| Objective: The study analyzed Influential factors through the investigation of the current situation of adolescent functional and interactive health literacy, and validated the existing adolescent functional and interactive health literacy measurement tools.Methods: The study belongs to non-experimental study. Five districts of Province Jilin(City Jilin, City Yanji, City Hunchun, City Dunhua, City Meihekou) were selected by the multi stage stratified cluster sampling method to carry out the survey. One junior high school and one senior high school were selected from each school in each area. Junior high schools were stratified according to the grade one and grade two, and Senior high school were stratified according to the grade one and grade two. Every class was selected by 50-60 human standards.4800 questionnaires of 10 schools were sent out,4560 effective questionnaires are to meet the requirements, the effective recovery rate is 95%. The research instruments are following: general situation questionnaire, adolescent functional health literacy B and C of junior middle school students, adolescent functional health literacy A and C of senior middle school students, Chinese youth interactive health literacy scale. The statistical software of EpiData, spss19.0 and AMOS 17.0 were used for data entry, conversion, collation and analysis. And the percentage, mean, standard deviation, t test, F test, multiple regression analysis and factor analysis, confirmatory factor analysis were usd.Results:1. The general demographic characteristics of adolescentsA total of 4560 young people participated in the survey,2133 of which are male, accounting for 43.6%,2427 of which were female, accounting for 53.2%.51.2% of the teenagers were Korean, Han and other ethnic minority adolescents were 47.9%. The average age was (15.88+1.818). Non left-behind children are more than left-behind children.74.6% students are from urban in the study. Senior high school students are more than junior high school.40.4% teenage mother’s culture are in senior high school / technical school / college stage, which accounts for the largest proportion. In this survey, 71.7% of adolescents reported that they lived together with their mothers, 63.6% of adolescents lived with their fathers and 32.4% lived with grandparents .The IBM of the adolescents was mainly between 18.5-24.99, which were mostly within the normal range, only 3.6% of people surveyed haved a greater BMI than 28.91.8% of surveyed students were boarders at school. Most of the students reported that their health status were in the general state. Young people got the way of health education mainly by parents and teachers,and the proportion was respectively 63% and 61.2%. More than half respondents reported that they liked the healthy contents ,only 4.9% did not like the healthy contents.2. The status and influent factor analysis of adolescent functional and interactive health literacy2.1 Functional health literacy B in Junior high school student The overall health literacy average score was 0.74+0.11 which is in the upper level, and the dimensions of health literacy with scores from high to low were: the concept of health 0.75+0.18、the health knowledge 0.75+ 0.14, health skills 0.74+0.20、health behavior 0.71+0.10. By t test and single factor analysis of variance, the results showed that girls, Korean, high school students, non left-behind students, city, non- boarding students, above the middle grades and students who like healthy contents had scores of higher health literacy.2.2 Functional health literacy C in Junior high school student .The overall health literacy was 0.65+0.12, which is in the upper level. The dimensions of health literacy scores from high to low were:the concept of health 0.71+0.22、health behavior 0.70+0.12、health skills 0.64+0.17、 health knowledge 0.61+0.14. By t test and single factor analysis of variance, the results showed that female, the Han nationality, non left- behind students, city, high grade, mother’s high cultural degree, non-boarding students, above middle grades, better self-rated health status and students who like healthy contents had higher scores of health literacy.2.3 Functional health literacy A in Senior high school student The overall score of health literacy was 0.65+0.11, which is in the upper level. The dimensions of health literacy with scores from high to low were: the concept of health 0.74+0.23. health behavior0.68+0.12、health skills 0.64+0.15、health knowledge 0.61+0.19. By t test and single factor variance ,the results shewed that female, the Han nationality, non left-behind students, city, higher body mass index, non-boarding students, above self-rated middle grades and students who like healthy contents had higher scores of health literacy.2.4 Functional health literacy C in Senior high school student The overall score of health literacy was 0.67+0.12, which is in the upper level.The dimensions of health literacy with scores from high to low were:health behavior 0.71+0.11、health knowledge 0.67+0.16、health skills 0.61+0.18、the concept of health 0.59+0.21. By t test and single factor analysis of variance,the results showd that female, the Han nationality, non left- behind students, city, high grade, above middle grades, better self-rated health and the students who like healthy contents had higher scores. of health literacy.2.5 Interactive health literacy scores. The overall score of health literacy was 3.29+0.83,which is in the middle level. The dimensions of health literacy scores with from high to low were: interpersonal relationship 3.88+1.11、spiritual growth 3.55+1.20、stress management 3.51 + 1.13、nutrition 3.49+1.06、health consciousness 2.93+0.96、physical activity 2.55+1.03. By t test and single factor analysis of variance, the results showed that non left-behind, city, low grade, mother’s high cultural degree, low body mass index, non-boarding students, above middle grades, better self-rated health status and students that like healthy contents had higher scores of health literacy.3.Multiple linear regression analysis of adolescent functional and interactive health literacy The independent variables were gender, age, nationality, resident pace, grade, mother’s cultural degree, whether are boarders or not, self-rated health status, self-rated scores, whether like the healthy contents or not, the BMI index and whether they are left behinds or not, and the functional health literacy or interactive health literacy scores were regarded as the dependent variables.3.1 Functional health literacy B in Junior high school student The regression equation accounted for.22.4%(p<0.001). The peredictors of functional health literacy B with the explanation from high to low were: the city & countryside、bellow middle grades & general、above the middle grades & general、resident & non -resident、junior high school students & junior students、age.3.2 Functional health literacy C in Junior high school student The regression equation accounted for.24.8%(p<0.001). The peredictors of functional health literacy C with the explanation from high to low were:junior high school students & junior students、The Korean nationality & Han nationality, bellow middle grades & general、like healthy contents or doesn’t matter, city & countryside, male & female、above the middle grades & general, don’t like healthy contents or doesn’t matter、age、resident & non -resident.3.3 Functional health literacy A in Senior high school student The regression equation accounted for20.9%(p<0.001). The peredictors of functional health literacy A with the explanation from high to low were:male & female、don’t like healthy contents or doesn’t matter、bellow middle grades & general、The Korean nationality & Han nationality、city & countryside、above the middle grades & general、resident & non-resident、BMI index.3.4 Functional health literacy C in Senior high school student The regression equation accounted for.15.2%(p<0.001). The peredictors of functional health literacy C with the explanation from high to low were: male & female、city & countryside、above the middle grades & general、 like healthy contents or doesn’t matter、bellow middle grades & general、self- rated healthy & healthy generality.3.5 Interactive health literacy scores. The regression equation accounted for.18.1%(p<0.001). The peredictors of interactive literacy with the explanation from high to low were:like healthy contents or doesn’t matter, junior high school students & junior students% city & countryside、resident & non resident. The Korean nationality & Han nationality, mother’s education level above & below junior high school culture、BMI index、mother’s education in the senior high school/technical secondary school/Vocational School & junior high school culture、don’t like healthy contents or doesn’t matter.4. The confirmatory factor analysis of adolescent functional health literacy and interactive health tools4.1 Functional health literacy B in Junior high school student .The basic adaptation index reached the standard before and after the modification the standard model. The absolute fit index, the value of fitness index of the modified model reaches the acceptable standard model. When the degree of freedom was equal to 1，X2=0.201, P=0.654>0.05, which indicated the model and the actual data is good. But the three index of simple model adaptation (PGFI、PCFI、PNFI) didn’t meet the standard. Overall, the intrinsic quality and external quality of junior high school functional health literacy B fit the standard.4.2 Functional health literacy C in Junior high school student. The basic adaptation index reached the standard before and after the modification of the standard model. When the degree of freedom was equal to 1, X2=5.096,,P=0.024, RMR=0.103, the absolute fit index of the modified model showed that the hypothesis model and the actual data did not fit. Reference to other indicators, the value of model fit index (NFI、RFI、IFI、TLI、CFI) fited the standard. But the simple model fit index (PGFI、PNFI、PCFI、X2ratio、AIC、CAIC) were not up to standard, and the inner quality standard of the model was poor. Overall, the intrinsic quality and external quality of junior high school fuctional health literacy C did fit the standard, the measuring tool needed to be further improved.4.3 Functional health literacy A in Senior high school student The basic adaptation index reached the modification of the standard model. When the degree of freedom was equal to 1, X2=5.467, P=0.019, the absolute fit index of the modified model showed that the hypothesis model and the actual data did not fit. The value of model fit index (NFI、RFI、IFI、TLI、CFI) fited the standard. But among the simple model fit indexes, the only CN value reached the standard. The internal quality standard of the model reached the standard. Overall, the external quality of senior high school functional health literacy A didn’t fit the standard, the intrinsic quality basically fitted. The overall modelwas not very ideal.4.4 Functional health literacy C in Senior high school student Because all the indexes reached the standard, the model data can fit and we didn’t modify it. When the degree of freedom was equal to 2,X2=0.349,P=0.840, which indicated that the model and the actual data could fit the standard. The absolute fit indexes of the model and the value of fitness indicators had reached the standard of adaptation. The simple model fit index values (PGFI、PNFI、PCFI) was less than 0.50, and the rest of the index fited well. Internal quality tests of the model basically fited. Overall, the intrinsic quality and external quality of senior high school functional health literacy C could reach an ideal fit standard.4.5 Interactive health literacy scores. The basic fitness index, absolute value, relative index value and the simple adaptation index fitted the standard model after the modifiation of first-order confirmatory factor.Which were consistent with the uncorrected model. But the inherent quality of the model was superior to the unmodified model, the intrinsic quality external quality of the modified first-order model reached the standard. The modified two-order confirmatory factor model fit index was good, When the degree of freedom was equal to 289, X2=1412.723,P=0.000,which did not meet the standards, the rest absolute fit index and the value of fitness index indicators had reached the standard, the simple model fit index is basically fitted, the model and the data fit the standard by the overall model evaluation.Conclusions:The results show that the status of functional health literacy of teenagers was in the upper level, interactive health literacy was at a medium level. Health literacy had different predictors and different scales Therefore, the influent factors of adolescent functional and interactive health literacy remain to be further studied. The results show that functional health literacy of junior high school students C and senior high school students need to be further improved and corrected.To reach a good modefl fit, functional health literacy of junior high school students B and senior high school students C had an ideal fit index. Adolescent interactive health literacy model basically meet the standard by EFA,CFAand orrection analysis ,but the result was not very ideal, so the model needs to be further improved. Therefore, the assessment of adolescent functional and interactive health literacy needs a careful selection of tools, and the tools should be improved to match the subject and to evaluate the health litracy in adolescents. |
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