Health literacy and influencing factors in university students across diverse educational fields in Kazakhstan

Health literacy and influencing factors in university students across diverse educational fields in Kazakhstan

Internal consistency of the HLS19-Q12 tool and distribution of participants and comparison of HL levels according to sociodemographic determinants

The internal consistency of the Russian and Kazakh versions of the HLS19-Q12 was measured using Cronbach’s alpha. This score ranges from 0 to 1, with higher values indicating that the questionnaire is more reliable. The Cronbach’s alpha value for the Kazakh version of the HLS19-Q12 questionnaire was 0.94 (CI [0.93-0.94]); for the Russian version, this indicator was 0.93 (CI [0.92-0.94]).

The social and demographic characteristics of the respondents are presented in Table 1. Overall, 3230 respondents returned the questionnaires; of these, 1810 (56.04%) were female. The mean age of the participants was 20.14±4.76 y.o. The mean BMI was 21.48±3.56 Participants were from all 17 regions of Kazakhstan and the three large cities (Figure 1).

Table 1 HL level according to the sociodemographic characteristics of the respondents.
Fig. 1
figure 1

Geographic distribution of the HL scores of study participants across Kazakhstan (the map in Fig. 1 was created using the official version of the graphic editor Adobe Photoshop Ver: 20.0.0 20,180,920.r.24 2018/09/20 (manufacturer’s website: https://www.adobe.com/products/photoshop.html).

More than half of the students (2181; 67.52%) were from urban areas, with the greatest percentage residing with their parents/relatives (1029; 31.86%), followed by those with their own apartment (820; 25.39%). A total of 714 (22.11%) and 661 (20.46%) individuals lived in the dormitories and rental apartments, respectively. The vast majority of the respondents indicated that they had both parents.

The respondents were almost evenly distributed according to the field of study, with 1180 participants (36.53%) from the fields of Humanities and Social Sciences, 1019 (31.55%) from the Health Sciences field and 1029 (31.86%) from the Engineering fields of study.

The majority of the respondents (2798, 86.63%) completed secondary school, while some also had secondary special education (397, 12.29%). A small proportion of participants had completed education, with 31 participants (0.95%) falling into the category “Bachelor” and 1 participant (0.03%) having achieved a master’s level of education.

The majority of the respondents (1258, 38.94%) reported that the highest level of education achieved by their father was a bachelor’s degree, followed by a secondary education level (923, 28.57%) and a secondary special education level (668, 20.68%). A bachelor’s degree was achieved by 1466 (45.38%) of the participants’ mothers, 711 (22.01%) respondents had a secondary school education, and 559 (17.30%) respondents had a secondary special education level.

The average social status of the students was 7.86±1.77 points. At the same time, the mean financial status was 7.24±1.87.

The mean HL score for the total sample was 85.86±18.67, which indicates excellent level of HL. The highest HL score was in students of Health Sciences field (88.22±17.53), whereas mean HL score in students of Engineering field of study was 83.27±20.07, and it was 86.13±18.11 for the Humanities and Social sciences field of study (Figure 2).Fig. 2Distribution of HL levels of study participants by field of study, mean scores ± 2SE.Fig. 2Distribution of HL levels of study participants by field of study, mean scores ± 2SE.Fig. 2Distribution of HL levels of study participants by field of study, mean scores ± 2SE.

Fig. 2
figure 2

Distribution of HL levels of study participants by field of study, mean scores ± 2SE.

The mean HL score was significantly greater for female students (p=0.0001), participants from urban areas (p=0.012), students in health-related fields of study (p=0.0001), and senior students (p= 0.015). In addition, respondents whose fathers’ or mothers’ education level was reported as ‘master’ had significantly greater levels of general HL (p=0.027, p=0.017, respectively).

HL level according to self-assessment of health status and health behavior of students

The majority of respondents who reported searching for health information (2381, 73.7%) demonstrated a significantly greater level of general HL than did those, who answered otherwise, with a p-value of 0.0001 (Table 2). Participants previously trained in basic life support skills (1743, 54%) had significantly greater levels of general HL (p=0.0001).

Table 2 HL level according to self-assessment of respondent health status.

Most students indicated easy affordability of medication (2145, 66.4%), and medical examinations and treatments (2007, 62.1%). General HL was significantly greater in those students who answered that it was ‘easy’ or ‘very easy’ for them to afford medication and medical examination and treatments (p=0.0001).

Students who reported having 6 or more close individuals whom they could rely on in case of serious personal problems demonstrated a significantly greater level of general HL (p = 0.0001). Those respondents who self-assessed their health as ‘good’ or ‘very good’ had a greater level of general HL than did those who answered differently (p=0.0001).

Participants who denied long-term illness or health problems had significantly greater levels of general HL (p=0.0001). Respondents who did not have health problems or limitations had a higher level of general HL (p=0.0001).

The average usage of emergency services over the last 24 months was 0.69, with a standard deviation of 1.47. Respondents, on average, visited a GP or family doctor approximately 0.69±1.47 times in the last 12 months. Students, on average, visited a medical or surgical specialist approximately 1.69±2.40 times in the last 12 months. The students were admitted to the hospital as an inpatient approximately 0.12±0.43 times in the last 12 months. The respondents had been to the hospital as a day patient approximately 0.75±1.83 times in the last 12 months. Approximately 2.87±5.59 days of education were missed in the past 12 months due to health problems.

The majority of the participants indicated that they had never smoked (2835, 87.8%) and had never consumed alcohol (2898, 89.7%). The majority of the respondents (642, 19.9%) had never engaged in any kind of physical activity or were involved in less than one day per week (571, 17.7%).

Certain health behaviors of the respondents, such as eating habits, were linked to HL (Table 3). Thus, those respondents who consumed fruits and vegetables 7 times per week had the significantly higher level of general HL (p=0.037). Those who never smoked had one of the highest HL scores (p=0.000). There was no statistically significant difference in the mean HL score between the respondents according to their physical activity and alcohol consumption.

Table 3 HL according to the health behavior of the study subjects.

Factors affecting HL

A multiple regression analysis with interactions examining the impact of age, gender, and educational field on HL Score revealed no significant main effects for age, gender, or educational field independently (Figure 3). However, significant interaction effects were observed: students older than 19 years combined with studying in Engineering field showed a negative impact on HL, as did male students in Engineering field of study. Interestingly, a three-way interaction between being male, older than 19, and studying in Engineering field positively influenced HL (intercept = 85.46, coefficient = 7.7, p-value < 0.05).

Fig. 3
figure 3

Interaction effects of factors on HL score.

An analysis of the influence of socioeconomic indicators, students’ region of origin, and health behaviors on HL revealed several significant findings. The West region exhibited a negative coefficient (-40.27) with a p-value < 0.05, indicating that students from this region have significantly lower HL Scores compared to the reference region. Furthermore, interaction effects demonstrated that non-smoking students from the South and East regions scored higher on HL, with coefficients of 38.75 and p-values < 0.05 for both regions. Students from rural areas of West Kazakhstan who neither smoke nor drink exhibit significantly lower HL (coefficient = -42.39, p-value < 0.05) compared to their smoking and drinking counterparts from urban areas in other regions of Kazakhstan (coefficient = -68.82, p-value < 0.05). Additionally, students from rural areas in the Central, North, and South regions of Kazakhstan who do not follow a healthy diet have lower HL scores (coefficients = -3.34, p-value < 0.05; -2.27, p-value < 0.05; -1.99, p-value < 0.05) compared to students from urban areas in other regions who maintain a healthy diet. Students from the Central Kazakhstan who perceive their social and material status as low, coupled with a lack of physical activity, exhibit significantly lower levels of HL compared to their peers (coefficient = -26.63, p-value < 0.05; coefficient = -47.12, p-value < 0.05, respectively). This finding underscores the combined impact of socioeconomic challenges and physical inactivity on HL outcomes. Additionally, students from Central Kazakhstan who consume alcohol show even more pronounced deficits in HL, with notably low values recorded (coefficient = -58.69, p-value < 0.001).

Regression analysis demonstrated that the mean HL score was associated with the range of factors (Table 4). Thus, participants who studied in the Humanities and Social Sciences and Health Sciences had higher mean HL scores than did students in the Engineering fields of study (B=2.27, p=0.008 and B=3.86, p=0.0001, respectively). HL was greater for those respondents who indicated that the procedure was very easy (B=15.41, p=0.0001), easy (B=13.03, p=0.0001) or difficult to afford medical examinations and treatments (B=5.48, p=0.038) than for those respondents who indicated that the affordability of those procedures was very difficult. The students who reported having 6 or more close individuals had 5.32 points greater mean HL than did those who did not have any close persons (p=0.002). The students who reported having 3-5 close individuals had 3.08 points greater mean HL scores than those who did not have any close persons (p=0.049).

Table 4 Determinants of HL.

Compared to those who were from West Kazakhstan region, students from East Kazakhstan region had, on average, a HL that was 9.47 points lower, with a statistically significant p-value of 0.025. The respondents who did not actively search for health information had a HL scores 1.98 points lower than those who did actively search for health information, with a statistically significant p-value of 0.017. Students who did not have basic life support skills training had a 3.97-point lower HL than did those who had such skills, with a statistically significant p-value of 0.0001.

On average, students who smoked and used tobacco for 6 days per week had a significantly lower HL (10.08 points) than those students who had never smoked, with a p-value of 0.033. Students who assessed their health status as bad in comparison with very good assessment of health had a 6.72 points lower HL, with a statistically significant p-value of 0.013. A highly statistically significant difference was 4.88 points lower for students who assessed their health status as fair than for those who assessed it as very good (p-value of 0.0001).

Each one-unit increase in age was associated with a 0.24-point increase in HL, with a p-value of 0.01. Each one-day increase in absent days in university due to health problems was associated with a 0.17-point decrease in HL, with a statistically significant p-value of 0.01. Each one-unit increase in the social status scale is associated with a 0.50-point increase in HL, with a statistically significant p-value of 0.034.

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