Background
Health literacy is an important determinant of residents' health, and also a key indicator for evaluating health education and health promotion. Exploring the factors that influence health literacy is especially important for improving health literacy levels. Social capital can promote the spread of health knowledge and thus affect health literacy.
Objective The purpose of this study is to investigate the health literacy status of community residents in Xuhui District of Shanghai, explore the impact of social capital on health literacy, and provide an effective target for health literacy intervention.
Methods A cross-sectional survey of residents from the district of Shanghai was conducted using the 2017 National Health Literacy Monitoring Questionnaire and the Social Capital Scale. A total of 640 questionnaires were distributed, and 600 were recovered. The recovery rate was 93.75% and the percentage of recovered questionnaires valid for analysis was 100%. The National Health Literacy Monitoring Questionnaire consisted of three aspects:health knowledge and concept, healthy lifestyle and behaviors, and basic skills. The Social Capital Scale included five aspects:social support, social participation, social network, control of life, and feelings for the community. Descriptive analysis of demographic characteristics was carried out, and chi-square tests was used to compare health literacy scores across selected demographic characteristics. Logistic regression analysis was conducted with health literacy scores as a dependent variable and selected demographic characteristics & social capital as independent variables.
Results There were 600 respondents, including 275 males (45.8%) and 325 females (54.2%). The largest age group was 60-74 years old, accounting for 41.8%. The number of people with basic qualified health literacy was 213, accounting for 35.5%. The proportions of people with qualified health knowledge and concept, healthy lifestyle and behaviors, and basic skills were 34.2%, 31.7% and 49.0%, respectively. The two dimensional (healthy lifestyles and behaviors, health skills) and total scores of health literacy had statistically significant differences across educational attainment categories (Ps < 0.05). The proportions of residents with qualified health literacy in middle school and below, high school, and college and above group were 26.7%, 32.1%, and 45.0%, respectively. The higher education level was attained, the higher proportion of residents with qualified health literacy were. The logistic regression analysis results showed that social network (OR=1.081, 95%CI:1.019-1.147) and social support (OR=1.084, 95%CI:1.023-1.149) were the main social capital related factors affecting health literacy level. In addition, social support was the influencing factor of health knowledge and concept (OR=1.115, 95%CI:1.066-1.167) and healthy lifestyle and behavior (OR=1.141, 95%CI:1.088-1.196), while social network (OR=1.095, 95%CI:1.036-1.157) and social support (OR=1.072, 95%CI:1.018-1.130) were the influencing factors of basic skills.
Conclusion Education level is an impact factor of health literacy level, and the promotion of health literacy should focus on groups with lower education levels. Social support and social network in social capital are associated with health literacy level. The health literacy level of residents may be ameliorated by improving social capital, so as to improve the health status of residents.
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