ArticleBMC public health2023
Effect modification by geographic area on the association between health literacy and self-rated health: a nationwide cross-sectional study in Japan.
Article in BMC public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Public awareness of anesthesiologists in Japan: information sources and sex-age differences in a nationwide cross-sectional web survey.Journal of anesthesia · 2026Article
- Article
- Socioeconomic disparities in colorectal cancer oncologic emergencies: a nationwide multilevel analysis in Japan.International journal of clinical oncology · 2025Article
- Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India.SSM - population health · 2025Article
- Health Literacy in People with Type 1 Diabetes: A Scoping Review.International journal of environmental research and public health · 2025Article
- Combined associations of education and health literacy with preventive dental visits in patients with diabetes: a nationwide cross-sectional study.Diabetology international · 2025Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHealth literacy (HL) has gained increasing attention as a factor related to health behaviors and outcomes. This study aimed to investigate geographic differences in HL levels and effect modification by geographic area on their relationship with self-rated health in the Japanese population using a nationwide sample.
methodsData for this study were derived from a nationally representative cross-sectional survey on health information access for consumers in Japan using a mailed self-administered questionnaire in 2020 (INFORM Study 2020). Valid responses from 3,511 survey participants, selected using two-stage stratified random sampling, were analyzed in this study. HL was measured using the Communicative and Critical Health Literacy Scale (CCHL). Multiple regression and logistic regression analyses were conducted to examine the associations between geographic characteristics and HL and effect modification on the association between HL and self-rated health by geographic area, controlling for sociodemographic characteristics.
resultsThe mean HL score was 3.45 (SD = 0.78), somewhat lower compared with previous studies on the Japanese general population. HL was higher in Kanto area than in Chubu area, after controlling for sociodemographic factors and municipality size. Furthermore, HL was positively associated with self-rated health after controlling for sociodemographic and geographic factors; however, this association was more evident in eastern areas than in western areas.
conclusionThe findings indicate geographic differences in HL levels and effect modification by geographic area on the relationship between HL and self-rated health in the general Japanese population. HL was more strongly associated with self-rated health in eastern areas than in western areas. Further investigation is needed to explore the moderating effects of areal features, including the distribution of primary care physicians and social capital, when formulating strategies to improve HL in different contexts.
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