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The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey.

van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E - J Health Commun (2013)

Bottom Line: Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey.Health literacy was found to partially mediate the association between low education and low self-reported health status.As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.

View Article: PubMed Central - PubMed

Affiliation: a Centre for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.

ABSTRACT
Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.

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Conceptual model of health literacy as a mediator between education and self-reported general health, self-reported physical health, and self-reported mental health, adjusting for age and sex in all steps of the model.
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Figure 1: Conceptual model of health literacy as a mediator between education and self-reported general health, self-reported physical health, and self-reported mental health, adjusting for age and sex in all steps of the model.

Mentions: To test the hypothesis that health literacy is a pathway by which education affects health, we examined the mediation effect of health literacy on the relationship between education and health status (i.e., self-reported general health, self-reported physical health, and self-reported mental health). Separate mediation models were applied for all three indicators of health status on the basis of linear regression analyses (see Figure 1). All linear regression analyses were controlled for age and sex as covariates, because both were expected to be associated with health, education, and health literacy (Fleishman & Lawrence, 2003; Lee et al., 2010; Nielsen-Bohlman et al., 2004; Paasche-Orlow et al., 2005; Schillinger et al., 2002). The product-of-coefficients test by MacKinnon was used to estimate the mediating effect on the basis of four steps, as illustrated in Figure 1 (MacKinnon, Fairchild, & Fritz, 2007): (a) regress the mediator health literacy on the independent variable education (a-coefficient); (b) regress the dependent variable health on the mediator health literacy while controlling for the independent variable education as a potential confounder (b-coefficient); (c) calculate the total effect by regressing the dependent variable health on the independent variable education (c-coefficient); (d) calculate the direct effect by regressing the dependent variable health on the independent variable education while controlling for the mediator health literacy (c'-coefficient).


The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey.

van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E - J Health Commun (2013)

Conceptual model of health literacy as a mediator between education and self-reported general health, self-reported physical health, and self-reported mental health, adjusting for age and sex in all steps of the model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3814618&req=5

Figure 1: Conceptual model of health literacy as a mediator between education and self-reported general health, self-reported physical health, and self-reported mental health, adjusting for age and sex in all steps of the model.
Mentions: To test the hypothesis that health literacy is a pathway by which education affects health, we examined the mediation effect of health literacy on the relationship between education and health status (i.e., self-reported general health, self-reported physical health, and self-reported mental health). Separate mediation models were applied for all three indicators of health status on the basis of linear regression analyses (see Figure 1). All linear regression analyses were controlled for age and sex as covariates, because both were expected to be associated with health, education, and health literacy (Fleishman & Lawrence, 2003; Lee et al., 2010; Nielsen-Bohlman et al., 2004; Paasche-Orlow et al., 2005; Schillinger et al., 2002). The product-of-coefficients test by MacKinnon was used to estimate the mediating effect on the basis of four steps, as illustrated in Figure 1 (MacKinnon, Fairchild, & Fritz, 2007): (a) regress the mediator health literacy on the independent variable education (a-coefficient); (b) regress the dependent variable health on the mediator health literacy while controlling for the independent variable education as a potential confounder (b-coefficient); (c) calculate the total effect by regressing the dependent variable health on the independent variable education (c-coefficient); (d) calculate the direct effect by regressing the dependent variable health on the independent variable education while controlling for the mediator health literacy (c'-coefficient).

Bottom Line: Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey.Health literacy was found to partially mediate the association between low education and low self-reported health status.As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.

View Article: PubMed Central - PubMed

Affiliation: a Centre for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands.

ABSTRACT
Health literacy has been put forward as a potential mechanism explaining the well-documented relationship between education and health. However, little empirical research has been undertaken to explore this hypothesis. The present study aims to study whether health literacy could be a pathway by which level of education affects health status. Health literacy was measured by the Health Activities and Literacy Scale, using data from a subsample of 5,136 adults between the ages of 25 and 65 years, gathered within the context of the 2007 Dutch Adult Literacy and Life Skills Survey. Linear regression analyses were used in separate models to estimate the extent to which health literacy mediates educational disparities in self-reported general health, physical health status, and mental health status as measured by the Short Form-12. Health literacy was found to partially mediate the association between low education and low self-reported health status. As such, improving health literacy may be a useful strategy for reducing disparities in health related to education, as health literacy appears to play a role in explaining the underlying mechanism driving the relationship between low level of education and poor health.

Show MeSH
Related in: MedlinePlus