Level of health literacy and factors associated with it among school teachers in an education zone in Colombo, Sri Lanka

BACKGROUND Health literacy refers to people's competencies to access, understand, judge and apply health information in healthcare, disease prevention and health promotion. This study aimed to describe the level of health literacy and the factors associated with it among school teachers in an Education Zone in Colombo, Sri Lanka. METHODS A cross-sectional study among 520 teachers measured health literacy using the selfadministered, culturally adapted Sinhalese translation of Health Literacy Survey-European Union (HLS-EU). Health literacy assessment was based on self-reported competencies to access, understand, judge and apply health information in the domains of disease prevention, healthcare and health promotion. Based on a score, respondents were divided into four levels of health literacy as 'inadequate', 'problematic', 'sufficient' and 'excellent' as well as into two levels as 'limited' and 'adequate'. Factors associated with 'limited' health literacy was determined by using univariate analysis and assessing their associations using chi square test. Multivariate analysis was also done using multiple logistic regression to determine factors associated with limited health literacy controlled for confounding effects. A p value of 0.05 determined the significance. RESULTS The response rate was 96.5%. Mean age was 43years (SD = +9.75), 81.7% (n = 410) were females and 66.1% (n = 332) were graduates. Only 3.6% (n = 18) taught the subject health while 18.3% (n = 92) taught science. 'Limited' health literacy was found in 32.5% (95% CI 28.4%-36.6%) while 67.5% (95% CI 63.4%-71.6%), 61.2% (95% CI 56.9%-65.5%) and 6.4% (95% CI 4.3%-8.5%) showed 'adequate', 'sufficient' and 'excellent' levels, respectively. 'Problematic' and 'inadequate' health literacy were 31.5% (95% CI 27.4%-35.6%) and 1% (95% CI 0.1%-1.9%). Univariate analysis showed not being a member of health club/welfare group (p = 0.002), having not done any special course on health (p = 0.009), not getting an opportunity to participate/being exposed to a health awareness program (p = 0.007), visit to a medical practitioner/preventive health staff for six months (p = 0.049), not accessing print media to obtain general information (p = 0.007) and not accessing print media to obtain health information for six months (p = 0.009) and poor health knowledge (p = 0.036) to be factors associated with 'limited' health literacy that are modifiable. Nonmodifiable factors were age being ≤ 45 years (p = 0.025) and service as a teacher being ≤ 10 years (p = 0.012). When multivariate analysis was performed, service as a teacher being ≤ 10 years (p = 0.042), monthly income ≤ Rs.50,000.00 (p = 0.024), not being a member of health club/welfare group (p = 0.034) and visit to a medical practitioner/preventive health staff for six months (p = 0.002), were found to be associated with limited health literacy among school teachers when adjusted to the effect of confounding of the other factors in the model. CONCLUSIONS The high proportions of 'limited' health literacy among school teachers in the Colombo Education Zone and the need of interventional programmes should be brought to the attention of the policy makers in the education and health sectors. Improving health literacy among teachers and adoption of the Health Promoting School concept as a evidence based path to improve health literacy should be highlighted in the advocacy efforts. Identified factors associated with 'limited' health literacy should be taken into in the interventional efforts.