Exploring factors associated with health literacy and the underlying mechanism among primary school children

AimA better understanding of health literacy (HL) within a local context is needed before developing and implementing interventions in Hong Kong. The current study aimed to explore factors associated with HL and functional HL and the underlying mechanism of functional HL.Subject and methodsThe study recruited students from grades 4-6 in 18 Hong Kong primary schools. Self-administrated questionnaires with 49 items were given to children to assess their HL and 20 factors of interest (e.g., screen time, healthy behaviours). Data were analysed using logistic regression, with the levels of HL and functional HL as outcomes. Mediation analysis was used to assess whether the associations between factors of interest and functional HL were mediated by HL.ResultsA sample of 405 students were included (mean age = 10.0 years, 54.6% female). The majority of students (n = 304, 75.1%) had low family socio-economic status. Higher HL levels were significantly associated with children's higher self-rated health levels (good: OR = 2.23; very good: OR = 4.09), more health information sources (OR = 1.10), more healthy behaviours (hand washing: OR = 1.83; dental cleaning: OR = 1.76), better efficacy (OR = 4.45) and motivation (OR = 2.61), and less screen time on TV (school days: OR = 0.60; holidays: OR = 0.47). Children's higher functional HL levels were significantly associated with regular breakfast eating (OR = 2.08), fewer health information sources (OR = 0.94), poorer personal hygiene (OR = 0.57), insufficient physical activity (OR = 0.66), and less screen time on games (OR = 0.52) and social media (school days: OR = 0.30; holidays: OR = 0.42). HL partially explained functional HL's positive associations with hand hygiene (indirect effect = 0.078, SE = 0.033) and the number of health information sources (indirect effect = 0.011, SE = 0.004).ConclusionThe current study identified potential intervention targets for HL and functional HL. For greater intervention benefits, intervention should focus on specific targets that have direct effects on the functional HL outcome rather than factors mediated by HL. Continuing research with longitudinal data is needed to draw causal findings.