Is college education an equalizer for social disparities in health literacy? A case study in Shanghai, China

What are the acceptances and associated influences of hospice care in Mainland China? A national cross-sectional study

Background

China ranks 53^rd out of 81 countries in the Quality of Death Index for 2021. Although hospice care demand is increasing, the progress remains slow. It is of great significance to explore the acceptances and associated influencing factors of hospice care.

Methods

A cross-sectional survey by quota sampling was conducted in China from July 10^th to September 15^th, 2021. We collected demographic data and hospice care acceptance. A stepwise linear regression analysis was used.

Results

This survey contained 11,031 valid questionnaire results to investigate the hospice care acceptance. It was found that individuals with undergraduate or above (β = 0.04), more properties [2 (β = 0.02), 3 (β = 0.01)], and higher reimbursement types of medical insurance [employee health insurance and commercial health (β = 0.03), government insurance (β = 0.04)] had higher hospice acceptance willingness, while males (β = -0.02) were less willing to accept than females. Psychological conditions [mild anxiety (β = 0.03), moderate anxiety (β = 0.01), moderate stress (β = 0.05), and severe stress (β = 0.06)] also played an important role. The Self-Management Scale (SHMS) (β = 0.12), EuroQol Five Dimensions Questionnaire (EQ-5D) (β = 0.05), EuroQol Visual Analog Scale (EQ-VAS) (β = 0.21), Short-Form Family Health Scale (FHS-SF) (β = 0.12), higher scores of the Short-Form Health Literacy Instrument (HLS-SF12) (β = 0.16), and Perceived Social Support Scale (PSSS) (β = 0.10) also contributed. Gender subgroup showed that in the male group, age, highest educational level, marital status, number of properties, whether having children, psychological conditions, the SHMS, EQ-5D, EQ-VAS, HLS-SF12, and PSSS showed significant difference. Urban and rural subgroups showed that age, highest educational level, number of properties, whether having chronic disease or psychological conditions, the SHMS, EQ-VAS, HLS-SF12, and PSSS were contributing factors in rural areas.

Conclusion

The average score of acceptance of hospice care was 65.02 points. Gender, house, anxiety, pressure, social support, and health literacy were the main influencing factors on residents' attitudes.

Intention to Pay for Vaccination and Influencing Factors of General Residents: A National Cross-Sectional Study

BACKGROUND

As an important part of the promotion of immunization programs and the suppression of infectious diseases, paid vaccines can prevent a variety of diseases and meet the needs of different populations. However, few studies focus on the public's intention to pay for vaccination.

METHODS

The survey was conducted from 10 July to 15 September 2021, adopting a cross-sectional survey in China. We used a multi-stage sampling strategy to recruit participators from 120 cities. Participants filled out questions which assessed their intentions to pay for vaccination. A linear regression analysis was given to identify the predictors associated with the subjects' attitudes.

RESULTS

There were 11,031 residents who finished our questionnaire. Chinese residents' intention to receive paid vaccines scored 74.5 points. Residents who were male (β = -0.03) and older (30-44 (β = -0.03) or 45-59 (β = -0.06) or ≥60 (β = -0.08)), living alone (β = -0.03), who had moderate to severe anxiety (β = -0.03) or severe anxiety (β = -0.03) were more likely to refuse vaccination, while those who lived in Western China (β = 0.03) who had higher PSSS scores and HLS-SF12 index might acquire the intention to pay for vaccination.

CONCLUSIONS

The study found that gender, age, region, living alone, anxiety, social support, and health literacy were the main influencing factors of residents' attitudes. Governments and health institutions should take targeted measures to improve the health literacy and mental health of the population in order to facilitate the implementation of vaccination withdrawal and immunization policies.

Definitions and measurement of health literacy in health and medicine research: a systematic review

OBJECTIVES

The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments.

DESIGN

Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019.

ELIGIBILITY CRITERIA

We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years.

DATA EXTRACTION AND SYNTHESIS

Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam's descriptions of the different health literacy levels.

RESULTS

120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1).

CONCLUSION

Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies.

PROSPERO REGISTRATION NUMBER

CRD42020179699.