title: Health literacy as a moderator of health-related quality of life responses to chronic disease among Chinese rural women.
abstract: BACKGROUND
  Chronic disease is the leading global health threat and impairs patients' health-related quality of life (HRQoL). Low health literacy is linked with chronic diseases prevalence and poor HRQoL. However, the interaction of health literacy with chronic disease on HRQoL remains unknown. Therefore, we examined how health literacy might modify the association between chronic disease and their HRQoL impacts.
  
  
  METHODS
  We conducted a health survey of 913 poor rural women aged 23-57 years in Northwestern China. We assessed health literacy and HRQol using the revised Chinese Adult Health Literacy Questionnaire (R-CAHLQ) and Euroqol-5D (EQ-5D), respectively. Low health literacy was indicated by a cut-off of less than the mean of the factor score. Self-reported preexisting physician-diagnosed chronic disease and socio-demographic characteristics were also included. We fitted log-binomial regression models for each dimension of EQ-5D to examine its association with health literacy and chronic disease. We also ran linear regression models for EQ VAS scores and utility scores.
  
  
  RESULTS
  The low health literacy group was 1.33 times more likely to have a chronic disease than the high health literacy group. Pain/discomfort was the most prevalent impairment, and was more common in the low health literacy group (PR [prevalence ratio] = 1.23; 95% CI = 1.01, 1.50). Chronic disease strongly predicted impairments in all the EQ-5D dimensions, with PRs ranging from 2.14 to 4.07. The association between chronic disease and pain/discomfort varied by health literacy level (health literacy × chronic disease: P = 0.033), and was less pronounced in the low health literacy group (PR = 2.15; 95% CI = 1.76, 2.64) than in the high health literacy group (PR = 3.19; 95% CI = 2.52, 4.05). The low health literacy group had lower VAS scores and utility scores, and slightly less decrement of VAS scores and utility scores associated with chronic disease.
  
  
  CONCLUSIONS
  Health literacy modified the impacts of chronic disease on HRQoL, and low health literacy group reported less HRQoL impacts related to chronic disease. Research should address health literacy issues as well as root causes of health disparities for vulnerable populations.
authors.affiliation: Shandong University School of Nursing, Jinan, 250012, China. wangcuili@sdu.edu.cn.
authors.forename: Cuili
authors.initials: C
authors.lastname: Wang
authors.affiliation: University of Minnesota School of Public Health, Minneapolis, 55455, US. kanex001@umn.edu.cn.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.affiliation: Shandong University School of Nursing, Jinan, 250012, China. xuxxx584@umn.edu.|University of Minnesota School of Public Health, Minneapolis, 55455, US. xuxxx584@umn.edu.
authors.forename: Dongjuan
authors.initials: D
authors.lastname: Xu
authors.affiliation: Peking University China Center for Health Development Studies, Beijing, 100191, China. qmeng@bjmu.edu.cn.
authors.forename: Qingyue
authors.initials: Q
authors.lastname: Meng
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology; D003710:Demography; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires