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*Corresponding Author: Eshetu Elfios
Citation: Citation: Eshetu Elfios, Israel Asale, Kidist Ashager, Getachew Nigussie, Ayele Agena, et al, (2024), Level of Health Literacy and Associated Factors among Adult Admitted Patients at Public Hospitals in Wolaita Zone, Southern Ethiopia, 2023, J. Women Health Care and Issues, 7(4); DOI:10.31579/2642-9756/202
Copyright: Copyright: © 2024, Eshetu Elfios. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 16 April 2024 | Accepted: 27 April 2024 | Published: 07 May 2024
Keywords: potassium permanganate; clandestine abortion; necrotic lesion; maternal mortality; unsafe abortion
Background: Health literacy is an individuals' ability to access, process, and utilize knowledge to make informed decisions about their health. While hospitalizations often result from an interplay of complex factors, addressing patients' health literacy can offer a promising avenue for reducing unnecessary admissions. With this in mind, our study sought to investigate the prevalence of limited health literacy and its contributing factors among adult patients admitted to public hospitals in the Wolaita zone of South Ethiopia.
Methods: Institution-based cross-sectional study was conducted among adult admitted patients at public hospitals of Wolaita Zone, South Ethiopia. An interviewer-administered Health Literacy Questionnaire tool assessed patients’ health literacy. All statistical analysis was performed using SPSS Windows version 25. Binary logistic regression analysis was conducted to determine the relationship of each independent variable with the dependent variable. All variables with a p-value below 0.25 were entered into a multivariable logistic regression analysis to determine the association between the set of independent variables and the dependent variable.
Results: A total of 473 respondents participated in this study. The majority of the participants were males 260 (54.9%) and 177(36.1%) had a diploma and above. The prevalence of Limited Health Literacy was 64%. Those respondents who were not able to read and write were 4 times more likely to have limited health literacy (AOR = 4.09, 95% CI: 2.16, 7.72) compared to those who are above grade 12 (tertiary). Rural residents were 2 times more likely to have limited health literacy (AOR = 2, 95 %CI: 1.250, 2.897). Female participants were likely to have limited health literacy (AOR 2.62 95% CI: 1.412, 3.952) and those who didn’t found medical information via the internet/television (AOR =2.25, CI: 1.31, 3.88) had 2 times likely to have limited Health Literacy.
Conclusion and Recommendation: The prevalence of Limited Health Literacy was 64% and education, rural residency, female gender and finding medical information via the internet/television are significant factors. Concerned stakeholders especially health policy makers should implement strategies to improve the level of health literacy.
Providing safe, equitable and accessible healthcare is an ongoing challenge for all healthcare providers. Pressure from an aging population, an increase in chronic and preventable diseases, rising healthcare costs and labor shortages, and changing community expectations, growing, hospitals are under unprecedented pressure [1-4] A constant challenge for hospitals is managing admissions for potentially avoidable symptoms, whether or not they were treated outside the hospital. Although the reasons for hospitalization are complex and multifactorial, addressing the health literacy needs of patients can be a potential strategy to reduce avoidable hospitalizations [5]
Health literacy (HL) is the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and utilize information to improve and maintain health [6]. Health literacy is a multifaceted concept that encompasses all aspects of individuals capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions [7-9].
According to the World Health Organization (WHO) definition: HL is the cognitive and social skills which determine the motivation and ability of individuals to gain access to, aware and use information in ways which improve and maintain health [10]. Health literacy is the achievement of a level of knowledge, skills and confidence to take action by improving people’s access to health information, and their capacity to use it effectively [9,11]
An adequate level of health literacy is important to an individual in that it helps them to take responsibility for their own health as well as their family health and community healt [12]. Individuals with limited health literacy face difficulties in understanding items that affect disease treatment such as realizing educational materials, reading appointment and medication labels [13], and may also face challenges when communicate with health care professionals [14]. Other international studies have shown that limited health literacy affects large parts of the population [15,17]
Although it is important for improved health status, individuals with Limited Health literacy are common. A large-Scale Danish survey on health literacy shows that between 8.8% and 20.2% of the entire population find tasks related to understanding health information or engaging with healthcare providers difficult [18]. According to a national survey conducted in United States of America, more than 33% of Americans had Limited Health literacy, and According to the European Health Literacy Survey conducted over eight countries shows that 35% of respondents had Limited Health Literacy, while about 30% of adults in Taiwan had limited Health Literacy [19,20]
Individuals with Limited health literacy were about 3 times more at risk to experience adverse health outcomes [21]. The cost associated with Limited Health Literacy is tremendous, and accounts about 5% of the entire health care cost per annum [22]. Moreover, patients with limited health literacy are at greater risk for poor care and outcomes including lack of awareness about disease, poor personal care, increased hospital admissions, and increased death risk [14,23-25].
According to several research findings, patient sociodemographics and disease features influence the degree of health literacy. In order to increase medication adherence, various patient empowerment initiatives and strategies would be necessary. As a result, healthcare professionals should evaluate their patients' health literacy level and provide information and support that is appropriate for their patients' level of health literacy as well as their personal circumstance [26-28].
Globally, health literacy has been recognized as an essential issue in health research in the past decades. However, given the heavy burden of communicable and non-communicable diseases on Ethiopia, as a developing country, information on the level of health literacy is still lacking. Previous study conducted didn’t address clinical characteristics including: number of medical illnesses, family history of medical illness, family members with medical training, accompanied by family to the clinic, and finding medical information on the television or internet. Therefore, the aim of this study was to find the prevalence of limited health literacy and its associated factors among adult admitted patient at public hospitals in Wolaita Sodo zone, Southern Ethiopia.
Study design and setting
An institution-based cross-sectional study was conducted from March 24 up to May 25, 2023, at public Hospitals in the Wolaita zone, Southern Ethiopia. Wolaita zonal administration is 380km away from Addis Ababa, which is the capital city of Ethiopia. The annual report for 2020 shows that the Wolaita Zone health department has six administrative towns and 16 woredas with total population of 5,385,782 with an area of 451,170.7 hectares (1,741.980 sq mi)(29). In Wolaita Zone during the study period, there are 6 public hospitals; Wolaita Sodo university referral and teaching hospital (WSUTRH), Bodity Primary Hospital, Gasuba Primary Hospital, Bitana Primary Hospital, Bale Primary Hospital, and Bombe primary hospital. The net sample of 493 was recruited using a proportionate sampling method to each hospital.
Data collection procedure and measurements
Data collection methods included interviewer-administered standardized questionnaires. Before actual data collection, the study instruments were pretested and adjusted accordingly. The data collection instrument consists three sections: Sociodemographic data, clinical characteristics, and Health Literacy Questionnaire (HLQ)(30). The HLQ contents were contextualized to Ethiopian patients.
Sociodemographic and clinical characteristics collected included the participants’ age, gender, marital status, education level, occupation, number of medical illnesses, family history of medical illness, family members with medical training, accompanied by family to the clinic, finding medical information on the television or internet, and limitations on activities. The contents of HLQ comprised of five areas; Having sufficient information to manage my health, ability to good health information, understanding health information well enough to know what to do considered as functional health literacy; ability to actively engage with health care providers considered as communicative or interactive health literacy; and appraisal of health information considered as critical health literacy.
According to HLQ the participants were asked to what extent they agree with the statements: understanding health information well enough to know what to do and having sufficient information to manage my health. Accordingly, responded as 1= strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree. Participants responded for ability to actively engage with health care providers, appraisal of health information, and ability to good health information as 1 = cannot do, 2 = very difficult, 3 = quite difficult, 4 = quite easy, and 5 = very easy. As it was normal data distribution, the cut-offs to define “adequate health literacy” was determined considering those patients who scored mean and above mean and otherwise as “limited health literacy” [31].
The collected data were entered to Epi-Data Manager version 3.1, checked and coded, and then exported into Statistical package for social sciences (SPSS) version 25. Descriptive statistics such as frequencies, percentages, means, standard deviations, and crosstabs were applied to summarize data. Binary logistic regression was done to determine the relationship of each independent variable with the dependent variable. All variables with a p-value below 0.25 were entered into a multivariable logistic regression analysis to determine the association between a set of independent variables with the dependent variable using a stepwise backward method [32]. The significance was checked using a p-value of 0.05 and a 95% confidence interval. The strength of association was interpreted by using an adjusted odds ratio.
Socio-demographic Characteristics of Respondents
From the total 493 samples, 473 of them participated with a response rate of 96%. Out of 473 participants, 266 [55.8%] were males and 170[44.2%] were females. The age range of the patients was from 25 to 89 years with the mean age of the respondents was 54 [SD+12.95]. Out of all respondents, 185[36.1%] had a diploma and above followed by149 [29%] who attended secondary education (Table 1).
Table 1: Socio demographic characteristics of patients admitted in hospitals in Wolaita zone, Southern Ethiopia, March 24 up to May 25, 2023. (n=473)
Clinical characteristics of Respondents
From the total 473 respondents, 312 [66%] respondents didn’t find medical information on the television or internet and majority [86%] of respondents do not have family members with medical training (Table 2).
Health Literacy of Respondents
From all 473 respondents, the magnitude of the limited health literacy was 64%. Mostly limited health literacy among health literacy question was understands of health information well enough to know what to do(Table 3).
| HL Questions | Mean | SD | Health | Literacy |
| Limited | Adequate | |||
| Having sufficient information to manage my health | 2.16 | 1.16 | 310(65.6%) | 163(34.4%) |
| Appraisal of health information | 2.49 | 1.03 | 303(64.1%) | 170(35.9%) |
| Understanding health information well enough to know what to do | 2.11 | 1.13 | 260(72.6%) | 130(27.4%) |
| Ability to good health information | 2.36 | 1.09 | 311(65.8%) | 162(34.2%) |
| Ability to actively engage with health care providers | 2.31 | 1.06 | 244(51.6%) | 229(48.4%) |
Table 3: Health Literacy of Respondents in Public Hospitals of Wolaita Zone, Southern Ethiopia, 2022 (n=473)
Factors Associated with Health Literacy
All independent variables have been considered for the bivariable logistic regression analyses. All independent variables that showed a p-value less than 0.25 in bivariable analyses were considered candidate variables for the multivariable analysis. Those respondents who were not able to read and write were 4 times more likely to have limited health literacy (AOR = 4.09,
95% CI: 2.16, 7.72) compared to those who are above grade 12 (tertiary). Rural residents were 2 times more likely to have limited health literacy (AOR = 2, 95 %CI: 1.25, 2.89). Female participants were 2 times more likely to have limited health literacy (AOR 2.62 95% CI: 1.41, 3.95) and those who didn’t found medical information via the internet/television 2.25 (1.31, 3.88) had lower odds of having limited Health literacy (Table 4).
Table 4: Factors Associated with Health Literacy of Admitted Patients in Government Hospitals of Wolaita Zone, Southern Ethiopia, 2020 (n= 473)
* Statistically significant at p < 0>
An adequate level of health literacy is important to an individual in that it helps them to take responsibility for their own health as well as their family health and community health [12]. Individuals with low health literacy face difficulties in understanding items that affect disease treatment such as realizing educational materials, reading appointment and medication labels [13], and may also face challenges when communicate with health care professional [14]. Health literacy is a multifaceted concept with various contributing factors. Importantly, these factors might vary from one setting to another. This is necessary to identify the contributing factors that, in each setup, could become essential pillar of public health programs aiming at improving health literacy [33].
The purpose of this study was to determine the prevalence of limited Health literacy and associated factors among patients admitted at public hospitals of Wolaita zone, Southern Ethiopia. The result showed that the prevalence of limited Health literacy was 64%. The findings of this study were similar to a study conducted among adult admitted patients in government hospitals of West Shoa Zone, Ethiopi[34], and Jimma Medical Center, Ethiopia;[35]. Where as in this study the prevalence of limited health literacy is slightly lower when compared with the study conducted in the University of Gondar Comprehensive Specialized Hospital [36].
In this study level education of was significantly associated with limited health literacy. Those respondents who were not able to read and write were 4 times more likely to have limited health literacy (AOR = 4.09, 95% CI: 2.16, 7.72) compared to those who are above grade 12 (tertiary). This finding is similar with a study done in government hospitals of West Shoa Zone, Ethiopia(34), Jimma Medical Center, Ethiopia;[36] and consistent with the study conducted in Nigeria[37]. Those respondents from urban residency were 2 times higher levels of health literacy when compared to rural residents. Similarly, study conducted in Southern Illinois University School of Medicine showed that rural residents had lower levels of health literacy compared to urban population [38]. This might be due to that urban residents have great access to health information than those from rural residents.
Female participants were 2 times more likely to have limited health literacy (AOR 2.62 95% CI: 1.412, 3.952), these finding requires additional in-depth study. This study did not find a significant predictive association between age of respondents and health literacy in contrast to previous studie[34,39].
Among from different clinical characteristics, finding medical information via television/internet was significantly associated with health literacy. Thus, who didn’t find medical information via the internet/television (AOR =2.25, CI: 1.31, 3.88) had 2 times likely to have limited Health literacy. This finding was supported by the study conducted in Malaysia [40].
Our study found that there is high prevalence in limited health literacy. We didn’t find any association between limited health literacy and age of respondents. However, level of education, female gender, being rural resident and finding medical information via the internet/television were significantly associated with limited health literacy. Strategies to address these are needed to reduce limited health literacy. Disparities in health literacy between educated and uneducated as well as in urban and rural residents should be minimized to the lowest possible level. We recommend that future researcher to implement qualitative and interventional study in which, this study didn`t address it due to resource and other associated constraints.
We obtained ethical clearance from the Ethical review committee of College of Health Sciences of Wolaita Sodo University with a reference number WSU/R/37/1971/23. Written informed consent was obtained from respondents during data collection after explaining the purpose of the study and the benefits. Ethical review committee has approved this consent. Respondents were interviewed voluntarily by assuring confidentiality.
Not applicable
The datasets used and/or analyzed during the current study are available from the corresponding author.
EE, CK and TT conceptualized the study; EE, MG and TG analyzed the data; EE interpreted the data and wrote the first draft of the manuscript; EE, BA, and KA reviewed and substantively revised the manuscript. All authors read and approved the final manuscript. We authors read and confirmed to submit the journal and gave the final approval of version to be published, and agreed to be accountable for all aspect of the work.
The authors have declared that no competing interests exist.
No funding was obtained for this study.
We extend our thanks to Wolaita Sodo University College of Health Science, data collectors, supervisors and study participants for their willingness to participate in the study.
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