湖南省居民健康素养状况及其中介效应分析

目的 了解居民健康素养水平及其影响因素，并探究基本知识和理念、健康生活方式与行为之间健康技能的中介效应，为居民健康素养水平的提高提供理论依据。方法 2012年10-12月，采用概率抽样的方法抽取湖南省12个区（县）36个街道（乡镇）72个居委会（村）的3475名15~69岁居民作为研究对象进行现场问卷调查，研究对象的健康素养水平比较采用χ²检验，居民健康素养的影响因素分析采用logistic回归分析，中介效应分析选取Bootstrap检验。结果 共获得有效问卷3475份，459人（13.2%）具有基本健康素养，具备健康素养基本知识和理念、健康生活方式与行为、健康技能者的比例分别为18.6%、15.0%和14.2%；logistic回归分析显示，文化程度、民族、职业及收入是居民健康素养水平的影响因素（P<0.05），随着文化程度的升高，健康素养升高（OR=1.447，95%CI=1.259~1.664），医务人员健康素养水平高于农民（OR=8.556，95%CI=4.676~15.658）；基本知识和理念与健康技能、基本知识和理念跟健康生活方式与行为、健康技能和健康生活方式与行为之间均呈现出强关联性（r=0.821、0.821、0.836，P<0.01）；健康技能的中介效应为0.136（95%CI=0.119~0.154），基本知识和理念对健康生活方式与行为的总效应为0.497，中介效应占总效应的比例27.4%。结论 湖南省居民健康素养水平高于全国平均水平，但仍需提高，应重视健康技能的中介效应，加强对农民的健康教育，建立健全健康素养监测体系，全面提高居民健康素养水平。

Health literacy and its mediating effect on health behaviors among residents in Hunan province

Objective To examine the level and influence factors of health literacy and to explore the mediating effect of health knowledge and attitude on healthy lifestyle and behaviors among residents,and to provide theoretical bases for improving health literacy of residents.Methods With probability sampling,a questionnaire survey was carried out among 3 475 residents aged 15-64 years selected from 72 villages or cummunities in 12 counties or districits of Hunan province during October to December 2012.The diffenrence in health literacy was ananlyzed using Chi-square test; influencing factors of health literary were explored with logistic regression and mediating effect of health literacy on health life style and behaviors was evaluated with bootstrap test.Results Of all the participants,459 (13.2%)reported having basic health literacy; 18.6%,15.0%,and 14.2% reported havig basic health knowledge and concept,healthy lifestyle and behavior,and health skills, respectively.Logistic regression analyses showed that the health literacy level was mainly influenced by nationality,education,occupation,and income (P<0.05 for all).Health literacy level presented an upward trend with the increase of education (odds ratio [OR]=1.447,95% confidence interval [95%CI]=1.259-1.664).Among the participants,medical personnel exhibited a significantly higher health lieracy than farmers (OR=8.556,95%CI=4.676-15.658).Basic health knowledge and concepts showed strong correlation with health skill (r=0.821) and with healthy lifestyle and behavior (r=0.821) (both P<0.01); health skill was significantly correlated with healthy lifestyle and behavior (r=0.836) (P<0.01).The mediating effect of health skills on the correlation between health literacy and behaivor was 0.136 (95%CI:0.119,0.154).The total effect of the basic health knowledge and concept on healthy lifestyle and behavior was 0.497,with a mediating effect proportion of 27.44%.Conclusion The health literacy level among residents in Hunan province is higher than the national average,but still needs to be improved.The mediating effect of health skill shoud be concerned in health education programs for the promotion of health literacy among the residents,especially among the famers in the province.