| BackgroundThe military is the strategic support of the country great power status and an important cornerstone for maintaining national security,and the grassroots officers and soldiers are the main force of the military.The unique occupational environment of soldiers requires stable psychological quality,strong physical fitness,abundant physical energy,endurance,and high survival ability in rugged conditions.Military personnel with higher health literacy ensure a stronger force in battle and improve combat effectiveness."Health is to ensure combat effectiveness",requires in ordinary times should master the relevant health knowledge,establish a scientific health concept,and actively cultivate and improve health literacy.Current research focuses on the prevention and treatment of training injuries,psychological health education,and disease spectrum analysis;whereas,little attention has been paid to increasing health literacy after institutional adjustment.Therefore,this study investigates the health literacy level of military personnel after institutional adjustment,and analyzes the challenges and difficulties and dilemmas faced by military personnel’s health literacy based on a multidisciplinary perspective.Through empirical research,we identify the influencing factors and intervention measures for enhancing health literacy in military personnel,to develop health promotion strategies that provide data-driven support and theoretical basis to increase combat effectiveness.Methods1.In the period of April to June 2022,a cluster sampling technique was applied to select 9768 military personnel from various levels and types belonging to a specific joint logistics support center,including members from hospitals,warehouses,bases,and disease control agencies.The health literacy of military personnel belonging to this center was evaluated using a self-designed general information survey form and the "National Resident Health Literacy Monitoring Survey Questionnaire" published by the Chinese Health Education Center in 2015.The statistical description and analysis of the current health literacy level and score of the center’s military personnel,as well as the level and score of three aspects of literacy and six types of problem literacy,was conducted using SPSS22.0.Two group means were compared using t-tests,multiple group means were compared using one-way ANOVA,inter-group ratios were compared using χ2 tests,and multivariate logistic regression analysis were used to analyze the influencing factors of health literacy.A statistical significance level of P<0.05 was considered appropriate for identifying differences.2.During the period from September,2022 to March,2023,266 military personnel(including 134 in the control group and 132 in the intervention group)from two hospitals of the same level under a joint logistics support center were selected for health literacy investigation and intervention.The control group received traditional health education,while the intervention group received a health management model based on the Three-level tight linkage(T-DSS).The survey was conducted again after 6 months of intervention to evaluate its effectiveness.Continuous variables were showed as mean(standard deviation)or median(interquartile range).Categorical variables were reported as numbers with percentages.Statistical analysis was conducted using appropriate tests,including independent sample t-test,Paired Wilcoxon signed ranks test,χ2 test,and Paired McNemar statistics test,while P<0.05 was considered statistically significant.Results1.The changes in He a lth Literacy after the intervention in selected participants.4,517 of the 9,768 military personnel belonging to this joint logistics support center have health literacy,and the overall health literacy level is 46.24%;among the three aspects of health literacy,the highest level of Basic knowledge and attitude(BKA)is 57.82%,the second highest level of Health-related skills(HRS)is 50.24%,and the lowest level of Healthy behaviors and lifestyle(HBL)is 44.75%;among the six categories of health literacy,the literacy levels of scientific health concept(SVH),Infection diseases(ID),Chronic diseases(CD),Safety and First aid(SFA),Primary medical care(BMC)and Health information(HI)were 56.62%,41.18%,35.17%,79.86%,51.24%,and 62.24%in order.Multivariate logistic regression analysis showed that the type of unit,type of personnel,smoking,own literacy,number of medical examinations,parental literacy and occupation were related to the health literacy level of army personnel.The health literacy level of military personnel in all types of depots was 0.425 times higher than that of medical institution personnel,and that of basic unit personnel was 0.202 times higher than that of medical institution personnel;the health literacy level of officers was 2.791 times higher than that of enlisted personnel,and that of civilian personnel was 4.033 times higher than that of enlisted personnel;the health literacy level of non-smoking military personnel higher,and the health literacy level of non-smokers is 1.199 times that of smokers;at the same time,the health literacy of those who insist on one health checkup per year is 1.308 times that of those who have two or more checkups per year;the education level of parents also has an important impact on the health literacy level of individuals,as shown by the fact that the health literacy level of military personnel whose fathers have a college/bachelor’s degree is 1.448 times that of military personnel whose fathers have high school/junior high school or less.The health literacy level of military personnel whose fathers are medical personnel and mothers are medical personnel is the highest,which is 1.761 times and 1.953 times of the health literacy level of military personnel whose parents are farmers,respectively.2.The current status of Health Literacy of Military personnel in a joint logistic support center and related influencing factors.After conducting different health education intervention methods,the scores of HL,BMC,HLB,HI,CD,PMC,and HI in the intervention group were significantly improved compared with those before the intervention,while the scores of the control group in each index were almost not improved compared with those before the intervention;after the intervention,the level of overall health literacy,HBL,HRS,ID,PMC,and HI in the intervention group were significantly improved compared to the pre-intervention level,while the control group only showed significant improvement in the level of HBL.The scores and levels of HBL in the intervention group were significantly improved by 0.97 and 16.67%,respectively;the scores of HBL in the control group were improved by 0.53,which was not significant,and the levels of HBL in the control group were improved by 13.43%after the intervention,which was significant,but the improvement The overall improvement was lower than that of the intervention group.Further comparison of the three aspects and six categories of literacy scores between the control group and the intervention group after the intervention revealed that there was no significant increase in BKA,ID,CD,and SFA;the levels of ID,SFA,and PMC were found to have no significant increase.After 6 months of intervention,the overall health literacy scores and levels of military personnel with different demographic characteristics were statistically different between the intervention group and the control group,and the specific intervention effects showred that:the improvement of civilian personnel was more significant after the intervention,women had higher he alth literacy scores and levels than men after the intervention,the Han ethnic group had higher improvement than minority,and military personnel who did not smoke,did not drink alcohol and played fewer online games per week military personnel who did not smoke,did not drink alcohol,and played less online games per week had more significant improvement in health literacy scores and levels;military personnel whose family location before enlistment was a village or town had more significant improvement;military personnel whose parents’ education level was high school/vocational high school/junior high school had the most significant improvement,while their own education level,whether they were the only child,their annual medical examination,and their parents’ occupation did not have significant improvement.Conclusion1.The overall health literacy level of the military personnel belonging to this joint insurance center is high,but the level of healthy behaviors and lifestyle and disease prevention literacy need to be further improved;the health literacy level of military personnel is affected by various factors such as work environment,personal behavior habits,education level,family background and so on.In the future work,we should strengthen health education for military personnel who do not have a medical background,have a low education level,have a relatively poor family background,lack work experience and have an unhealthy lifestyle should be targeted to strengthen health education,actively carry out health knowledge popularization,regularly update health education materials,urge them to develop a healthy lifestyle,and frequently conduct training on health skills operation,etc.,so as to solidly and steadily improve the health literacy of military personnel and escort the troops to enhance their combat effectiveness.2.The Three-level tight linkage approach to health management(T-DSS)has been constructed.The T-DSS management is a three-tiered hierarchical,categorical,and linkage,from the auxiliary decision-making management of health service organs(D is decision-making),supervisory management of disease prevention and control institutions(S is supervisory),and self-regulation management of military personnel(S is self-regulation),through remote and local interaction,random and targeted transformation,and online and offline joint intervention,through remote and local interactions,random and targeted shifts,and joint online and offline interventions.Based on the T-DSS three-level tightly linked health management model to make short-term interventions for military personnel,the health literacy level was effectively improved,and the health literacy scores and levels of different demographic characteristics were improved to different degrees after the intervention,and the model deserves further promotion and application. |
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