Assessing health literacy in the eastern and middle-eastern cultures

Abstract

BackgroundHealth literacy is a term employed to assess the ability of people to meet the increasing demands related to health in a rapidly evolving society. Low health literacy can affect the social determinants of health, health outcomes and the use of healthcare services. The purpose of the study was to develop a survey construct to assess health literacy within the context of regional culture. Different socioeconomic status among the Eastern and Middle Eastern countries may restrict, health information access and utilization for those with low literacy.MethodsBy employing expert panel, Delphi technique, focus group methodologies, and pre-testing using participants (N = 900) from the UAE and India, a survey construct to the Eastern-Middle Eastern cultures was developed. Reliability was assessed using Cronbach’s α and validity using Factor analysis. Kiaser-Meyer-Olkin (KMO) sampling adequacy and Bartlett’s tests were used to assess the strength of the relationship among the variables.ResultsInclusion of non-health related items were found to be critical in the authentic assessment of health literacy in the Eastern and Middle Eastern population given the influence of social desirability. Thirty-two percentage of the original 19-item construct was eliminated by the focus group for reasons of relevance and impact for the local culture. Field pretesting participants from two countries, indicated overall construct reliability (Cronbach’s α =0.85), validity and consistency (KMO value of 0.92 and Bartlett’s test of sphericity was significant).ConclusionThe Eastern-Middle Eastern Adult Health Literacy (EMAHL13), screening instrument is brief, simple, a useful indicator of whether or not a patient can read. It assessespatients’ ability to comprehend by distinguishing between health and non-health related items. The EMAHL13 will be a useful too for the reliable assessment of health literacy in countries, where culture plays a significant impact. This will be the first steptowards providing equitable access to healthcare for countries that have large populations with low socioeconomic status.

Health literacy among Iranian adults: findings from a nationwide population-based survey in 2015

“…Overall health literacy score was determined by aggregating correct answers from all questions and Research article ranged between 0 and 20. Scores were then categorized into 3 groups: inadequate (< 10), moderate (10)(11)(12)(13)(14) and adequate (> 14). Independent variables included age, sex, education, residence and occupation.…”

“…Insufficient health literacy levels vary greatly across different settings, varying from 54.3% in Germany to 58% in Turkey and 28.5% in England (9)(10)(11). Lower levels of health literacy are often observed in developing settings such as the Middle Eastern context (12). In the Islamic Republic of Iran, one of the most populated countries in the Middle East, several studies have tried to measure health literacy and reported overall insufficient health literacy levels, ranging from 41% in adults in the central province of Yazd to 68% in the southeastern province of Baluchistan (13).…”

Health Literacy Measurements with The Newest Vital Sign Instrument Among Adolescents from Dubai, United Arab Emirates

“…Less than 3% of UAE females are illiterate, compared with 6% illiteracy rate among Emirati males, and about 30% illiteracy rate among Arab women. 25 UAE's inclusive education system has facilitated the emergence of female Emiratis who not only outperform their male fellow citizens educationally but also outperform females from other Middle East and North African nations where cultural norms still put females at a disadvantage vis-à-vis access to quality education. 27 As the UAE and other Gulf Cooperation Council nations' health systems progresses into the digital age, the need for highly health literate citizens cannot be over-emphasized if optimal returns on impressive investments in health are to be realized.…”

“…23,24 To the best of our knowledge, this is the first study to systematically examine health literacy among adolescents in the Middle East and North Africa region. Unfortunately, a recently proposed instrument for assessing health literacy in this region, the Eastern-Middle Eastern Adult Health Literacy (EMAHL13) screening instrument 25 , focusses mainly on comprehension, but not numeracy, an important skill in health promotion and disease management. The survey participants in our research study in schools, where English is the main language of instruction and any difficulty in understanding the survey questionnaire was clarified by two of the authors (ZA & AA) who personally administered the survey.…”

Gender-based Inequalities in Health literacy among an Iranian Kurd Population: Results of a Community Survey

“…Although in the Middle East and North African (MENA) region countries a number of studies have been carried out to investigate HL measures [17][18][19][20], among older adults and patients with chronic diseases [18], as well as the determination of HL [21], few studies have previously investigated the contribution of different socio-demographic factors to HL, and the associations between gender and HL in the region. Also, a majority of previous studies has only investigated the associations between sociodemographic characteristics and HL.…”