Health literacy and health: rethinking the strategies for universal health coverage in Ghana
Health literacy and health: rethinking the strategies for universal health coverage in Ghana
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DOI：
10.1016/j.puhe.2018.03.002
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发表时间：
2018-06-01
期刊：
影响因子：
5.2
通讯作者：
Phillips, David R.
中科院分区：
文献类型：
--
作者：
Amoah, Padmore Adusei;Phillips, David R.
目的：健康素养（HL）通常被认为与积极的健康行为，适当的卫生服务利用和接受干预措施，以最大限度地提高健康结果。因此，越来越多的人建议，以证据为基础的研究应该调查如何HL可能在全民健康覆盖（UHC）的背景下运作。然而，HL在全民健康覆盖的要素之间的关系，如获得医疗保健和医疗保险的作用还没有得到广泛的探讨。这尤其适用于撒哈拉以南非洲，尽管许多国家之间和国家内部的服务覆盖面和健康成果差异很大。本文针对加纳的这一空白，加纳是当今非洲最有前途的卫生系统之一。研究设计：这是一项横断面研究。方法：本研究采用结构化访谈，采用多阶段整群抽样方法从779名农村和城市成年人中收集数据。结果：在三步多元分层线性回归模型中，HL（B =-0.09，标准误[SE]-0.04）和健康保险订阅（B =-15，SE = 0.04）与健康相关生活质量（HRQoL）差呈负相关。获得医疗保健不能预测HRQoL（B = -.02，SE = .02）。然而，获得医疗保健和HL之间的相互作用对HRQoL不良产生了负面影响（B = -.08，SE = .03）。HL和健康保险订阅之间的相互作用也显示出对HRQoL的类似影响（B = -.10，SE = .03）。进一步的分析表明，获得医疗保健（β = -.09，P = .05）和健康保险订阅（β = -.24，P = .00）与HRQoL呈正相关，只有当HL是high.Conclusion：本文认为，HL是低的，即使是UHC的有利政策很可能错过设定的目标。在不忽视相关社会文化因素的同时，加强人道主义应成为旨在消除健康不平等和改善全民健康覆盖政策的核心战略。(C)2018年皇家公共卫生学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: Health literacy (HL) is generally thought to be associated with positive health behaviour, appropriate health service utilisation and acceptance of interventions to maximise health outcomes. It is, therefore, increasingly suggested that evidence-based research should investigate how HL may operate in the context of universal health coverage (UHC). However, the role of HL in the relationships between elements of UHC such as access to health care and health insurance has not been widely explored. This applies in particular in Sub-Saharan Africa, although service coverage and health outcomes vary hugely between and within many countries. This article addresses this lacuna in Ghana, today one of the Africa's most promising health systems.Study design: It is a cross-sectional study.Methods: The study used structured interviews to gather data from 779 rural and urban adults using a multistage cluster sampling approach.Results: In a three-step multiple hierarchical linear regression model, HL (B = -.09, standard error [SE] -.04) and health insurance subscription (B = -15, SE = .04) were found to be inversely associated with poor health-related quality of life (HRQoL). Access to health care did not predict HRQoL (B = -.02, SE = .02). However, the interaction between access to health care and HL produced a negative effect on poor HRQoL (B = -.08, SE = .03). The interaction between HL and health insurance subscription also showed a similar effect on HRQoL (B = -.10, SE = .03). Further analysis depicted that access to health care (beta = -.09, P = .05) and health insurance subscription (beta = -.24, P = .00) related positively to HRQoL only when HL was high.Conclusion: The article argues that where HL is low, even favourable policies for UHC are likely to miss set targets. While not losing sight of relevant sociocultural elements, enhancing HL should be a central strategy for policies aimed at bridging health inequalities and improving UHC. (C) 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.