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This study aimed to investigate the prevalence of health literacy levels among Malaysian adults and associated socio-demographic markers of communities with limited health literacy. A population-based self-administered survey using the HLS-M-Q18 instrument was conducted as part of Malaysia’s National Health Morbidity Survey (NHMS, 2019). Responses from 8,933 respondents were included for analysis. The nationwide survey utilized a two-stage stratified random sampling method. The health literacy score was divided into three levels; limited, sufficient and excellent. The Association between the health literacy level of the Malaysian population and the demographic characteristics was analysed with a multinomial logistic regression model. Complex sampling multinomial logistic regression models were used for estimations where the dependent variable has more than two nominal categories that are discrete, while the independent variables are of Likert scales. Comparison between the Malaysian population having limited health literacy level and sufficient health literacy level shows significant association in specific demographic characteristics and level of health literacy; gender, age group, education level and ethnicity. Comparison between the Malaysian population having limited health literacy and excellent health literacy shows significant association in terms of age group, education level and ethnicity. The study results highlighted the significant association of social demographic characteristics contributing to the health literacy level among populations. It is recommended that public health interventions and health promotion strategies are developed based on the existing socio-demographic disparities among the population.
Aljassim N, Ostini R. (2020). Health literacy in rural and urban populations: A systematic
review. Patient Educ Couns. 2020 Oct;103(10):2142-2154. doi: 10.1016/j.pec.2020.06.007. Epub 2020 Jun 20. PMID: 32601042.
Asharani, P.V., Lau, J.H., Roystonn, K., Devi, F., Peizhi, W., Shafie, S., Chang, S.,
Jeyagurunathan, A., Yiang, C.B., Abdin, E. (2021). Health Literacy and Diabetes Knowledge: A Nationwide Survey in a Multi-Ethnic Population. Int. J. Environ. Res. Public Health 2021, 18, 9316. https://doi.org/10.3390/ ijerph18179.
Bayati T, Dehghan A, Bonyadi F, Bazrafkan L (2018). Investigating the effect of education on
health literacy and its relation to health-promoting behaviors in health center. J Educ Health Promot. 2018 Oct 29;7:127. doi: 10.4103/jehp.jehp_65_18. PMID: 30505855; PMCID: PMC6225398.
Berens, EM., Vogt, D., Messer, M (2016). Health literacy among different age groups in
Germany: results of a cross-sectional survey. BMC Public Health 16, 1151 (2016). https://doi.org/10.1186/s12889-016-3810-6.
Bostock S, Steptoe A (2012) Association between low functional health literacy and mortality
in older adults: longitudinal cohort study. BMJ. 2012;344:e1602. doi: 10.1136/bmj.e1602. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
Bodil Ohlsson, Jonas Manjer (2020). Socio-demographic and Lifestyle Factors in relation to
Overweight Defined by BMI and Normal-Weight Obesity. Journal of Obesity, vol. 2020, Article ID 2070297, 11 pages, 2020. https://doi.org/10.1155/2020/2070297.
Cho YI, Lee SY, Arozullah AM, Crittenden KS (2008). Effects of health literacy on health status
and health service utilisation amongst the elderly. Soc Sci Med 2008;66:1809?16.
Colombo F, Llena-Nozal A, Mercier J, Tjadens F (2011. )Help Wanted?: Providing and Paying
for Long-Term Care [Internet]. OECD; 2011. https://www.oecd-ilibrary.org/social-issues- migration-health/help-wanted_9789264097759-en.
Don Nutbeam and Jane E. Lloyd (2021). Understanding and Responding to Health Literacy as
a Social Determinant of Health. Annual Review of Public Health 2021 42:1, 159-173.
Economist Intelligence Unit Limited (2021).Health literacy around the world: Policy
approaches to well-being through knowledge and empowerment.
Greene, J., Hibbard, JH., Sacks, R., Overton, V., Parotta, CD. (2015). When Patient
Activation Levels Change, Health Outcomes And Costs Change, Too. HEALTH AFFAIRS; 34(3).
Geboers B, Uiters E, Reijneveld SA, Jansen CJM, Almansa J, Nooyens ACJ, Verschuren
WMM, de Winter AF, Picavet HSJ (2018). Health literacy among older adults is associated with their 10-years’ cognitive functioning and decline - the Doetinchem Cohort Study. BMC Geriatr. 2018 Mar 20;18(1):77. doi: 10.1186/s12877-018-0766-7. PMID: 29558890; PMCID: PMC5859753.
Jaafar N, Perialathan K, Krishnan M, Juatan N, Ahmad M, Mien TYS, Salleh KZ, Isa A,
Mohamed SS, Hanit NHA, Hasani WSR, Mohamad EMW, Johari MZ (2021). Malaysian Health Literacy: Scorecard Performance from a National Survey. Int J Environ Res Public Health. 2021 May 28;18(11):5813. doi: 10.3390/ijerph18115813. PMID: 34071455; PMCID: PMC8197907.
Jansen, T., Rademakers, J., Waverijn, G (2018). The role of health literacy in explaining the
Association between educational attainment and the use of out-of-hours primary care services in chronically ill people: a survey study. BMC Health Serv Res 18, 394 (2018). https://doi.org/10.1186/s12913-018-3197-4.
Janet N. Chu, Urmimala Sarkar, Natalie A. Rivadeneira, Robert A. Hiatt, Elaine C. Khoong
(2022). Impact of language preference and health literacy on health information-seeking experiences among a low-income, multilingual cohort, Patient Education and Counseling, Volume 105, Issue 5, 2022.
Joveini H, Rohban A, Askarian P, Maheri M, Hashemian M (2019). Health literacy and its
associated demographic factors in 18-65-year-old, literate adults in Bardaskan, Iran. J Educ Health Promot. 2019 Dec 31;8:244. doi: 10.4103/jehp.jehp_26_19. PMID: 32002416; PMCID: PMC6967154.
Lee HY, Lee J, Kim NK (2015). Gender Differences in Health Literacy Among Korean Adults: Do
Women Have a Higher Level of Health Literacy Than Men? American Journal of Men’s Health. September 2015:370-379. doi:10.1177/1557988314545485
Mahdavi Z, Ramezani A, Ghanbari S, Khodakarim L (2017). Relationship between health
literacy and female cancers preventive behaviors. Payesh 2017;16:613-625 2017.
Mondal, Md. Nazrul (2015). Socio-demographic and Health Determinants of Inequalities in
Life Expectancy in Least Developed Countries. International Journal of MCH and AIDS (IJMA). 4. 10.21106/ijma.43.
Mohamad E.M.W., Kaundan M.K., Hamzah M.R., Azlan A.A., Ayub S.H., Tham J.S., Ahmad
A.L. (2020). Establishing the HLS-M-Q18 short version of the European health literacy survey questionnaire for the Malaysian context. BMC Public Health. 2020;20:580.
National Health and Morbidity Survey (NHMS) 2019. Institute for Public Health, National
Institutes of Health (NIH); Selangor, Malaysia: 2020. [Google Scholar].
Nguyen HT, Kirk JK, Arcury TA, Ip EH, Grzywacz JG, Saldana SJ, Bell RA, Quandt SA (2013).
Cognitive function is a risk for health literacy in older adults with diabetes. Diabetes Res Clin Pract. 2013 Aug;101(2):141-7. doi: 10.1016/j.diabres.2013.05.012. Epub 2013 Jun 24. PMID: 23806477; PMCID: PMC3742688.
Polster, Debra S. DNP, MS, APRN, CCRN, CCNS (2018). Confronting barriers to improve
healthcare literacy and cultural competency in disparate populations, Nursing: December 2018– Volume 48–Issue 12–p 28-33.
Ratzan SC, Parker RM (2000). Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM,
editors. National Library of Medicine current bibliographies in medicine: health literacy. Bethesda (MD): National Institutes of Health, U.S. Department of Health and Human Services; 2000. NLM Pub. No: CBM 2000.
Rajah, R., Hassali, M., Murugiah, M., (2019). A systematic review of the prevalence of limited
health literacy in Southeast Asian countries. Public Health 2019, 167, 8–15.
Raghupathi, V., Raghupathi, W (2020). The influence of education on health: an empirical
assessment of OECD countries for the period 1995–2015. Arch Public Health 78, 20 (2020). https://doi.org/10.1186/s13690-020-00402-5.
Robb M and Shellenbarger T (2014). Influential factors and perceptions of eHealth literacy
among undergraduate college students. Online J Nurs Inform 2014; 18(3).
Salim, H., Shariff Ghazali, S., Lee, P.Y (2021). Health literacy levels and its determinants among
people with asthma in Malaysian primary healthcare settings: a cross-sectional study. BMC Public Health 21, 1186 (2021). https://doi.org/10.1186/s12889-021-11194-w.
Schillinger D (2020). The Intersections Between Social Determinants of Health, Health
Literacy, and Health Disparities. Stud Health Technol Inform. 2020 Jun 25;269:22-41. doi: 10.3233/SHTI200020. PMID: 32593981; PMCID: PMC7710382.
Stormacq, C., Wosinski, J., Boillat, E., Van den Broucke, S. (2020). Effects of health literacy
interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review, JBI Evidence Synthesis: 18 (7); 1389-1469 doi: 10.11124/JBISRIR-D-18-0002.
Swiss Med Wkly (2022). Health literacy among older adults in Switzerland: Cross-sectional
evidence from a nationally representative population-based observational study. 2022;152:w30158.
The HLS19 Consortium of the WHO Action Network M-POHL (2021): International Report
on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. Austrian National Public Health Institute, Vienna.
U.S. Department of Health and Human Services (2010). Office of Disease Prevention and
Health Promotion. National action plan to improve health literacy. Washington (DC): Author; 2010.
(Perialathan et al., 2023)
Perialathan, K., Seman, Z., Hanit, N. H. A., Jaafar, N., Mien, T. Y. S., Krishnan, M., Ahmad, M., Sanusi, N. H., Johari, M. Z., & Shahril, M. I. (2023). Association of Health Literacy and Socio-Demographic Factors among Malaysian Adults: Findings from National Health Morbidity Survey (NHMS) 2019. International Journal of Academic Research in Economics and Management Sciences, 12(3), 187–198.
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