Relationship between Health Literacy and Women’s Public Health: A Case Study of Health Centers in Neyshabour

Special Article – Family Practice

J Fam Med. 2018; 5(5): 1154.

Relationship between Health Literacy and Women’s Public Health: A Case Study of Health Centers in Neyshabour

Naseri N1, Nouhi E* and Rayan M3

¹Student, Nursing Research Center. School of Nursing & Midwifery, Kerman University of Medical Sciences, Kerman, Iran

²Associate Professor, Medical Surgical Nursing Department, Nursing Research Center of Kerman University of Medical Sciences, Kerman, Iran

³Assistance Professor, Nursing Research Center, School of Nursing & Midwifery, Kerman University of Medical Sciences, Kerman, Iran

*Corresponding author: Nouhi Esmat, Associate Professor, Medical Surgical Nursing Department, Nursing Research Center of Kerman University of Medical Sciences, School of Nursing & Midwifery Kerman University of Medical Sciences, Kerman, Iran

Received: November 13, 2018; Accepted: December 14, 2018; Published: December 21, 2018


Introduction: Nowadays health and welfare of women not only recognized as human rights, but also have a significant effect on health of family and community. Promoting public health of women is affected by several factors including health literacy of women. Health literacy doesn’t necessarily refer to years of study. But it is a set of skills such as analysis, decision-making and the ability to use knowledge in health situations. This study aimed to determine the relationship between health literacy and public health of women in Neyshabour health centers.

Methods: This study is a cross sectional research. The research population consists of women who referred to Neyshabur health centers from Dec, 2015 to May, 2016. The sample included 270 women referring to all health centers in Neyshabur city. The sequential method was also used. Data collection included the General Health Questionnaire (GHQ) and health literacy questionnaire Brief Test of functional health literacy in adults )TOFHLA.(Data were analyzed using descriptive and analytical statistics and by independent t-test, ANOVA, Pearson Correlation and Multiple Regression tests through SPSS 19. SPSS 19 was used for analyzing data.

Findings: The mean and standard deviation score of health literacy was (68/02±14/01). 54/2% of Persons has Inadequate and border health literacy. The mean and standard deviation of general health was (59/87±9/22). A meaningful relationship (p=0/001) was observed between health literacy and general health. The variables were statistically significant, with high level education, Job (Employee) and Source of Health Information being the strongest predictor for health literacy and only level of high education and Job (Employee) for general health.

Conclusion: According to the results of this study, general health is increasing through health literacy development. Thus, better decisions will be made by using her own knowledge in health care positions. so education of women is necessary in that it promotes health literacy and also their general health which leads to general health of population.

Keywords: Health literacy; General Health; Women; Health center


Women make up half of the global population, as well as being family managers, trainers and community activists. Likewise, women’s health and wellness support health of the families and society [1]. Women play a vital role in the society. considering their responsibilities in strengthening the family circle, their health should be quite provided [2]. General health is the quality of life including emotional, mental, spiritual states and biological fitness of a certain person which creates compatibility with her environment and make it possible to conduct physical, mental and social activities [3]. According to the World Health Organization, health is defined as feeling peace and tranquility of the body, mind and environment [4]. Accordingly, modern health care systems create various aspects of customer health. Since self-management of health care has been developed, individual shave been seeking new methods to obtain information, meet their rights, and also make health decisions for themselves and others. The prerequisite for such a task is to endorse a range of skills and knowledge, which came under concept of health literacy [5]. Nowadays health literacy is considered as a global issue in the 21st century. Health literacy includes individuals’ capacity to obtain, process, and understand rudimentary health information and services required to make appropriate health decisions (for care) [6]. WHO on Health Promotion Global Conference in Mexico introduces the health literacy as social and cognitive skills which determine the motivation and capabilities of individuals to access, understand, and implement the information in a way that it culminates in improvement of their health. The committee also declares that the health literacy is not only an individual characteristic, but also a major determinant of health at the population level [7]. Inadequate health literacy is usually accompanied by poor individual health status, inappropriate use of medications, reckless disregard of doctors’ orders, limited health knowledge, passive participation in treatment decision-making process, lack of concern regarding health, and unfriendly connections with the doctors. Besides, people with lack of health literacy skills are not well informed about health, they also receive less health services and get into difficulties with chronic disease. Such people give a poor performance in mental and physical health. In addition, emergency hospital services have been offered to them more [8,9].

According to studies conducted by the Center of American Health Care, individuals with low health literacy are less likely to understand written and spoken information provided by health experts and incur more medical costs [10]. The studies show that a patient quickly forgets 40-80% of medical information that he receives and half of the remaining data is incorrect [5]. In this regard, based on a study conducted in Iran 56.6% of the research population lacks health literacy and only 28.1% of higher levels enjoys it [11]. Further research entitled "study of health literacy of pregnant women in health centers at Shahid Beheshti university of medical sciences" in Iran demonstrated that 53.6% of the pregnant women have inadequate health literacy [12]. Likewise, health service providers are unaware of the patients’ reading capabilities [13]. Furthermore, limited health literacy not only leads to difficulties for patients but also a challenge for health care suppliers [14]. Although it is important to recognize people who fail to have adequate health literacy, health system staff gives a poor performance in this regard [10].

Health literacy is a significant maternal element to engage the mother and her children with health promotion and preventive activities. Similarly, without sufficient understanding of health care information, it would be impossible to make informed decisions that result in favorable outcomes for the health of family [15]. Consequently, women are identified as the initial population to increase health literacy since their proper education can adjust a person's health literacy capacity – which is influenced by culture, language, and health related positions [16]. Thus, health literacy is essential for health and modern lives of citizens and should be considered not only in health section, but also throughout the whole system [17]. Due to the fact that women's public health, health literacy and other related factors can be vital for planners and health authorities to provide education programs in association with women's needs, the present study aims to investigate the relationship between health literacy and women's general health.


This research is a cross sectional study conducted within six months from Dec, 2015 to May, 2016. The present study focused on the women referred to health centers under the supervision of Neyshaboor university of medical science. The process of sampling has been taken from the women who have the criteria for the research (180) and all urban health centers (9 centers). Criteria for research were as follows: reading and writing ability, tendency to study and having no diseases. The research excludes those candidates who suffered from sever auditory, visual, mental, or perceptional problems and also fail to fill the questionnaires. For assessment of health literacy, Brief-TOFHLA was used. It is an abridged version of the questionnaire TOFHLA and included both reading and calculation. The calculation section measures person's ability in terms of recommendations of his doctor for understanding and acting. The section is comprised of four explanation or health instructions on prescribed drugs, doctors’ appointment dates, and also an example of result of a medical experiment. Reliability and validity of this questionnaire were studied by Parker et al. who found test result a Chronbach’s a of 0.68 for calculation, aspects of the questionnaire and 0.97 for its reading aspects [18]. 1 In addition, Koushyar et al. in 2013 calculated its Chronbach’s a to be 0.77-0.71.

These explanations were submitted to the subject in the form of printed cards and then the related questions were asked women. The scores were considered in a range of 0-28. In reading comprehension section, the women demonstrate their ability to read and understand two research units in the context of health care. The forms have 36 multiple-choice questions with 2 points per question, totally 0-72 scores. The total number was between 0-100. Regarding this number, health literacy was divided into three levels: inadequate health literacy (0-53), marginal health literacy (54-66), and 67-100 adequate health literacy (67-100). Demographic features of candidates included age, occupation, marital status, education, family size, economic status, insurance status, source of medical information, and employment status of her immediate family. In this study, the second tool used to measure general health was General Health Questionnaire (GHQ). Although the original questionnaire contains 60 questions, it has been used in the forms of 30, 12, and 28 questions. In this research, the questionnaire included 28 questions. Reliability and validity of this questionnaire were studied by Thomas & Douglas. They found a Chronbach’s a of 0.91. 1 In addition Taghavi et al. in 2008 calculated its Chronbach’s a to be 0.90. In addition to total score of individual’s health status, the present paper consists of four subscales: physical symptoms, anxiety, social dysfunction, and depression. Test scores are based on Likerth scale (0,1,2,3), in which each individual gains five scores, that is four scores to sub-scale and 1 score to the whole questionnaire. Therefore, an individual’s total score ranges from 0-84 and subscale scores ranges from 0-21. Accordingly, it has been divided into four levels: no or minimal level (0-22 score), mild (23- 40), medium (41-60) and intense level (61-84 score). It is worth mentioning that, in the test, low and high levels indicate health and non-health, respectively.

Statistical Package for Social Scientists (SPSS19) was used to analyze the data including descriptive (percentages, mean score) and inferential statistics (i.e., ANOVA: t-test independent sampling assuming no equal variances; and Pearson Product Moment Correlation Coefficient). To evaluate the effect of each variable in the presence of other variables, multiple linear regressions were used to control their effects. Multiple regression analysis using was done and only statistically significant variables. Comparisons were considered significant at the P < 0.05.


The findings indicated that the average age of participants was 30.7±7.24. The minimum age was 18 and the maximum was 53. Most of them were housewives (65%). 16/7 percent were self employed and 18/3 percent of them were clerks. Most participants (86.3%) were married, 7/2% were single, 3/3% were divorced, and 1/7% were widowed. Education degree of most of candidates were diploma (55.9%), 24.9% had bachelor’s degree, 6% had master’s degree and 19.3% had low literate (Table 1).