ArticleInternational journal for equity in health2025
Socioeconomic gradients and mechanisms of chronic disease health literacy: the mediating role of preventive healthcare utilization in rural Shangdong, China.
Article in International journal for equity in health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Development and psychometric validation of the NICU parental agency scale: a multicenter cross-sectional study.Frontiers in pediatrics · 2026Article
- Patterns and associated factors of health literacy among residents aged 15-69 in Zhejiang, China: a latent profile analysis.Frontiers in public health · 2025Article
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10 authors.
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Abstract
purposeTo explore the social determinants and underlying mechanisms of health literacy in managing chronic diseases, and to analyze how socioeconomic status (SES) influences it.
methodThis study, based on Shandong Province’s 2022 Health Literacy Surveillance Database, selected 2,826 residents from some, counties in Shandong eligible areas using multistage stratified cluster random sampling. It explored the social determinants of chronic disease health literacy using multiple linear regression, multiple logistic regression, interactive analysis and mediation analysis.
resultsHigher SES (High vs. Low: OR = 2.21, 95%CI: 1.68–2.91, P < 0.001; Medium vs. Low: OR = 1.36, 95%CI: 1.08–1.71, P = 0.009), elevated household income (Highest vs. Lowest category: OR = 2.58, 95%CI: 1.58–4.22, P < 0.001), and higher educational attainment (Bachelor’s vs. Primary: OR = 3.46, 95%CI: 2.06–5.81, P < 0.001) were positively associated with higher chronic disease literacy. However, patients specifically diagnosed with hypertension (OR = 2.27, 95%CI: 1.35–3.79), coronary heart disease (OR = 2.57, 95%CI: 1.14–5.81), or diabetes (OR = 2.37, 95%CI: 1.21–4.63) demonstrated significantly higher literacy levels. The preventive healthcare services (indirect effect = 0.017, 95% CI: 0.016–0.041, P < 0.001), changes in health behavior (indirect effect = 0.007, 95% CI: 0.002–0.020, P < 0.001), and frequency of physical examinations (indirect effect = 0.006, 95% CI: 0.004–0.015, P < 0.001) significantly mediated the relationship between SES and chronic disease literacy. Subgroup analysis showed that in the low SES group, women (OR = 0.60, 95% CI: 0.50–0.75, P < 0.001) and elders (OR = 0.70, 95% CI: 0.42–0.91, P = 0.001) had significantly lower chronic disease literacy than men and young participants.
conclusionThis study elucidates the multidimensional mechanisms by which SES impacts chronic disease health literacy and provides a scientific basis for developing targeted interventions.
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