Yunxia Ni, RN, MNS.

1. The effect of health literacy interventions among baccalaureate students in Sichuan University in China Yunxia Ni, RN, MNS. West China School of Nursing Sichuan University

2. Introduction ♪ Health literacy is defined as‘the degree towhich individuals have the capacity to obtain,process, and understand basic health information and services needed to make appropriate decisions’(Ratzan ,2000). ♪ Limited health literacy has been associated with health outcomes and financial burden(Vernon,2007).

3. Introduction ♪ In China, though the government has publishedpolicies to improve the health literacy of citizens (Pleasant,2012), but the prevalence of adequate health literacy is only 6.48% in adults (Wang,2013). ♪ While the college students who are the pillars of society in the future also suffer low health literacy.

4. Introduction Surveys in Chengdu and Nanjing Universities found that the proportion of students with basic health literacy is only 15.8% and 1.8%,especially in lifestyle(7.4%) ,behavior literacy(0.5%) and chronic disease prevention (0.5%)(Shen,2011). A survey in Xi’an province indicated a prevalence of hypertension was 3.3% among college students(Wang,2011).

5. Introduction It’s clear that the college students are the high risk populations with chronic disease in the decades. So it’s high time to improve the health literacy in college students immediately. Therefore, our University have started the health literacy promotion programs since 2009, this research focuses on the effects of the health literacy intervention in our university in Sichuan.

6. Objective special objectives ♪ To understand the health literacy level of baccalaureate students in our university. ♪ To evaluate the effects of the health literacy intervention among baccalaureate students .

7. Methods research design A single-group pre–post nonexperimental designwas conducted in this study.

8. Methods Participants and setting ♪ The study was conducted in Sichuan University. ♪ Baccalaureate students enrolled through national entrance examination of university. ♪ Per semester opened the health literacy program. Each semester recruit 30-120 students.

9. Methods inclusion criteria: ♪ Full-time undergraduate students ♪ The students who were interested in this program and volunteered to participate ♪ There was time to participate in this program that didn’t conflict with their courses

10. Methods The 912 students have been involved in the project from 2010 to 2013, and there are 832 students have completed the project and effectively in return. This study was approved by the Ethical Committee at West China hospital of Sichuan university. The students have signed the informed consent before the project.

11. Methods The intervention The intervention consisted of two parts : Classroom-based education Self-study after class

12. Methods Classroom-based education ♪ In each semester ,there were eight sessions in total. ♪ Every session was a two-hours lecture in the evening once a week ♪ The first session started from the second week of every semester.

13. Methods Teaching Materials ♪ Health care handouts wrote by the teachers in our university ♪ Materials Content: The concept of health and health literacy Health Assessment Diet , Regular Exercise, Healthy Weight Psychological Adjustment and Stress Response Environmental Health, et al.

14. Methods Teaching Method ♪ The lectures were given by three teachers ♪ In class, combined teaching with interactive ♪ Focusing on students participation and solved students' health problems.

15. Methods Self-study after class ♪ How to choose the content? The students' ability of understanding Needs Classroom teaching content ♪ Self-study Content Theories and models of health promotion Chinese citizens health literacy Self-care for common diseases Work environment , et al. ♪ Provide students with self reference.

16. Methods Communication between students and teachers Conveying learning requirements, courseware and reference materials through public e-mail. Students can also consult the teachers through e-mail , telephone , etc., to solve the health problems.

17. Methods Effect Evaluation and Data collection , Analysis Evaluation included two parts: Basic health literacy survey (functional health literacy) The homework of open questions

18. Methods Health Literacy Survey Questionnaire According to the college students’ characteristics and “The 2008 Chinese Citizens Health Literacy Questionnaire”, formed our questionnaire(Theministry of health center news propaganda,2009)

19. Methods ♪ The questionnaire includes 40 questions coveringthree sections ☆Basic knowledge (20 questions) ☆Healthy lifestyle and behaviour (15 questions) ☆ Basic medical skills (5 questions)

20. Methods ♪ Thequestionnaire related to five health problems ☆ Scientific view of health ☆ Infectious disease prevention ☆ Chronic disease prevention ☆ Safety and first aid ☆ Basic medical technology

21. Methods The 2008 Chinese Citizens Health Literacy Questionnaire issued by the National Ministry of Health was used as the standard to judge the answers from the students on the health-related questions. Each correct answer was assigned a point of 1,otherwise 0. Thus, the full score of all health-related questions for each student was 40. According to the scoring system, a score of 32 (80%) or above was defined as adequate basic health literacy .

22. Methods ♪ The correlation coefficient of the questionnaire was 0.948 and no collinearity was existed among different dimensions. ♪ The survey carried out before the first class and after the end of class ☆ The teacher gave students some notes ☆ Students completed it within 30 minutes independently ☆ Took back immediately

23. Methods The homework of open questions The purpose of the open questions ♪ Understood their concerns to different health problems ♪ Trained students' ability to find and solve their own health problems 17 open-questions were designed ♪ health status ♪ lifestyle ♪ environmental health ♪ psychological adjustment ♪ health skills, et al.

24. Methods ♪ Students selected one of the questions or other questions they were interested in ♪ Using what they have learned, relevant information or professional support to complete the work ♪ Submitting their work after the whole lecture.

25. Methods ♪ Teachers scoring based on : ☆A comprehensive answer ☆Health knowledge and skills application ☆Analysis profound ☆Detailed measures ☆Written expression from excellent to bad in Five Grades. ♪ Using SPSS17.5 statistical software for statistical analysis.

26. Result ♪ Before the lecture, 881 students returned the questionnaires of 912 students(96.8%). ♪ 848 students participated in the whole project. ♪ After the lecture,832 valid questionnaires retuned of 848 students(98.1%).

27. Result Students’ health literacy before and after the intervention Table 1 The number of students who have adequate health literacy n(%) Before and after the intervention , N=881 and 832, Respectively.P<0.05

28. Result Table 2 The questions that the students got the lowest correct rate

29. Result Students’ work performance and their concerns of health topics Students’ work : 138 students( 16.6% ) get A 502 students ( 60.3% ) get B 163 students ( 19.6% ) get C 28 students ( 3.4% ) get D 1 students ( 0.1% ) get F.

30. Result Table 3 Health Topics the Students Concerned about

31. Result Table 3 Health Topics the Students Concerned about

32. Discussion 1 It’s necessary to promote health literacy for college students ♪ From the enrollment, health literacy promotion activities attract students' attention in our school, indicating a strong intention to improve health literacy and put it into action among the students. Pre-intervention survey showed 29.2 percent of the students with the basic health literacy. Higher than the 2009 national survey of college students and Guo's survey in Beijing(Guo jing,2011)

33. Discussion The college students’ health literacy level and their education do not match , so there is still great demand and need to carry out health literacy promotion activities for the universities.

34. Discussion 2 The intervention have an positive effect on health literacy, while the lifestyle and chronic disease prevention literacy need further improvement. ♪ The results show that both the general health literacy and its various have significantly upgraded. ♪ The literacy of lifestyle and chronic disease prevention increase poorly, especially the latter, which is only 4.4 percent.

35. Discussion The reasons may the two aspects: ♪ Before the intervention, their literacy was already poor in lifestyle and chronic disease prevention , only 9.3% and 4.9 % ♪ Behavior change is difficult and the major health problems that college students currently suffer is not chronic disease.

36. Discussion ♪ Despite more and more young people suffer from chronic diseases nowadays, it doesn’t cause the college students’ enough attention. This may be one reason why the incidence of chronic diseases increased year by year. ♪ Thus, the promotion of healthy behavior especially chronic disease prevention behavior need to draw our attention.

37. Discussion 3 The students’ desire to improve their health is strong , but the willpower to stay healthy is poor. The 76.9% of students get A or B score, suggesting that: ♪ The majority of students' awareness to promote their own health is relatively strong, they can use the health knowledge to solve their own health problems flexibly ♪ Indicate this intervention achieve the primary purpose.

38. Discussion The first three health issues that students are most concerned about are: ♪ Their health level and how to enhance their health ♪ Their lifestyle nearly a week ♪ The effect of environmental on their health. Homework content indicate that our students are in a sub-health condition in general and they have many kinds of unhealthy lifestyles : ♪ Lack of exercise ♪ Irregular ♪ Negative responses such as complaints and fluke mind.

39. Discussion Thus, enhancing people's health beliefs and training their inner consciously is one of the indispensable aspect of health education and health promotion activities. While the inner experience is lack among younger generation especially the only child during their growing up today. To this end, promoting health literacy should start from childhood , which is a required course in life.