Health Literacy and Health Behavior in Late School-age Children

Byeong-Soon Jang; Dong-Hee Kim

doi:10.12799/jkachn.2015.26.3.199

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Jang and Kim: Health Literacy and Health Behavior in Late School-age Children

Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(3): 199-208.

Published online: 30 September 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.3.199

Health Literacy and Health Behavior in Late School-age Children

Byeong-Soon Jang, Dong-Hee Kim

College of Nursing, Pusan National University, Yangsan, Korea.

Corresponding author: Kim, Dong-Hee. College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 626-870, Korea. Tel: +82-51-510-8338, Fax: +82-51-510-8308, dongheekim@pusan.ac.kr

Received 27 April 2015 Revised 1 August 2015 Accepted 14 September 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to analyze the association between health literacy and health behavior and the effect of health literacy on health behavior in late school-age children.

Methods

Data were obtained from 333 participants who were 5^th and 6^th-grade students sampled from 8 elementary schools in Busan. Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen) and Newest Vital Sign (NVS) was used for assessing linguistic and functional health literacy, and the health promotion behavior score was measured for health behavior.

Results

The percentage of those with limited linguistic and functional health literacy was high (47.1%, 56.8%). Linguistic health literacy (r=.38, p<.001) and functional health literacy (r=.11, p=.048) had a correlation with health behavior. Health behavior was significantly associated with perceived health status (β=1.94, p<.001), number of times of health education (β=0.18, p<.001), academic achievement (p<.001), home literacy environment (β=0.13, p=.016), perception of changes after health education (p=.011), and linguistic health literacy (β=0.23, p<.001).

Conclusion

The results of this study indicate that children with adequate health literacy are more likely to do health behaviors. Therefore, it is important to develop educational strategies to raise children's health literacy level and consequently to induce them to perform more health behaviors in daily life.

Keywords: Health literacy, Health behavior, Children

Figures and Tables

Table 1

Characteristics of the Participants (N=333)

Characteristics	Categories	n (%)	M±SD
Grade	5th	165 (49.5)
Grade	6th	168 (50.5)
Gender	Male	171 (51.4)
Gender	Female	162 (48.6)
Self reported achievement	High	21 (6.3)
	Middle	174 (52.6)
	Low	136 (41.1)
	No answer	2 (0.6)
Mother's education level	≤High school	55 (25.7)
	College	128 (59.8)
	≥Graduate	31 (14.5)
	Don't know	119 (35.7)
Home literacy environment (books)	<10	67 (20.1)	139.3±244.27
Home literacy environment (books)	≥10	262 (78.7)	139.3±244.27
Self reportde health status	≤5	32 (10.1)	8.1±1.73
	≥6	284 (89.9)
	No answer	7 (2.1)
Diagnosed Disease	No	295 (88.6)
	Yes	38 (11.4)
	Allergic disease	21 (55.3)
	Other disease	17 (44.7)
Admission	No	298 (90.0)
	Yes	33 (10.0)
	No answer	2 (0.6)
Frequency of health education	≤0.5/wk	96 (28.8)	0.7±0.21
	>0.6/wk	237 (71.2)
	Total		17.7±7.81
Primary source of learning health	School	170 (51.2)
	Media, Internet	57 (17.2)
	Home	37 (11.1)
	Books	32 (9.6)
	Other	36 (10.8)
	No answer	1 (0.3)
Major health information providers	Parents	120 (36.1)
	Health teacher	103 (31.0)
	Doctors	61 (18.4)
	Other	48 (14.5)
	No answer	1 (0.3)
Interest in health education	No interest	5 (1.6)
	Usually	60 (18.8)
	Interest	255 (79.7)
	No answer	13 (3.9)
Perceived benefit for health education	No benefit	3 (0.9)
	Usually	37 (11.6)
	Beneficial	280 (87.5)
	No answer	13 (3.9)
Perceived changes after health education	Knowledge	151 (46.3)
	Attitude	115 (35.3)
	Behavior	26 (8.0)
	No change	34 (10.4)
	No answer	7 (2.1)

Table 2

Health behavior Score and Health Literacy (N=333)

Variables	Linguistic health literacy		t (p)	Functional health literacy			F (p)
	Limited (n=157)	Adequate (n=176)		Likelihood of limited (n=63)	Possibility of limited (n=125)	Adequate (n=142)
	n (%)	n (%)		n (%)	n (%)	n (%)
Health literacy score	21.9±13.51	54.5±7.41	-27.68 (<.001)	0.6±0.50	2.6±0.49	4.9±0.81	1,065.63 (<.001)
Health behavior score	117.6±14.33	126.1±12.18	-5.84 (<.001)	119.9±15.07	121.8±13.68	123.2±13.55	1.30 (.275)
daily life and health	4.3±0.53	4.4±0.51	-4.34 (<.001)	4.2±0.55	4.3±0.54	4.4±0.50	1.55 (.214)
disease prevention and health	4.4±0.60	4.6±0.60	-2.85 (.005)	4.4±0.80	4.6±0.04	4.5±0.54	2.52 (.082)
Drug abuse prevention	4.4±0.60	4.6±0.60	-2.85 (.005)	4.4±0.80	4.6±0.04	4.5±0.54	2.52 (.082)
Gender and health	4.0±0.61	4.3±0.62	-4.29 (<.001)	4.1±0.75	4.2±0.62	4.3±0.55	2.41 (.092)
Mental health	4.3±0.77	4.6±0.69	-4.15 (<.001)	4.2±1.01	4.5±0.66	4.6±0.62	6.43 (.002)
Society and health	4.1±0.94	4.5±0.81	-3.85 (<.001)	4.0±1.06	4.3±0.82	4.4±0.88	2.90 (.057)
Injury prevention and first aid	3.9±0.75	4.2±0.76	-3.04 (<.001)	4.0±0.92	4.1±0.75	4.1±0.70	0.31 (.735)

Table 3

Differences in Health Literacy and Health Behavior Score according to Characteristics (N=333)

Characteristics	Categories	Linguistic health literacy		x² (p)	Functional health literacy			x² (p)	Health behavior	x² (p)
		Limited	Adequate		Likelihood of limited	Possibility of limited	Adequate		Health behavior
		n (%)	n (%)		n (%)	n (%)	n (%)		M±SD
Grade	5	75 (45.5)	90 (54.5)	0.38 (.584)	43 (26.2)	55 (33.5)	66 (40.2)	11.23 (.004)	120.2±14.55	-2.52 (.012)
Grade	6	82 (48.8)	86 (51.2)	0.38 (.584)	20 (11.9)	71 (42.3)	77 (45.8)	11.23 (.004)	124.1±13.29	-2.52 (.012)
Gender	Male	69 (48.9)	102 (53.1)	0.57 (.450)	38 (22.4)	63 (37.1)	69 (40.6)	2.67 (.264)	122.9±14.21	1.00 (.317)
Gender	Female	72 (51.1)	90 (46.9)	0.57 (.450)	25 (15.4)	63 (38.9)	74 (45.7)	2.67 (.264)	121.4±13.86	1.00 (.317)
Self reported achievement	High	56 (39.7)	80 (42.1)	3.42 (.181)	19 (14.0)	43 (31.6)	74 (54.4)	16.11 (.003)	125.9±12.40	19.83 (<.001) (a>b>c)^†
	Middle	72 (51.3)	102 (53.7)		40 (23.1)	68 (39.3)	65 (37.6)		120.8±13.68
	Low	13 (9.2)	8 (4.2)		4 (19.0)	13 (61.9)	4 (19.0)		107.5±13.71
Mother's educational level (N =214)	≤High school	32 (38.6)	23 (17.6)	12.44 (.002)	8 (14.5)	28 (50.9)	19 (34.5)	5.12 (.275)	117.7±15.43	7.56 (.001) (a, c<b)^†
	Graduate	39 (47.0)	89 (67.9)		14 (10.9)	54 (42.2)	60 (46.9)		126.0±11.77
	≥Postgraduate	12 (14.5)	19 (14.5)		7 (22.6)	11 (35.5)	13 (41.9)		124.9±14.67
Home literacy environment	<10	39 (27.9)	28 (14.8)	8.44 (.004)	13 (19.7)	29 (43.9)	24 (36.4)	1.82 (.403)	45.7±16.03	-4.55 (<.001)
Home literacy environment	≥10	101 (72.1)	161 (85.2)	8.44 (.004)	47 (17.9)	96 (36.6)	119 (45.4)	1.82 (.403)	41.0±20.04	-4.55 (<.001)
Self reported health status	≤5	15 (46.9)	17 (53.1)	0.00 (.986)	6 (18.8)	10 (31.3)	16 (50.0)	0.75 (.686)	112.9±16.38	-3.96 (<.001)
Self reported health status	≥6	135 (47.0)	152 (53.0)	0.00 (.986)	54 (18.9)	110 (38.5)	122 (42.7)	0.75 (.686)	123.1±13.44	-3.96 (<.001)
Diagnosed disease	No	123 (42.1)	169 (57.9)	0.03 (.862)	56 (19.2)	111 (38.1)	124 (42.6)	0.54 (.764)	122.7±14.00	-0.96 (.338)
Diagnosed disease	Yes	17 (43.6)	22 (56.4)	0.03 (.862)	7 (17.9)	13 (33.3)	19 (48.7)	0.54 (.764)	124.0±12.94	-0.96 (.338)
Admission	No	129 (43.3)	169 (56.7)	2.06 (.152)	54 (18.1)	115 (38.6)	129 (43.3)	1.10 (.577)	121.8±14.06	-1.06 (.292)
Admission	Yes	10 (30.3)	230 (69.7)	2.06 (.152)	8 (26.0)	10 (46.9)	9 (28.1)	1.10 (.577)	124.5±12.64	-1.06 (.292)
Frequency of health education	≤0.5/wk	45 (46.9)	51 (53.1)	0.00 (.950)	27 (28.4)	32 (33.7)	36 (37.9)	7.72 (.021)	119.6±14.05	-2.05 (.041)
Frequency of health education	>0.5/wk	112 (47.3)	125 (52.7)	0.00 (.950)	36 (15.2)	94 (39.7)	107 (45.1)	7.72 (.021)	123.1±12.72	-2.05 (.041)
Perceived change after health education	Attitude	47 (34.1)	68 (36.2)	1.04 (.792)	24 (21.1)	48 (42.1)	42 (36.8)	6.67 (.353)	122.9±14.73	5.14 (.001) (a, b, c>d)^†
	Knowledge	67 (48.6)	84 (44.7)		28 (18.5)	49 (32.5)	74 (49.0)		122.3±13.63
	Behavior	9 (6.5)	17 (9.0)		5 (19.2)	10 (38.5)	11 (42.3)		125.6±8.10
	No change	15 (10.9)	19 (10.1)		4 (11.8)	17 (50.0)	13 (38.2)		114.4±14.17

^†Scheffé test.

Table 4

Correlation among Health Literacy and Health Behavior

Variables	Health behavior	Linguistic health literacy	Functional health literacy
Variables	r (p)	r (p)	r (p)
Health behavior	1
Linguistic health literacy (REALM-TEEN)	.38 (<.001)	1
Functional health literacy (NVS)	.11 (.048)	.01 (.874)	1

REALM-TEEN=rapid estimate of adolescent literacy in medicine; NVS=newest vital sign.

Table 5

Hierarchical Multiple Linear Regression of Health Literacy on Health Behavior

Variables	Model 1			Model 2
Variables	β	t	p	β	t	p
Self reported health status	1.94	3.73	<.001	0.21	4.18	<.001
Times of health education	0.18	3.56	<.001	0.15	3.03	.003
Self reported achievement^† (1=high)	0.56	4.96	<.001	0.46	4.30	<.001
Self reported achievement^† (1=middle)	0.44	3.94	<.001	0.35	3.27	.001
Perceived changes after HE (1=no change)	-0.13	-2.55	.011	-0.15	-3.11	.002
Home literacy environment (books)	0.13	2.42	.016
Linguistic health literacy				0.32	6.55	<.001
F (p)	15.15 (<.001)			23.01 (<.001)
R²	.24 (.235)			.32 (.319)
Adjusted R²	.22 (.219)			.31 (.305)

β=standarized beta; HE=health education; ^†Dummy variables.

Notes

This study was supported by Research Institute of Nursing Science, Pusan National University.

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