy.Secondly,health literacy directly affected the prevalence of chronic diseases,and health literacy directly affects individual health behaviors.The factors affecting chronic diseases were social demographic characteristics and health literacy in order of importance.Among them,health literacy was a mediator variable that influences the relationship between demographic characteristics and chronic diseases.Compared with traditional statistical methods,the structural equation model simultaneously estimates the structure of chronic diseases and its relationship with internal observation factors of the sociodemographic characteristics-health literacy – behavior – chronic diseases,so we concluded that structural equation models have unique advantages in health literacy research.