Health literacy and its effect on chronic disease prevention: evidences from China's national health literacy surveillance data

Objectives Improving health literacy is an important public health goal in many countries. Although many studies have suggested that low health literacy has adverse effects on an individual’s health outcomes, factors that may be confounding the relationship between health literacy and health outcomes are often not accounted. This paper examines the interplay between health literacy and chronic disease prevention. Methodology A sample of 2,835 residents aged 14-71 years old in Ningbo province of China were selected from China’s National Health Literacy Surveillance Survey in 2017. The multivariate regression analysis is used to untangle the relationship between health literacy and chronic disease prevention. Results We find the association between health literacy and the occurrence of the first chronic condition is attenuated after we adjust the results for age and education. In contrast, we find having one or more chronic conditions leads to better knowledge about chronic diseases and thus improved health literacy on chronic disease prevention. Thus, when a respondent has one chronic disease, health literacy could reduce the incidence of a new chronic condition (comorbidities). However, the protective effect of health literacy is only found among our urban sample, suggesting health literacy might be a key factor explaining the rural-urban disparity in health outcomes. Conclusion Our findings highlight that health literacy plays a more important role in helping individuals preventing comorbidity than preventing their first chronic disease. Moreover, family support could be a potential channel through which health literacy accumulates and results in beneficial effects on health.