Malaysian Health Literacy: Socio-Demography Odd Ratio Analysis

Introduction: Health literacy is an indicator of a society’s ability to make better health judgement for themselves and the people around them. The National Health and Morbidity Survey (NHMS) was conducted in 2019 with target population of adult respondents aged 18 years and above. This paper studies odd ratio analysis carried out on NHMS 2019 Health Literacy data to measure association between the socio-demography characteristics and health literacy status of the respondents. Methodology: This is a cross-sectional study using multinomial logistic regression (MLR) model, and the assessment of health literacy among the population was done using the validated HLS/M/Q18 instrument. The dependent variable is a three-level category of health literacy status; 1-Limited, 2-Sufficient and 3-Excellent with two (2) outcomes, with Limited as the reference category. The first outcome is the relative health literacy status of Excellent compared to Limited, and the second outcome the relative health literacy status of Sufficient compared to Limited. The independent variables are the population socio-demographic characteristic inclusive of sex, age, strata, marital status, education, ethnic group, income and occupation. Results: There are 8,933 valid cases for the analysis. 42.7% of respondents are in the sufficient health literacy category, followed by limited (35.1%) and excellent (22.2%). The mean age respondents is 43.8 years (median=50 years). For each status, mean age for respondents with excellent health literacy status is 42.3 years (median=47.4 years), mean age for sufficient is 42.2 years (median=47.7 years) and mean age for limited is 46.8 years (median=54.7 years). MLR odd ratio analysis outcome. Statistical test of likelihood ratio and Pearson goodness of fit both indicate a good model fit. However, only 48.8% of the cases are predicted correctly by the model. Comparison between Malaysian population having Excellent and Limited health literacy status shows significant association in all age groups, higher-level educations, the Indians, government sector employees and married persons. Comparison between the population having Sufficient and Limited health literacy status shows evidence of significant association in all age groups, higher education levels, the Malays, government and private sector employees, M40 income group and married persons. Adjusted odds ratio analysis shows that in general, the population of younger ages has higher odds for higher literacy level compared to those of age 65 years and above and this is true for both Excellent and Sufficient health literacy status. By gender base, both males and female have no significant differences when it comes to odd ratio analysis, and the same goes with urban and rural localities. Among the higher education levels, respondents with tertiary education has the highest odds to be in both Excellent and Sufficient health literacy status compared to those with no formal education. Compared to Bumiputera Sarawak, Indians has higher odds to be in the Excellent health literacy status, while Malays in Sufficient. Compared to single persons, married persons have higher odds to be in both Excellent and Sufficient health literacy status. Discussion/Conclusion: Overall contribution of independent variables to the model shows significant result of association between health literacy with age, strata, education, ethnic group, occupation, income and marital status (p-value<0.250) except sex. However, the analysis includes sex factor due to its importance in the literature associated with quality of life. Attaining a comprehensive information pertaining to Health literacy of population, as well as the prevalence of social factors in literacy levels, is critical for developing population-based healthcare services and policy.