The effect of health literacy The effect of health literacy interventions among baccalaureate interventions among baccalaureate

students in Sichuan University in Chinastudents in Sichuan University in China

Yunxia Ni, RN, MNS.

West China School of Nursing Sichuan University

Introduction Introduction

♪ ♪ Health literacy is defined as‘the degree towhich individuals have the capacity to obtain,process, and understand basic health information and services needed to make appropriate decisions’(Ratzan ,2000).♪ ♪ Limited health literacy has been associated with health outcomes and financial burden(Vernon,2007).

Introduction Introduction

♪ ♪ In China, though the government has published

policies to improve the health literacy of citizens

(Pleasant,2012), but the prevalence of adequate health

literacy is only 6.48% in adults (Wang,2013).

♪ ♪ While the college students who are the pillars of

society in the future also suffer low health literacy.

Introduction Introduction

Surveys in Chengdu and Nanjing Universities found that the proportion of students with basic health literacy is only 15.8% and 1.8%,especially in lifestyle(7.4%) ,behavior literacy(0.5%) and chronic disease prevention (0.5%)(Shen,2011).

A survey in Xi’an province indicated a prevalence of hypertension was 3.3% among college students(Wang,2011).

Introduction Introduction It’s clear that the college students are the high risk

populations with chronic disease in the decades.

So it’s high time to improve the health literacy in

college students immediately.

Therefore, our University have started the health

literacy promotion programs since 2009, this research

focuses on the effects of the health literacy intervention

in our university in Sichuan.

Objective

♪ ♪ To understand the health literacy level of

baccalaureate students in our university.

♪ ♪ To evaluate the effects of the health literacy

intervention among baccalaureate students .

special objectivesspecial objectives

Methods

A A single-group pre–post nonexperimental design

was conducted in this study.

research design

Methods

Participants and setting

♪ ♪ The study was conducted in Sichuan University.

♪ ♪ Baccalaureate students enrolled through national

entrance examination of university.

♪ ♪ Per semester opened the health literacy program.

Each semester recruit 30-120 students.

Methods

inclusion criteria:

♪♪ Full-time undergraduate students

♪ ♪ The students who were interested in this program

and volunteered to participate

♪♪ There was time to participate in this program that

didn’t conflict with their courses

Methods

The 912 students have been involved in the project

from 2010 to 2013, and there are 832 students832 students have

completed the project and effectively in return.

This study was approved by the Ethical Committee

at West China hospital of Sichuan university.

The students have signed the informed consent

before the project.

Methods

The intervention

The intervention consisted of two parts :

Classroom-based education

Self-study after class

Methods

Classroom-based education Classroom-based education

♪ In eIn each semester ,there were eight sessions in total.

♪ Every Every session was a two-hours lecture in the

evening once a week

♪ The first The first session started from the second week of

every very semester.

Methods

Teaching Materials ♪ Health care handouts wrote by the teachers in our university

♪ Materials Content:

The concept of health and health literacy Health Assessment Diet , Regular Exercise, Healthy Weight Psychological Adjustment and Stress Response Environmental Health, et al.

Methods

Teaching Method

♪ The lectures were given by three teachers

♪ In class, combined teaching with interactive

♪ Focusing on students participation and solved

students' health problems.

Methods Self-study after classSelf-study after class

♪ How to choose the content? The students' ability of understanding Needs Classroom teaching content ♪ Self-study Content Theories and models of health promotion Chinese citizens health literacy Self-care for common diseases Work environment , et al. ♪ Provide students with self reference.

Methods

Communication between students and teachers

Conveying learning requirements, courseware and

reference materials through public e-mail.

Students can also consult the teachers through e-

mail , telephone , etc., to solve the health problems.

Methods

Effect Evaluation and Data collection , Analysis

Evaluation included two parts:

Basic health literacy survey (functional health literacy)

The homework of open questions

Methods

Health Literacy Survey

Questionnaire

According to the college students’ characteristics

and “The 2008 Chinese Citizens Health Literacy

Questionnaire”, formed our questionnaire(The ministry of

health center news propaganda,2009)

Methods

♪ ♪ The questionnaire includes 40 questions covering

three sections

☆ Basic knowledge (20 questions)

☆ Healthy lifestyle and behaviour (15 questions)

☆ Basic medical skills (5 questions)

Methods

♪ ♪ The questionnaire related to five health problems

☆ Scientific view of health

☆ Infectious disease prevention

☆ Chronic disease prevention

☆ Safety and first aid

☆ Basic medical technology

Methods

The 2008 Chinese Citizens Health Literacy

Questionnaire issued by the National Ministry of

Health was used as the standard to judge the answers

from the students on the health-related questions.

Each correct answer was assigned a point of 1,

otherwise 0. Thus, the full score of all health-related

questions for each student was 40. According to the

scoring system, a score of 32 (80%) or above was

defined as adequate basic health literacy .

Methods

♪ ♪ The correlation coefficient of the questionnaire was

0.948 and no collinearity was existed among different

dimensions.

♪♪ The survey carried out before the first class and after

the end of class

☆ The teacher gave students some notes

☆ Students completed it within 30 minutes independently

☆ Took back immediately

Methods The homework of open questions

The purpose of the open questions

♪ ♪ Understood their concerns to different health problems

♪ ♪ Trained students' ability to find and solve their own

health problems

17 open-questions were designed

♪ ♪ health status ♪♪ lifestyle

♪ ♪ environmental health ♪ ♪ psychological adjustment

♪ ♪ health skills, et al.

Methods

♪ ♪ Students selected one of the questions or other

questions they were interested in

♪ ♪ Using what they have learned, relevant information

or professional support to complete the work

♪ ♪ Submitting their work after the whole lecture.

Methods

♪ ♪ Teachers scoring based on : ☆ A comprehensive answer ☆ Health knowledge and skills application ☆ Analysis profound ☆ Detailed measures ☆ Written expression

from excellent to bad in Five Grades.

♪ ♪ Using SPSS17.5 statistical software for statistical

analysis.

Result

♪ ♪ Before the lecture, 881 students returned the

questionnaires of 912 students (96.8%).

♪ ♪ 848 students participated in the whole project.

♪ ♪ After the lecture,832 valid questionnaires retuned

of 848 students (98.1%).

ResultStudents’ health literacy before and after the intervention

Variable pre-intervention post-intervention χ2

Health Literacy 257(29.2) 677(81.4 ） 470.2Knowledge & Belief 279(31.7) 716(86.0) 561.0Lifestyle 86(9.8) 368(44.2) 261.0Health Skills 602(68.3) 697(83.7) 55.7Healthy outlook 665(73.2) 728(88.4) 40.7Infectious disease prevention 279(31.7) 670(81.4) 413.4Chronic disease prevention 42( 4.9) 77( 9.3) 13.3Safety 559(63.4) 689(83.7) 81.1Medical treatment 300(34.1) 612(74.4) 268.3Others 366(41.5) 492(69.8) 53.0

Before and after the intervention , N=881 and 832, Respectively.P<0.05

Table 1 The number of students who have adequate health literacy n(%)

Result

Table 2 The questions that the students got the lowest correct rate

Variable pre-intervention post-intervention Z P

Different kinds of food intake 14.6% 16.3% 0.91

0.360

Pregnant women’ antenatal care 19.5% 27.9% 4.04

0.000

Dealing with dead poultry and birds 19.5% 25.6% 2.97 0.003

Daily intake of dairy products for adults 24.4% 25.6% 0.52

0.604Spreading the diseases via Mosquitoes, flies, mice and cockroaches 26.8% 39.5% 5.54 0.000

Willing to work with disabilities and people with mental illness 31.7% 37.2% 2.34 0.019

Result

Students’ work performance and their concerns of health topics

Students’ work :

138 students( 16.6% ) get A

502 students ( 60.3% ) get B

163 students ( 19.6% ) get C

28 students ( 3.4% ) get D

1 students ( 0.1% ) get F.

Result

Table 3 Health Topics the Students Concerned aboutHealth Topics Students Concerned about Frequency （ %）Health View& LevelSelf-evaluation of health status & measures to improve health 171 （ 20.6% ） Evaluating their own health literacy 22 （ 2.6%) Health promotion through the project 18 （ 2.2% ）Lifestyle Their healthy and unhealthy behaviors and lifestyle nearly a week 119 （ 14.3 ） The nutrients and energy intake 89 （ 10.7 ）The daily exercise 65 （ 7.8 ） Health Care skills Health assessment & Health plans 18 （ 2.2 ） Develop self-care measures and the difficulty of implementation 59 （ 7.1 ）Whether your weight is health& How to maintain a healthy weight 8 （ 1.0 ）

Result

Health Topics Students Concerned about Frequency(%)Mental Health Describe psychological stress events experienced & how to cope 45(5.4)The common defense mechanism in the past & Defensive measures can be applied in the future 11(1.3)The impact of mental health on health & how to adjust 31(3.7)List the irrational beliefs that make their emotion and behavior adverse & how to change 18(2.3)Environmental Health The impact of environment on health 117(14.1) Unfavorable factors for self-health in large environments& measures to cope 18(2.2) Unfavorable factors for self-health in small environments & measures to cope 21(2.5)The impact of radiation on health and coping 2(0.2)

Table 3 Health Topics the Students Concerned about

Discussion

1 It’s necessary to promote health literacy for college students ♪ ♪ From the enrollment, health literacy promotion activities

attract students' attention in our school, indicating a strong

intention to improve health literacy and put it into action

among the students. Pre-intervention survey showed 29.2 percent of the students with the basic health literacy. Higher than the 2009 national survey of college students and Guo's survey in Beijing(Guo jing,2011)

Discussion

The college students’ health literacy level and

their education do not match , so there is still great

demand and need to carry out health literacy

promotion activities for the universities.

Discussion

2 The intervention have an positive effect on health literacy, while the lifestyle and chronic disease prevention literacy need further improvement.

♪ ♪ The results show that both the general health literacy and its

various have significantly upgraded.

♪ ♪ The The lliteracy of lifestyle and chronic disease prevention

increase poorly, especially the latter, which is only 4.4 percent.

Discussion

The reasons may the two aspects:

♪ Before the intervention, their literacy was already

poor in lifestyle and chronic disease prevention , only

9.3% and 4.9 %

♪ Behavior change is difficult and the major health

problems that college students currently suffer is not

chronic disease.

Discussion

♪ ♪ Despite more and more young people suffer from

chronic diseases nowadays, it doesn’t cause the college

students’ enough attention. This may be one reason why

the incidence of chronic diseases increased year by year.

♪ ♪ Thus, the promotion of healthy behavior

especially chronic disease prevention behavior need

to draw our attention.

Discussion

3 The students’ desire to improve their health is strong , but the willpower to stay healthy is poor.

The 76.9% of students get A or B score, suggesting that:

♪ ♪ The majority of students' awareness to promote their own

health is relatively strong, they can use the health knowledge to

solve their own health problems flexibly

♪ Indicate this intervention achieve the primary purpose.

Discussion

The first three health issues that students are most concerned about are: ♪ ♪ Their health level and how to enhance their health ♪ ♪ Their lifestyle nearly a week ♪ ♪ The effect of environmental on their health.

Homework content indicate that our students are in a sub-health condition in general and they have many kinds of unhealthy lifestyles : ♪ ♪ Lack of exercise ♪ ♪ IIrregular ♪ ♪ Negative responses such as complaints and fluke mind.

Discussion

Thus, enhancing people's health beliefs and training their

inner consciously is one of the indispensable aspect of health

education and health promotion activities.

While the inner experience is lack among younger generation especially the only child during their growing up today.

To this end, promoting health literacy should start from

childhood , which is a required course in life.