Factors related to health literacy among Brazilian adolescents: cross-sectional study

Pimentel, Sidiany Mendes; Avila, Marla Andréia Garcia de; Medeiros, Vinnicius Dias Alves de; Prata, Rafaela Aparecida; Nunes, Hélio Rubens de Carvalho; Silva, Juliana Bastoni da

doi:10.1590/1980-220X-REEUSP-2023-0310en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0310en copy

Factors related to health literacy among Brazilian adolescents: cross-sectional study

Factores relacionados con la alfabetización en salud de adolescentes brasileños: estudio transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the relationship between sociodemographic and clinical factors with health literacy in Brazilian adolescents.

Method:

This is a cross-sectional study with 526 adolescents aged 14 to 19. Data were collected virtually between July and September 2021 using a sociodemographic characterization questionnaire, clinical profile and the Health Literacy Assessment Tool – Portuguese version. The variables were evaluated by multiple linear regression with normal response, with significance p < 0.05.

Results:

The average age was 16.9 years (±1.6), the average health literacy score was 25.3 (±5.4). Female gender (p = 0.014), university educational level (p = 0.002) and use of medication (p = 0.020) were related to higher levels of health literacy. Adolescents with chronic illnesses had a higher total literacy score, on average 1.51 points, compared to those without chronic illnesses.

Conclusion:

Male adolescents and those with less education performed worse in health literacy and, therefore, deserve special attention in health promotion actions.

DESCRIPTORS
Adolescent Health; Health Literacy; Health promotion; Social Determinants of Health; Adolescent Development

Variable	Total
Variable	N	%
Gender
Female	356	67.7
Male	170	32.3

Age (in Years)
14	49	9.3
15	71	13.5
16	94	17.9
17	71	13.5
18	137	26.0
19	104	19.8

Region
North	258	49.0
North East	31	5.9
Midwest	36	6.8
Southeast	191	36.3
South	10	1.9

Education (in progress or completed)
Elementary School	67	12.7
High school	353	67.1
University education	106	20.2

*Income (minimum wage)^ Minimum wage in 2021: R$ 1,2121*
< 0.5	116	22.1
0.5 – <1	52	9.9
1 – <2	136	25.9
2 – <5	141	26.8
5 – <10	45	8.6
10 – <20	26	4.9
≥20	10	1.9

Chronic disease
No	477	90.7
Yes	49	9.3

Recent hospitalization
No	505	96.0
Yes	21	4.0

Medication use
No	424	80.6
Yes	102	19.4

Variable	B	CI95%		p^* B: Estimation of regression model parameters; CI: confidence interval; Regression with normal response; Reference for regions of Brazil; Continuous quantitative variable; Reference for education levels; ***Reference for income levels; †Dichotomous variables, had as reference the absence of the analyzed event.
Male gender	−1.30	−2.29	−0.32	.010
Brazil Regions
South region	0.77	−2.66	4.19	.662
Southeast region	0.75	−0.27	1.76	.150
Midwest region	−0.48	−2.37	1.41	.620
North East region	0.61	−1.41	2.63	.554
North East^** B: Estimation of regression model parameters; CI: confidence interval; Regression with normal response; Reference for regions of Brazil; Continuous quantitative variable; Reference for education levels; ***Reference for income levels; †Dichotomous variables, had as reference the absence of the analyzed event.	0a
Age^*** B: Estimation of regression model parameters; CI: confidence interval; Regression with normal response; Reference for regions of Brazil; Continuous quantitative variable; Reference for education levels; ***Reference for income levels; †Dichotomous variables, had as reference the absence of the analyzed event.	0.23	−0.06	0.52	.120
Educational background
Universtiy level (in progress)	2.70	1.06	4.34	.001
High school level (in progress or completed)	0.60	−0.80	2.01	.398
Elementary school level (in progress or completed)^**** B: Estimation of regression model parameters; CI: confidence interval; Regression with normal response; Reference for regions of Brazil; Continuous quantitative variable; Reference for education levels; ***Reference for income levels; †Dichotomous variables, had as reference the absence of the analyzed event.	0a
Income	−0.18	−3.68	3.32	.919
Income of more than twenty minimum wages
Income between ten and twenty minimum wages	1.40	−0.91	3.70	.235
Income between five and ten minimum wages	1.06	−0.80	2.93	.264
Income between two and five minimum wages	−0.09	−1.42	1.24	.896
Income between one and two minimum wages	0.19	−1.16	1.53	.785
Income between half and one minimum wage	−0.39	−2.17	1.38	.664
Income up to half the minimum wage^***** B: Estimation of regression model parameters; CI: confidence interval; Regression with normal response; Reference for regions of Brazil; Continuous quantitative variable; Reference for education levels; ***Reference for income levels; †Dichotomous variables, had as reference the absence of the analyzed event.	0a
Chronic illness^†	1.51	−0.08	3.11	.063
Recent hospitalization^†	−0.83	−3.21	1.54	.492
Medication use^†	1.87	0.71	3.04	.002

Variable^* The variables “regions of the country” and “age” showed weaker associations and were not included in the multivariate regression to increase the precision of the estimates; B: Estimation of regression model parameters; CI: confidence interval; Multiple linear regression; **Reference for education levels, †Dichotomous variables, had as reference the absence of the analyzed event.	B	CI95%		p^** The variables “regions of the country” and “age” showed weaker associations and were not included in the multivariate regression to increase the precision of the estimates; B: Estimation of regression model parameters; CI: confidence interval; Multiple linear regression; **Reference for education levels, †Dichotomous variables, had as reference the absence of the analyzed event.
Intercept	24.48	23.17	25.78	0.000
Male gender	−1.22	−2.19	−0.25	.014
Educational background
Universtiy level (in progress)	2.55	0.93	4.18	.002
High school level (in progress or completed)	0.57	−0.82	1.96	.419
Elementary school level (in progress or completed)^**** The variables “regions of the country” and “age” showed weaker associations and were not included in the multivariate regression to increase the precision of the estimates; B: Estimation of regression model parameters; CI: confidence interval; Multiple linear regression; **Reference for education levels, †Dichotomous variables, had as reference the absence of the analyzed event.	0a
Chronic illness†	0.68	−0.96	2.33	.417
Medication use†	1.44	0.23	2.65	.020

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Sidiany Mendes Pimentel, 605 sul alameda 30 Qi 14, 77016-420 – Palmas, TO, Brazil, sidiany.pimentel@ifto.edu.br