Many Filipinos have limited health literacy which can hinder their ability to effectively manage their health, according to the National Health Literacy Survey (NHLS), the first nationwide survey on the prevalence of health literacy in the Philippines.
Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Low health literacy is associated with more hospitalizations, greater use of emergency care, decreased use of preventive services, poorer ability to interpret labels and health messages, poorer health status, higher mortality, and higher healthcare costs. On the other hand, a high level of health literacy among the general population can reduce sickness (morbidity), death (mortality), and disability, as well as enhance health equity.
The NHLS is a project of the Department of Health (DoH) in cooperation with the Philippine Council for Health Research and Development, an attached agency of the Department of Science and Technology. Results of the survey were published in the April 2022 issue of the peer-reviewed journal Health Literacy Research and Practice.
Conducted by the College of Public Health Foundation of the University of the Philippines-Manila, the cross-sectional nationwide survey involved 2,303 randomly selected Filipinos aged 15 to 70 years. The mean age of the respondents was 40, and the majority were women (74%), urban residents (70%), married (55%), Catholic (79%), and not gainfully employed (52%).
The NHLS used an adapted Asia version of the European Health Literacy Survey Questionnaire that measured the components of health literacy, including its dimensions (ability to access, understand, appraise, and apply health information) and domains (healthcare, disease prevention, health promotion).
The survey showed that the nationwide prevalence of limited health literacy is 51.5%, with the National Capital Region (NCR) having the highest prevalence (65.4%) and Luzon the lowest prevalence (48.2%).
The nationwide prevalence of limited health literacy was higher for accessing (45.9%) and appraising (43.8%) health information, compared to understanding (35.8%) and applying (35.7%) health information. This was the same pattern seen in Luzon and the Visayas. In NCR, the dimension with the highest prevalence of limited health was appraising health information, while in Mindanao it was applying health information.
Across domains, the nationwide prevalence of limited health literacy was highest in healthcare (50.9%) and consistent across the subnational levels. The study authors Tolabing et al noted that the NCR has the highest prevalence of limited health literacy in all three domains.
The proportion of limited health literacy increased with age, whereas it decreased with increasing level of educational attainment among respondents — findings that reflect the influence of formal education on health literacy by imparting health-related knowledge and forming skills essential for engaging with sources of information, the study authors explained.
Respondents without health insurance had the highest proportion of limited health literacy, which according to the study authors, may denote that the complexity of insurance information and enrolment procedures may hinder those with limited health literacy to obtain health insurance. Additionally, those without insurance have less use of health services due to higher out-of-pocket medical expenses. This lack of experience with the healthcare system may lead to limited engagement with health information and consequently limited health literacy.
Respondents without a relative with a medical background had a higher proportion of limited health literacy than those with relatives with medical background. The study authors noted that a health professional in the extended family may readily share health-related knowledge and persistently remind one of healthy behaviors. The nuanced spillover of health expertise may consequently lead to higher health literacy in their family members.
According to the study, the substantially higher prevalence of limited health literacy in NCR (65.4%) compared to Luzon and Mindanao implies differences in health promotion activities and their effectiveness and in health system demands. They cited reported variations in the quality of health services in different local government units at least partly due to the devolved health system. They also acknowledged the DoH’s recognition of the need to train health professionals on health promotion via field training facilities to ensure the standard delivery of health promotion services.
The study said it was noteworthy that health information access had the highest prevalence of limited health literacy considering that the process of engaging with sources of health information begins with accessing health information, which will trigger the rest of the steps, namely, understanding, appraising, and then applying the health information.
On the other hand, the highest prevalence of limited health literacy in healthcare implies that engaging with information about healthcare is more difficult than is the case with disease prevention or health promotion. Moreover, verbal health information from health providers on healthcare may be less understood than that of other domains. The reasons may include limited time available for health provider-patient interaction or communication skills of the health provider, the study authors explained.
The study authors concluded that the NHLS results highlight the need for targeted interventions focusing on specific population subgroups with limited health literacy and on improvements in the information access dimension and in the healthcare domain of population health literacy. Since the task of health literacy is too important, no one sector can do it alone. Therefore, public-private partnerships will be helpful in tackling health literacy to improve health.
Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.
