Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL).
Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL).
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DOI：
10.1186/s12889-016-3621-9
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发表时间：
2016-09-13
影响因子：
4.5
通讯作者：
Beauchamp A
中科院分区：
文献类型：
--
作者：
Rikard RV;Thompson MS;McKinney J;Beauchamp A
在美国，卫生知识普及方面的差异与卫生结果方面的差异同时存在。我们的研究有助于了解社会不平等的不同指标（即客观社会阶层、关系社会阶层和社会资源）如何有助于理解健康素养的差异。我们分析了2003年全国成人读写能力评估（NAAL）限制访问数据集中18岁及以上受访者的数据（N = 14,592）。一系列加权的普通最小二乘（OLS）回归模型估计了被调查者的人口统计学特征、社会经济地位（SES）、关系社会阶层、社会资源与基于项目反应理论（IRT）的健康素养测量之间的关系。我们的发现与之前关于健康素养的社会和社会经济地位决定因素的研究一致。然而，我们的研究结果揭示了关系社会地位对理解美国健康素养差异的重要性。社会地位的客观指标是卫生知识普及的持久而有力的指标。衡量相关社会地位的指标，如公民参与（即投票、志愿服务和图书馆使用）与较高的健康素养水平（不含客观资源）相关。社会资源包括说英语和婚姻状况与较高的健康素养水平有关。社会阶层相关指标与健康素养相关，独立于客观社会阶层指标。公民素养（如投票和志愿服务）是卫生素养的预测指标，并为卫生干预提供了机会。我们的研究结果支持健康素养是一种社会建构的概念，并建议需要制定一个理论驱动的健康素养概念定义，其中包括公民素养成分。
In the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources) contribute to understanding disparities in health literacy. We analyze data on respondents 18 years of age and older (N = 14,592) from the 2003 National Assessment of Adult Literacy (NAAL) restricted access data set. A series of weighted Ordinary Least Squares (OLS) regression models estimate the association between respondent’s demographic characteristics, socioeconomic status (SES), relational social class, social resources and an Item Response Theory (IRT) based health literacy measure. Our findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use) are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels. Relational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering) are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.
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