Health Literacy and Educational Initiatives: A Comprehensive Analysis of Shaanxi Province

Introduction

Harmony and stability are the cornerstones of social development and the guarantee of people’s happiness. Universities are an important part of society and play an important role for talent training, scientific research, social services and cultural heritage and innovation. Safety and stability are the basic prerequisites for the development of the university and in return the safety and stability of universities help to ensure social harmony and stability. Health literacy (HL) is the foundation for the health and safety of students and teachers in universities. This article will delve into the health literacy landscape of university students in Shaanxi Province, China, examining the Shaanxi Provincial Department of Education scientific research project guidelines, levels of health literacy, influencing factors, and potential strategies for enhancement. The aim is to provide a comprehensive overview that informs educational initiatives and contributes to improved public health outcomes.

The Significance of Health Literacy

Improving the public’s health literacy and enhancing the ability to respond to public health emergencies will help to better respond to public health emergencies and reduce unintended harm caused by public health events. An adequate level of health literacy will help university students to better respond to public health emergencies and reduce unintended harm caused by public health events. Also, increasing the level of health literacy is necessary to reduce health inequalities. To this end, good, reliable and accessible health information tailored to the needs and circumstances of different social groups is needed, especially for university students. University students are both a key group of people for public health protection and a reserve force for the public health system. The museum people hold various exhibitions with professionalism and enthusiasm, carry out educational activities for the purpose of inheriting and promoting the excellent history and culture of China for thousands of years, support education by researching collections, and develop cultural and creative products to cultivate the audience's museum awareness, which are the embodiments of the museum's characteristics.

In China, the scale of higher education continues to expand and the development process continues to accelerate. In 2021, there are 3012 universities, with a total enrollment of 44.3 million students. The high concentration of students in universities can lead to widespread transmission of infectious diseases if an epidemic occurs, which can have a serious impact on the safety and health of students and teachers. In the process of rapid development, university has also shown characteristics such as socialization of logistics, diversification of school subjects and diversification of student groups. The literature on HL is rapidly increasing, however little research has been done on the health literacy of university students in Shaanxi.

Overview of Shaanxi Province and its Educational Landscape

Shaanxi Province, as a major province of higher education in China, has more than one million university students. As an ancient capital with thousands of years of cultural history, Xi'an is considered to be a “natural history museum”. In 2003, the Xi'an Municipal Government proposed to build Xi'an “City of Museums”, and the museum business in Xi'an has developed rapidly. As a cultural force that promotes social change and social development, the museum is more and more deeply integrated into social life and assumes the responsibility of serving the society.

Methodology of Health Literacy Assessment

The cross-sectional study involved undergraduate and postgraduate students in Shaanxi Province, China.

Participants

A total of 1578 university students were surveyed, 756 (47.9%) male and 822 (52.1%) female, 381 (24.1%) freshmen, 367 sophomores (23.3%), 354 (22.4%) juniors, 205 (13.0%) seniors, 271 (17.2%) postgraduates; 303 (19.2%) literature, history, law and philosophy students, 338 (21.4%) engineering, agriculture and medicine students, 328 (20.8%) economic and management students, 313 (19.8%) education students, 296 (18.8%) art students; 684 (43.3%) urban students, 894 (56.7%) rural students.

Instrument

Health literacy (HL) scale used in this study was developed from HLS-EU-Q47. Based on relevant literature and expert interviews, we formed a pool of 3 primary indicators, 9 secondary indicators and 38 tertiary indicators on health knowledge, attitude and practice. The Likert 5-point scale was used to rate the importance of each item, and there was a column for “comments for revision”. The 38 indicators were compiled into specific entries and two rounds of consultation were conducted with 24 experts using the Delphi method to collect their comments and suggestions on the 38 entries. 100% and 94.4% of the questionnaires were returned in the two rounds of consultation. The questionnaire consists of 27 questions on three dimensions: health knowledge (9 items), health attitude (9 items) and health practice (9 items), covering disease prevention knowledge, policy and regulation knowledge, healthy living knowledge, self-protection awareness, information screening awareness, responsibility awareness, injury and disease detection skills, life safety skills and accident first aid skills. The total Cronbach’s alpha value is 0.802 and the KMO value is 0.847 (the experimental data is attached as “407113-results.pdf” in the Supplementary Materials), which indicates good reliability. The validity of all variables and dimensions was measured using AMOS 21.0, and the fit indices of all variables met the criteria. The standardised loadings of all items were further examined, and Table 1 shows that the standardised loadings of all items were above 0.6, which met the criteria. Finally, the CR and AVE values of the variables were tested for compliance with the criteria based on the standardised loadings, and Table 1 shows that the CR values of all variables and dimensions were greater than 0.7 and the AVE values were greater than 0.5. Each item was scored on a 5-point scale as follows: the score of positive questions in the questionnaire was “strongly agree” (5 points), “agree” (4 points), “average” (3 points), “disagree” (2 points) and “strongly disagree” (1 point), the opposite is true for reverse questions. A score of 45 was calculated for health knowledge, 45 for health attitude and 45 for health practice, giving a total score of 135. A total score of 80% or more, ie a total score ≥108(135×80%= 108), is considered to be adequate health literacy.

Data Collection

In October 2022, 1635 students from five universities in Shaanxi Province were selected for the study using convenience sampling method. A total of 1635 questionnaires were actually distributed, and 1578 completed self-administered questionnaires were collected, with a valid questionnaire return rate of 96.51%. The research data is attached as “407113-data.xls” in the Supplementary Materials.

Data Analysis

The analysis was conducted using SPSS 20.0 software, with t-test and ANOVA for comparison of means and χ2 test for comparison of rates or composition ratios. Statistical analyses were conducted using a dichotomous logistic regression with the inclusion criterion of α=0.05 and the exclusion criterion of α=0.10. Overall health literacy was calculated using the sum of the scores of the core health literacy measurement items.

Key Findings on Health Literacy Levels

The results showed that the mean score of health knowledge, attitude and practice of university students was (105.33±10.14) out of 135, and the mean scores for the three dimensions of public health knowledge, attitude and practice were (36.093±4.192), (34.178±4.227) and (35.059±4.515) respectively.

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Overall Health Literacy

As shown (Table 2), the mean score of the respondents was (105.33 ± 10.14) out of 135, with a range of 51 to 134 and a median score of 108.

Gender Differences

Female scored higher (105.82 ± 9.51) than male (104.79±10.75). The level of female’s health knowledge and health attitude is higher than male students, but female’s health practice is lower than that of male’s. In terms of health knowledge (Table 5), female students scored higher than male students. In terms of health attitudes (Table 6), female students scored higher than male students. In terms of health practices (Table 7), male students scored higher than female students.

Grade Level

Sophomores scored the highest (106.02±10.17), while postgraduates the lowest (103.42±10.83). The results of this study showed that undergraduate students had higher health literacy level than graduate students.

Urban vs. Rural

Urban university students scored higher (106.50±10.71) than rural university students (104.43±9.58). The level of urban student’s health knowledge, health attitude and health practice is higher than that of rural students. In terms of health knowledge (Table 5), urban students scored higher than rural students. In terms of health attitudes (Table 6), urban students scored higher than rural students. In terms of health practices (Table 7), urban students scored higher than rural students.

Health Education Experience

Those who had health education experiences (106.43±10.13) scored higher than those who had not (103.91±9.98). The health literacy level of students with health education experience was higher than those without. In terms of health knowledge (Table 5), students with health education experience scored higher than those who lack of such experience. In terms of health attitudes (Table 6), students with health education experience scored higher than those without. In terms of health practices (Table 7), students with health education experience scored higher than those who did not have.

Discipline-Specific Differences

Students of Engineering, Agriculture and Medicine scored the highest (106.69±11.66), while Arts students scored the lowest (103.88±10.50). In terms of health knowledge (Table 5), art students scored the highest, and literature, history, law and philosophy students scored the lowest. In terms of health attitudes (Table 6), students in Education scored the highest, and Arts students scored the lowest. In terms of health practices (Table 7), students in the Engineering, Agriculture, Medicine scored the highest, and students in the Economics and Management scored the lowest.

Proportion of Adequate Health Literacy

As shown (Table 8), 39.2% of the participants (619/1578) had adequate health literacy, with 37.8% (596/1578), 58.0% (915/1578) and 46.4% (732/1578) having adequate health knowledge, attitude and practice respectively. The proportion of female students with adequate health literacy was higher than that of male students, the proportion of urban students with adequate health literacy was significantly higher than that of rural students, and the proportion of university students of adequate health literacy with health education experience was higher than that of those who without it.

Factors Influencing Health Literacy

There are gender differences in levels of health literacy. The results of this study show that female students have higher health literacy, and the levels of their health knowledge and attitude are higher than those of males, but the level of health practice is lower than male students. There are differences in the health literacy of urban and rural university students. The results of this study show that urban university students have higher health literacy. Their health knowledge, attitude and practice are all higher than those of rural university students, and the number of urban university students with adequate health literacy is higher than that of rural students. The reason for this probably is that health awareness in rural areas is not as high as that in urban areas and rural university students’ access to public health knowledge is less convenient than those urban students. Differences in health literacy levels among students in different disciplines was caused by different learning environments and learning abilities. There are differences in health literacy among university students of different grades. The results of this study showed that undergraduate students had higher health literacy level than graduate students. The reasons for this may be related to the educational situation and the forgetting law of long-time memory. The health education system at secondary school in China is complete and demanding. The study showed that the health literacy level of those who received health education training was significantly higher than that of the group did not not receive it.

Correlation Between Knowledge, Attitude, and Practice

We used Pearson correlation analysis to analyze and verify the relationship between the three dimensions of knowledge, attitude, and practice. The results showed that the correlation coefficient between knowledge and attitude was 0.600, and both were positively significant. The correlation coefficient between knowledge and practice was 0.668, and both were positively significant. The correlation coefficient between attitude and practice was 0.446, and both were positively significant (Table 4).

Implications and Recommendations

In summary, health literacy is a comprehensive reflection of individual’s level of knowledge, attitude and practice in relation to public health and safety events, and the level of health literacy of university students in Shaanxi province of China still needs to be improved. Improving the health literacy of university students is the basis and prerequisite for effectively responding to public health and safety incidents in universities.

Targeted Educational Programs

Develop and implement health education programs tailored to specific demographics, such as rural students, male students, and those in disciplines outside of health sciences. Specific to different age groups, there are juvenile audiences, young audiences, middle-aged audiences, and elderly audiences. Audiences of different age groups have different learning and visiting needs. At present, the audience service objects of various museums, especially the development of educational activities, are mostly carried out around adolescents and children, and there are relatively few educational activities dedicated to serving the elderly. The Shaanxi History Museum is no exception.

Enhanced Accessibility

Improve access to reliable health information for rural students through online platforms, community outreach programs, and collaborations with local health organizations. The arrangement of the Shaanxi History Museum in terms of educational services is mainly based on various specific activities that can inherit and promote excellent historical culture based on the development of collections, and the one that can best reflect the main purpose of its activities is the “Shaan Bo Xing Class - 18 Treasures Series”.

Interdisciplinary Collaboration

Encourage interdisciplinary approaches to health education, integrating health literacy into various academic disciplines to enhance understanding and application. Rababah emphasized the role of interprofessional education in optimising health outcomes for university students. Morrison described a public health emergency simulation exercise in which senior undergraduate nursing students participated, and 91.5% of the students felt that the importance of providing safe care in a public health emergency was highlighted.

Further Research

In order to objectively assess the health literacy of university students, the Shaanxi History Museum also provides professional resources and services for the public, colleges and universities, scientific research institutes, experts and scholars. The Shaanxi History Museum pays attention to academic research and has a team of researchers with scientific research strength. They mainly organize relevant materials and interpret the history and culture behind the cultural relics through project-based research and have achieved fruitful results.

Limitations

This study has certain limitations. The questionnaire used in this study is independently designed, which may have shortcomings in terms of authority. But the questionnaire is based on a large number of domestic and international public health literacy publications and revised by experts several times, therefore its scientific validity and reasonableness should stand test.

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