title: Infectious disease-specific health literacy in Tibet, China.
abstract: This study was aimed to develop an instrument to assess infectious disease-specific health literacy (IDSHL) in the general population of Tibet, China and identify the association between IDSHL and reported infectious disease-related symptoms. A survey using a standardized questionnaire, which included 25 questions on knowledge, behaviors and skills regarding infectious diseases, was conducted in the general population of Tibet, China between September 2011 and November 2011. The 25 questions formed the index system of the instrument assessing IDSHL (total scores: 25 scores). Factors associated with index scores of IDSHL were identified by general linear model. The association between the index score of IDSHL and the occurrence of the five selected infectious disease symptoms (fever, diarrhea, rash, jaundice or conjunctivitis) were investigated using multivariate unconditional logistic regression. Among 5717 eligible participants in the survey, 4631 participants completed all of the 25 questions in the instrument. The instrument was reliable and valid as measured by the Cronbach's alpha coefficient and split-half coefficient, and the confirmatory factor analysis. Only 1.0% (48/4631) answered ≥80% of the 25 questions correctly (score ≥ 20). Significant factors associated with lower health literacy score included female gender, older age, Tibetan group, lower education level, underlying diseases and more undeveloped area. For each increasing score of IDSHL, reports of fever, diarrhea or jaundice in the prior year were significantly decreased by 3% (p = 0.015), 4% (p = 0.004) and 16% (p < 0.001), respectively. Accurately measuring IDSHL could help identify those individuals with poor IDSHL, who could be targeted with specific interventions to improve health.
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing, China.|Beijing Research Center for Preventive Medicine, Beijing.|School of Public Health, Captial Medical University, Beijing.
authors.forename: Peng
authors.initials: P
authors.lastname: Yang
authors.affiliation: Tibet Center for Disease Prevention and Control, Tibet, China.
authors.forename: Ciren
authors.initials: C
authors.lastname: Dunzhu
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Marc-Alain
authors.initials: MA
authors.lastname: Widdowson
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing, China.|Beijing Research Center for Preventive Medicine, Beijing.|School of Public Health, Captial Medical University, Beijing.
authors.forename: Shuangsheng
authors.initials: S
authors.lastname: Wu
authors.affiliation: Tibet Center for Disease Prevention and Control, Tibet, China.
authors.forename: Pengcuo
authors.initials: P
authors.lastname: Ciren
authors.affiliation: Tibet Center for Disease Prevention and Control, Tibet, China.
authors.forename: Dunzhu
authors.initials: D
authors.lastname: Duoji
authors.affiliation: Tibet Center for Disease Prevention and Control, Tibet, China.
authors.forename: Wangqing
authors.initials: W
authors.lastname: Pingcuo
authors.affiliation: Pulan County Center for Disease Prevention and Control, Tibet, China.
authors.forename: Bian
authors.initials: B
authors.lastname: Dun
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing, China.|Beijing Research Center for Preventive Medicine, Beijing.|School of Public Health, Captial Medical University, Beijing.
authors.forename: Chunna
authors.initials: C
authors.lastname: Ma
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing, China.|Beijing Research Center for Preventive Medicine, Beijing.|School of Public Health, Captial Medical University, Beijing.
authors.forename: Jie
authors.initials: J
authors.lastname: Li
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing, China.|Beijing Research Center for Preventive Medicine, Beijing.|School of Public Health, Captial Medical University, Beijing.
authors.forename: Xinghuo
authors.initials: X
authors.lastname: Pang
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing, China.|Beijing Research Center for Preventive Medicine, Beijing.|School of Public Health, Captial Medical University, Beijing.
authors.forename: Quanyi
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000328:Adult; D003141:Communicable Diseases / Q000209:etiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D018609:Tibet
keywords: Tibet; health literacy; infectious disease