Transcript Methods

The effect of health literacy
interventions among baccalaureate
students in Sichuan University in China
Yunxia
Ni, RN, MNS.
West China School of Nursing
Sichuan University
Introduction
♪ Health literacy is defined as ‘ the degree to
which 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
♪
In China, though the government has published
policies to improve the health literacy of
(Pleasant,2012),
citizens
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
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
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
special objectives
♪ To understand the health literacy level of
baccalaureate students in our university.
♪ To evaluate
the effects of the health literacy
intervention among baccalaureate students .
Methods
research design
A single-group pre–post nonexperimental design
was conducted in this study.
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 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
♪ In each semester ,there were eight sessions in total.
♪ Every session was a two-hours lecture in the
evening once a week
♪ The first session started from the second week of
every 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 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 email , 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
health center news propaganda,2009)
ministry of
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%).
Result
Students’ health literacy before and after the intervention
Table 1 The number of students who have adequate health literacy
Variable
Health Literacy
Knowledge & Belief
Lifestyle
Health Skills
Healthy outlook
Infectious disease prevention
Chronic disease prevention
Safety
Medical treatment
Others
pre-intervention post-intervention
257(29.2)
279(31.7)
86(9.8)
602(68.3)
665(73.2)
279(31.7)
42( 4.9)
559(63.4)
300(34.1)
366(41.5)
677(81.4 ）
716(86.0)
368(44.2)
697(83.7)
728(88.4)
670(81.4)
77( 9.3)
689(83.7)
612(74.4)
492(69.8)
Before and after the intervention , N=881 and 832, Respectively.P<0.05
n(%)
χ2
470.2
561.0
261.0
55.7
40.7
413.4
13.3
81.1
268.3
53.0
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%
Spreading the diseases via Mosquitoes,
flies, mice and cockroaches
26.8%
25.6%
0.52 0.604
39.5%
5.54 0.000
37.2%
2.34 0.019
Willing to work with disabilities
and people with mental illness
31.7%
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 about
Health Topics Students Concerned about
Health View& Level
Self-evaluation of health status & measures to improve health
Evaluating their own health literacy
Health promotion through the project
Lifestyle
Their healthy and unhealthy behaviors and lifestyle nearly a week
The nutrients and energy intake
The daily exercise
Health Care skills
Health assessment & Health plans
Develop self-care measures and the difficulty of implementation
Whether your weight is health& How to maintain a healthy weight
Frequency（%）
171（20.6%）
22（2.6%)
18（2.2%）
119（14.3）
89（10.7）
65（7.8）
18（2.2）
59（7.1）
8（1.0）
Result
Table 3 Health Topics the Students Concerned about
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)
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 literacy 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
♪ Irregular
♪ 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.