Adult Functional Health Literacy and its Related Factors: A Cross-Sectional Study

Document Type: Original Article


1 Department of Public Health, School of Public Health, Social Determinants of Health Research Center Hamadan University of Medical Sciences, Hamadan, Iran

2 Research Center for Health Sciences Hamadan University of Medical Sciences, Hamadan, Iran

3 School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

4 Modeling of Noncommunicable Diseases Research Center & Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran


Background and aims: Health literacy (HL) can affect individual health, health communication and
error in taking medicine. The aim of this study was to determine the level of HL and associated factors
among Iranian adults.
Methods: In this cross-sectional study, 240 participants over 18 years of age referring to health centers
in Hamadan, west of Iran in 2015 were selected by multistage random sampling. HL was assessed
by the Test of Functional Health Literacy in Adults (TOFHLA). The questionnaire was completed by a
trained interviewer. The independent variables were structural and intermediate social factors based
on the Commission on Social Determinants of Health (CSDH). Data were analyzed by using IBM SPSS
version 22.
Results: Average age of the participants was 30.88 ±7.38 years and 75.4% of the them were female. The
total score of HL was 64.58 ±16.71 (range: 23.82-98.98). Overall, 31.7% (n = 76) of the participants
had adequate HL level, 32.5% (n = 78) had borderline HL level and 35.8% (n = 86) had inadequate
HL level. Additionally, participants with higher educational levels had higher HL scores than those
with lower educational levels (P < 0.001). HL score was significantly higher in males than in females
(P = 0.017).
Conclusion: HL level seems to be inadequate among Iranian adults in the west of Iran. Moreover,
enhancing social determinants such as educational level seems to increase HL. The results highlighted
the necessity for change and improvement in adults’ HL.


Main Subjects

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