health literacy, perceived-information needs and ...

Ozean Journal of Social Sciences 5(3), 2012

Ozean Journal of Social Sciences 5(3), 2012 ISSN 1943-2577 © 2012 Ozean Publication

HEALTH LITERACY, PERCEIVED-INFORMATION NEEDS AND PREVENTIVE-HEALTH PRACTICES AMONG INDIVIDUALS IN A RURAL COMMUNITY OF IKENNE LOCAL GOVERNMENT AREA, NIGERIA

BOLA CHRISTIE ATULOMAH*, and NNODIMELE ONUIGBO ATULOMAH** *Main Library, Adeleke University, Ede, Osun State, Nigeria. **Department of Public Health, Babcock University, Ilishan Remo, Nigeria. E-mail address for coreespondence: [email protected]

______________________________________________________________________________________ Abstract: A wide range of health-enhancing behaviours significantly depend on health literacy and conscequently, drives health-information seeking needs of individuals. Traditional social settings play significant role in determining general health outcomes of individuals in a community. Studies that explore health literacy and preventive health practices in Nigeria are scanty. This study was undertaken to ascertainthe level of health literacy,perceived-health information needs,preventive-health practices of a rural community in Ikenne Local Government area of south-western Nigeria.This was a cross-sectional study utilizing a validated 52-item questionnaire to collect information about health literacy, perceived health-information needs and preventivehealth practices from268individualsselected by a combination of multistage and systematic random samplingina rural community of Ikenne Local Government area, Nigeria.Male (32.8%) and female(67.2%) respondentshaving non-formal education 40(15.0%), primary education 56(20.9%), high school education 159(59.3%) and above high school education 12(4.5%)with mean age of 32.2±13.11 years were surveyed. Majority were from the Yoruba (49.3%) and Igbo (40.3%) ethnic expressions. Ratings for health literacy measured on an aggregated 27-point scale recorded a mean of 14.97±4.23and for perceived health information needs measured on a 51-point scale wasa mean of 25.7±5.65 while preventive health actions measured on a 48point scale for respondents in this study recorded a mean score of 23.37±7.27.The study concludes that levels of health literacy, perceived-information needs and preventive-health actions observed are unacceptably low. Health-informationdeficit could be aimportant factor in the observed low preventive-health action reported. Keywords: Health literacy, health-Information, health-choices, Preventive-health practices _____________________________________________________________________________________

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INTRODUCTION

Health prospects of individuals in a community are basicallydetermined, in part, by functional health literacy, cognitive awareness and available health information at their disposal (Nutbeam, 2008).These aremodified by the cultural settings, educational opportunities, behavioural skills developed and socio-economic variables that underpin social life in the community. It is now well known that health behaviour has links to health outcomes and these links in turn are dependent on factors associated with health literacy (DeWalt, et al., 2004), cognitive awareness,healthcare services,available health-related information and decision-making process at the individual level.Beyond the individual micro-level are the political-environmental and policy processes(Glanz, et al, 2008)that are required to establish certain resources that influence quality of life for all its citizens, including information resources. Health education is known to play significant role in closing knowledge gaps created due to disperities in social opportunities, even though this processmay be painfully slow, it has been identified as the most effective method of preventing disease than any other intervention(Glanz, et al, 2008). The literacy levels in a vast number of communities in developing and developed countries have been described as low and has been contrived as a factor contributing to poor health outcomes in these communities(Parker, 2000). For example, the adult literacy rate reported for Nigeria was 66.8% in 2008. Educational exposure and functional literacy, combined, are social factors responsible for the process of acculturation in any population. Acculturation is a social transition that can facilitate bridging the gap between native traditional culture and modern scientific culture. The fact that individuals in rural communities with low literacy may have difficulty in conceptualizing scientific ideas involved with health action, constitute an important consideration in health literacy(Nutbeam, 2008). Lack of functional health literacy is an important factor responsible for a considerable proportion of individuals in the rural communities failing to follow medical directives for health maintenance(DeWalt, et al., 2004). In profiling prostate cancer literacy among men in a rural community of Nigeria, a study showed that general awareness among men was unacceptably low and probably was responsible for the poor outcome of the disease in the community(Atulomah, et al, 2010). It is very important that when considering health literacy and health information needs, it should be in the context of cultural oriention of the population of interest.Traditional cultural perspectives have a strong social influence on community life of people and sometimes predispose individuals to conceptualize and act in a particular way which may be likened to how local language may interfere with the accent of an individual when speaking a foreign language. Two predominant cultural perspectives are known to exist in most developing communities and by extension may significantly influence the way meaning and understanding are derived from phenomena that may have far-reaching implications on decision-making process.These perspectives may be termedlocaltraditionalculture and the modern scientificculture. Both differ significantly in how they communicate understanding of health imformation rooted in their different cultures as a result of language idiomatic expressions, cultural health beliefs, locus of control and educational contexts. The local indigenous tradition often are at variance with scientific culture in which most of orthodox health practices and reasoning are conceptualized and communicated. Most times, structural understanding of health issues are needed in communities, where the predominant culture is traditional and not scientific, to apply health literacy in preventing diseases and improving quality of life. For example, in malaria and guinea worm control, it has been necessary to synthesize a half-way between what is believed and understood to be the causative aetiologies for indigenous communities and what has been clearly demonstrated as scientific theory of the diseases; many attemptsto provide health education has not yielded the desired impact (Ramakrishna, et al. 2007). The challenge in getting local people in the communities to accept preventive-health practices rooted in scientific culture, because of the variance between what is thought to be the scientific cause of the disease and the local health beliefshas hindered health literacy (Zola, 1973; Ramakrishna, et al. 2007). Similarly, the roll of locus of control becomes very significant in the understanding required to develop appropriate health literacy and are rooted in traditional culture and belief system (Omeje& Nebo, 2011).Personal-level psychological constructs and structural spharedetermined by educational attainment contribute significantly to the outcome of translating health-information to preventive health actions.Personal-levelpsychological construct,which include attitudinal disposition and perception sub-domains which express how a person internalize and process informationabout health and phenomena, are significantly subjective and are modulated by experiences garnered in specific culture. On the other hand, structural sphere which constitute cognitive experiences shape a wide range of experiences for an individual, and is determined by the educational experience of the individual.This simply means that the frame work for considering and measuring health literacy can not be a one-size -fit-all framework.The health choices and behaviour patterns displayed by an individual is a function of the level of health literacy and health-seeking behavior of the person. At the individual level, health education most importantly includes instructional activities that provides information about health in such a way that through social interactions it can strategically change individual

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health behaviour(Glanz, et al, 2008). Beyond this, health education includes organizational efforts, policydirectives,economicsupports,environmental activities, mass media and community-level programming which gives it an ecological perspective(Glanz, et al, 2008). Of course, health education provides the consciousness-raising, concern-arousing, action-stimulating impetus for public involvement and commitment to social reformsessentialtoitssuccessinademocraticsetting(Green, &Kreuter, 1991). Health literacy is therefore an important outcome expected from h ealth education activities and is primarily related to information dissemination and processing. Cox, Bowmer and Ring (2011)citing Nutbeam(1998), defined health literacy as ―the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health‖. Similarly, Sheridan and colleagues(2011)citing the Institute of Medicine(2004)stated that health literacy is ‗‗the degree to which individuals can obtain, process, and understand the basic health information and services they need in order to make appropriate health decisions‘‘. Furthermore, others have emphasized that health literacy is the extent to which individuals can source information, process and understand the basic health information, and services required to make important health decisions that would improve quality of life or stimulate help-seeking at health protection level(Nutbeam, 2008; Oliffe, et al, 2010; Parker, et al, 1995; Nutbeam, 2000; Matsuyama, et al, 2011; Sabate, 2003). From the on-going discussions and definitions, it can be derived that education and health education can be said to be the platform and framework for operationalizing health literacy. In resource constrained settings, education of the citizens can become compromised resulting to an ineffective venture. Decision-making is a very important personal attribute and may be likened to making a recommendation to one‘s self on choice of options on the basis of available information regarding the issue under review as the individual has and is able to obtain within the constraint of time. The challenge of low literacy to individuals from communities with low economy and marginal development can betremendous. Persons with limited health literacy can be at serious social disadvantage in terms of their ability to read and understand written medical instructions, including medication dosages and understanding results of medical tests and diagnosis, locate health providers and services offered, share personal information such as health history, provide self-care in chronic illnesses, understand how to take medicines. The study sought to answer a number of questions including where information related to health protection are obtained; what level of health literacy is present in the community. The purpose of this study was to determine the level of health literacy, perceivedhealth-information needs, and preventive-health practices among individuals of a rural community of the Ikenne Local Government area of south-western Nigeria. Furthermore, to find out whether an association exist between health literacy and preventive health activities of this sample of participants in order to validate the importance of health literacy in predicting both perceived health information needs and preventive health activities. The outcome of this study would provide empirical basis for strategically strengthening how information for rural dwellers may be packaged by information professionals and health educators for effective health care delivery and enhance access.

METHODOLOGY

The study design was a community-based cross-sectional survey utilizing a 5 2 -itemquestionnaire (Cronbach‘salpha of 0.75) validated by test–retest reliability, to collect information abouthealth literacy, perceived information needs and preventive-health practices from 268 randomly selected individuals from the rural community of Ilishan in Ikenne Local Government area, Nigeria located in the tropical rainforest of South-western Nigeria who participated in the study. Informed consent was sought from all whoacceptedtoparticipate. Theparticipants were selected by a combination of systematic and multi-stage sampling of streets and households drawn from a sampling frame of a rural community population of 22, 000 inhabitants .Participants were required to respond to the items in the questionnaire constructed in bothEnglishandthelocalYorubalanguagewith some guidance from trained research assistants who ensured that the questionnaires items were properly filled.

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Development of Instruments for the study A 52-item questionnaire was developed that measured responses of the participants regarding demographic characteristics, health literacy, perceived information needs and level of preventive-health actions performed by the respondents. In developing the questionnaire for this study, four conceptual domains related to health literacy were considered; educational attainment, ability to read in at least one language within the local region, ability to use the information to choose health options and ability to recognize health information on product packaging. Furthermore, perceived information need was conceptualized by considering information-insufficiencyrelated to what is necessary to maintain quality of life and well- being, information-insufficiency related to understanding specific prevalent health issues within the community, information-deficit affecting taking preventive actions in specific health situations, and respondents‘ reprtedreluctance of health workers to provide complete information to respondents during contact. Finally, Preventive health activities focused on actions within the domains of nutrition, hygiene practices, prevention of malaria and medical check up necessary to keep an individual relatively healthy. The validity of the instrument was derived from conceptually operationalizing the major variables in the study as measures described below.

Measures Health Literacy (HL) Measures in this study such as health literacy (HL)were operationalized through questionnaire items which incorporated educational attainment, ability to use a language to understand health instructions, cognitive awareness of basic health-related situations as it may affect the individual, symptom recognitions and health actions required and knowledge aboutpreventive-health activities, health-enhancing activitiesand selfmanagement. Health Literacy variables were measuredon a 27-point scale,where scores below 13points wereconsideredtoreflect below average health literacyandscoresbetween13 to 21pointsindicatedabove average health literacy while scores above 21 points indicated excellent health literacy . Perceived Health-Information Needs (PHIN) Furthermore, perceived health-information needs (PHIN) was similarly incorporated in the questionnaire and expressed by items considering issues of information-insufficiency related to what is necessary to maintain quality of life and well being, information-insufficiency related to understanding specific prevalent health concerns within the community, information-deficit to enable taking preventive actions in specific health situations, and reluctance of health workers to provide complete information to respondents during contact. Perceived Health-information need was measured on a 4-point Likert-type scale with responses such as Strongly Disagree, Disagree, AgreeandStrongly Agreecodedsothatalowvalue on the perception domain represented little or no perceived health-information need and that the respondent has relatively all it takes to resolve health issues with the information at their disposal.Theperceptionitemswere aggregatedtocreateascaleofmeasurementona 51-pointscale. Preventive Health Action (PHA) On theother hand, Preventive-health action (PHA) wasmeasuredonamaximum 48-pointscaleconsisting of items regarding dietary consumption of nutritionally balanced foods, sanitary and hygiene practices, prevention of malaria and medical check up necessary to keep an individual relatively healthy. Response categories was the 4-point Likert-type in which Not at all = 0, Rarely =1, Occasionally = 2 and Very often = 3 were used to indicate frequency of performance of the preventive-health action of interest. Here high scores represented healthy practices while low scores represented health practices that offered least protection from illness-related life style.

Ratings and Scales In order to determine levels and for purposes of evaluating measures in the study, scales were developed by coding questionnaire items for each sub-variable in such a way that options coded zero represented the lowest score possible while 3 represented the highest, especially for the questionnaire items that adopted the 4-point Likert-type response categories. Items in each main domain were aggregated to generate scores for the

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variable. The scales now measured scores below 50% as indicating below average rating and score above 50% indicating above average. Furthermore, where possible, the scales were segmented into quartiles; first quartile represented poor scores, second quartile below average scores, above average scores while fourth quartile represented excellent scores.This rating was reversed for perceived information need such that a high score indicated high perceived information need or information deficit and low scores represents sufficient information to deal with health challenges. Data analysis was conducted using Statistical Package for Social Sciences (SPSS) version15. Descriptive statistics such as frequency distributions,meansand standard deviation (SD)were used to evaluate levels of health literacy, perceived health information need and preventive health activities.Regression analysis was conductedto validate the association of health literacy with perceived health information need(PHIN) and preventive health activities (PHA),and whether they are independent of health literacy (HL). Furthermore, regression analysis was conducted forHLagainst PHA to determine health literacy levels that corresponded with optimal PHA appropriate for health maintenance. The level of significancewassetatP=0.05forallstatisticalprocedures.

RESULTS

Thebasicresults f o r thestudyarepresentedin this section in theformoftablesfordemographic characteristics of the participants, frequency distributions of some pertinent responses related to health literacy, perceived health information needs, preventive-health activitiesand their respective descriptivestatistics. The result showed that the mean age of the participants was 32.2 years (SD = 13.10) and there were 88(32.8%) males and 180 (67.2%) females who participated in the study. The majority of the participants are from the Yoruba (48.9%) and Igbo (39.6%) ethnic expressions. In the study, there were participants with non-formal education 40(15.0%), primary education 56(20.9%), high school education 160(59.7%) and respondents with above high school education 12(4.5%). Participants who reported most able to read in the English language were244(91.0%),and those who indicated proficiency to read in the local languages (77.6%), Pidgin English (4.5%), unable to read in any language was 10.4%. Questionnaire items that asked participants about their ability to read and understand health-related instructions with or without further assistance beyond the initial explanation of health care providers showed that 48(19.9%) respondents reported needing further explanations regarding medication instructions about when to take prescribed drugs, 40(14.9%) expressed requiring assurance and reiteration on how to take medications, and 90(33.6%) required assistance to explain their health conditions that warranted taking the medication. On the other hand, 152(56.7%) reported that they are able to follow instructions without getting confused if instructions are clearly written and verbally explained by health care personnel such as the nurse or pharmacist.Health Literacy measured on an aggregated 27-point scalerecorded a mean scoreof 14.97(SD= 4.23), just above average rating for participants in this study. Responses to sub-variables that measured perceived health information needs (PHIN)showed that 65% of the respondents accepted that health information is an important resource relevant for maintaining health and well being, that 112(41.8%) of them reported information-deficit in matters related to HIV/AIDS infection transmission, 64(23.9%) indicated needing information about malaria infection, and 152(56.7%)respondents reported lack of complete information about available health services in the community.Further, 64 (23.9%) respondents in the study indicated that they lacked complete information about HIV risk-reduction, while 88 (32.8%) reported being deprived information related to their health and 136 (50.7%) signified in their responses that not enough information was given to them when receiving treatment during consultations with care givers.Similarly, perceived health information needs measured on an aggregated 51-point scale recorded a mean score of 25.7 (SD= 5.65). Since high scores imply information-deficit, this group of participants demonstrated 50.4% deficiency in health information required to facilitate their health and contribute to improving their quality of life. Again, exploring the variables describing preventive-health activity, 112(41.8%) respondents reported that their health status constituted a constant concern to them,15(5.6%) very often add vitamin supplements to their diet, 20(7.5%) very often sleep under insecticide treated bed-netsand 124(46.3%) remember to wash their hands after using the toilet. Interestingly, the proportion of respondents who claim to have very regular blood pressure checks and annual medical checkups were 13.4% and 11.9% respectively. Preventive health activity measured on a 48-point scale for respondents in this study recorded a mean score of 23.37(SD=7.27) and translate to 48.7% for the sample of the population surveyed.

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Table 1: Summary of Descriptive Statistic for variables in the study. (To be Inserted Here) Variables

Frequency Distribution N(%)

Age (Years)

-

Maximum Point on Scale of measure

Mean Score

Standard Deviation (SD)

-

32.2

13.10

-

-

-

-

-

-

-

-

-

Gender; Male

88(32.8)

Females

180(67.2)

Ethnicity; Yoruba

131(48.9)

Igbo

106(39.6)

Others

31(11,5)

Educational Attainment; Non-Formal Primary High School

40(15) 56(20.9) 160(59.6)

More than High School 12(4.5) Health Literacy

-

27.0

14.97

4.23

Perceived Information Need

-

51.0

25.70

5.65

Preventive Health Practices

-

48.0

23.40

7.27

Finally, by subjecting the hypotheses that preventive health activities(PHA) and perceived health information needs (PHIN) of this sample of participants are independent of their level of health literacy (HL) to regression analysis and test of significance,resulted in the hypothesesbeing rejected. As anticipated in the two situations, preventive-health activitywas significantly dependent onhealth literacy(β = 0.313; F=28.98; p