The Effects of Health Lıteracy on Health Perceptıon and a Analysıs ın Respect of Socıo-Demographıc

Şebnem Yücel; Esma Atalı; Recep Yücel

doi:10.36690/2733-2039-2026-3-4-22

Authors

Şebnem Yücel Selçuk University https://orcid.org/0000-0003-2135-242X
Esma Atalı Selçuk University https://orcid.org/0000-0001-9792-0679
Recep Yücel Kırıkkale University https://orcid.org/0000-0002-4755-417X

DOI:

https://doi.org/10.36690/2733-2039-2026-3-4-22

Keywords:

health literacy, health perception, validity, reliability, socio-demographic difference, preventive healthcare, patient participation, health behaviour, healthcare utilization, socio-demographic factors, Kars, Türkiye

Abstract

Health literacy increasingly determines how individuals access, understand, evaluate, and use health information and therefore influences their participation in healthcare decisions and their perception of their own health. Examining this relationship is important because both health literacy and health perception may affect the use of health services and individual health behaviour. This study aims to determine the effect of health literacy on health perception and to examine differences in both variables according to socio-demographic characteristics. The research used a quantitative design and survey data obtained from 453 participants living in Kars, Türkiye. The 14-Item Health Literacy Scale and the Health Perception Scale were applied, and the data were analysed using descriptive statistics, confirmatory factor analysis, reliability analysis, correlation analysis, simple regression, independent-samples t-tests, and ANOVA. Confirmatory factor analysis supported a three-dimensional, 14-item structure for health literacy and a two-dimensional, six-item structure for health perception after item removal. Health literacy showed a positive but low relationship with overall health perception (r = .139, p < .001) and current health perception (r = .157, p < .001), while no statistically significant relationship was found with previous health perception. Regression analysis showed that health literacy significantly predicted overall health perception (R² = .019, β = .139, p = .003) and current health perception (R² = .025, β = .157, p = .001), but not previous health perception (R² = .001, p = .590). The analysis also revealed differences in health literacy and health perception across selected socio-demographic groups. The findings demonstrate the practical importance of health literacy for individuals’ participation in healthcare and support the development of health communication and preventive healthcare practices.

Downloads

Download data is not yet available.

Author Biographies

Şebnem Yücel, Selçuk University

Dr., Professor, Department of Health Management, Faculty of Health Sciences, Selçuk University, Konya

Esma Atalı, Selçuk University

Master’s Student, Department of Health Management, Konya, Institute of Health Sciences, Selçuk University, Konya

Recep Yücel, Kırıkkale University

Dr., Professor, Department of Business Management, Faculty of Economics and Administrative Sciences, Kırıkkale University, Kırıkkale

References

Akça, E., Gökyıldız Sürücü, Ş., & Akbaş, M. (2020). Health Perception, Health Literacy, and Related Factors in Pregnant Women. Inönü University Journal of Health Services Vocational School, 8(3), 630-642.

Altayı, B., Çavuşoğlu, F., and Çal, A. (2016). Health perception, quality of life, and health-related quality of life factors that affect the elderly. TAF Preventive Medicine Bulletin, 15(3), 181-189.

Bakan AB, Yıldız M, (2019). A study on determining the health literacy levels of individuals aged 21-64. Health and Society, 29(3), 33-40.

Baker, D.W., Gazmararian, J.A., Williams, M.V., Scott, T., Parker, R.M., Green, D. Et al. (2002). Functional Health Literacy and the Risk of Hospital Admission Among Medicare Managed Care Enrollees. American Journal of Public Health, 92(8), 1278-1283.

Balçık PY, Taşkaya S, Şahin B, 2014. Health Literacy. TAFPrevMedBull, 13(4),321-326.

Bennett, I.M., Chen, J., Soroui, J.S., White, S. 2009. The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Old Eradults. Ann Fam Med, 7(3),204-11.

Berens EM, Vogt D, Messer M, Hurrelmann K, Schaeffer D, 2016. Health literacy among differentage groups in Germany: results of a cross-sectional survey. BMC Public Health,16(1151).

Browne, M.W. & Cudeck, R. (1993). Alternative ways of assessing model fit. In Bollen, K.A. & Long, J.S. [Eds.] Testing structural equation models. Newbury Park, CA: Sage, 136–162.

Bryman, A. ve Cramer, D. (2001). Quantitative Data Analysis With SPSS 12 and 13; A Guide for Social Scientists. Taylor & Francis Group, London and New York. ISBN 0-203-49818-6 Master e-book ISBN, 1-159.

Bükecik N, 2019. Health literacy levels and related factors among employees of an education and research hospital, Unpublished Master's Thesis, Aydın Adnan Menderes University Institute of Health Sciences.

Cho, Y.I., Lee, S.Y.D., Arozullah, A.M., Crittenden, K.S. (2008). Effects of Health Literacy on Health Status and Health Service Utilization Amongst the Elderly. Social Science & Medicine, 66, 1809-1816.

Comrey A.L. ve Lee, H.B. (1992). A First Course in Factor analysis. Hillsdale NJ: Erlbaum. 41.

Çimen, Z. and Temel, A.B, (2017). The Relationship Between Health Literacy and Health Perception in Elderly Individuals with Chronic Diseases and an Examination of Factors Affecting Health Literacy. Ege University Journal of Nursing Faculty, 33(3), 105-125.

Değerli, H. and Tüfekçi, N. (2018). Determining the level of health literacy in society, AVRASYA International Research Journal, 6(15), 467-488.

Deniz, S., Öztaş, D., Akbaba, M. (2018). Determining the Health Literacy Level of Healthcare Personnel Working in Primary Health Care Services and Influencing Factors. Sakarya Medical Journal, 8(2), 214-228.

Diamond, J.J., Becker, J.A., Arenson, C.A., Chambers, C.V., Rosenthal, M.P. (2007). Development of A Scaleto Measure Adults’ Perceptions of Health: Preliminary Findings. Journal of Community Psychology, 35(5), 557–561.

Dwinger, S., Kriston, L., Harter, M., Dirmaier, J. (2014). Translation and Verification of a Multidimensional Tool to Evaluate Health Literacy. John Wiley & Sons Ltd. Sağlık Beklentileri,18, 2776–2786.

Eser, S., Saatlı, G., Eser, E., Baydur, H., Fidaner, C. (2010). World Health Organization Quality of Life Module for the Elderly WHOQOL-OLD: Turkish Field Study Validity and Reliability Results. Turkish Journal of Psychiatry, 21(1), 37-48.

Goldberg, P., Guéguen, A., Shmaus, A., Nakache, J.P., Goldberg, M. (2001). Longitudinal study of associations between perceived health status and self reported diseases in the French Gazel cohort. J. Epidemiol Community Health, 55, 233–238.

Goto, E., Ishikawa, H., Okuhara, T., Kiuchi, T. (2019). Relationship of Health Literacy with Utilization of Health-Care Services in a General Japanese Population. PreventiveMedicineReports,14.

Holt, K.A., Overgaard, D., Engel, L.V., Kayser, L., (2020). Health Literacy, Digital Literacy and e-Health Literacy in Danish Nursing Student Sat Entry and Graduate Level: A Cross Sectional Study. BMC Nursing, 19(22),1-10.

Ishikawa, H. ve Yano, E. (2008). Patient Health Literacy and Participation in the Health-Careprocess. Blackwell Publishing Ltd Health Expectations, 11, 113-122.

Ishikawa, H., Kiuchi, T., 2010. Health literacy and health communication. Bio Psycho Social Medicine, 4(18), 1-5.

Jessup, R.L., Osborne, R.H., Beauchamp, A., Bourne, A., Buchbinder, R., (2018). Differences in healthliteracyprofiles of patientsadmittedto a publicandprivatehospital in Melbourne, Australia. BMC Health Services Research,18, 134.

Karaoğlu, N., Karaoğlı, K.B. and Yardımcı, H. (2020). Comparison of Health Perception and Health Anxiety Levels of Osciology and Medical Students. Ankara Medical Journal, 3,615-628.

Keleher, H., Hagger, V. (2007). Health Literacy in Primary Health Services. Australian Journal of Basic Health, 13(2), 24-30.

Lee, S.D., Tsai, T., Tsai, Y.W., Kuo, K.N., (2010). Healthliteracy, health status, and healthcare utilization of Taiwanese adults: results from anational survey. Bio Med Central, 10,614.

Magnani, J.W., Mujahid, C.M.S., Aronow, H.D., Cene, C.W., Dickson, V.V., Havranek, E. et al. (2018). Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention. Circulation,138,48–74.

Marsh H. W, Hau K. T, Artelt C, Baumert J, & Peschar J. L, (2006). OECD's brief self-report measure of educational psychology's most useful affective constructs: Cross-cultural, psychometric comparisons across 25 countries. International Journal of Testing, 6(4), 311-360.

Nutbeam, D. (1998). Health Promotion Glossary. Oxford University Press, 13(4), 369-364.

Nutbeam, D. (2000). Health literacy as a Public Health Goal Challenge for Contemparary Health Education and Communication Strategies into The 21st Century. Oxford University Press, 15(3), 259-267.

Nutbeam, D. (2008). The Evolving Concept of Health Literacy. Social Science & Medicine, 67(12), 2072–78.

Okyay, P. & Abacıgil, F. (2016). Reliability and validity study of Turkish health literacy scales. (1st Edition). Ministry of Health Publication No: 1025,99.

Özcan, S., Baş, K. & Taş, Y.H. (2013). The Effect of Information Asymmetry on Patient Satisfaction in the Health Sector: An Application at Yalova Oral and Dental Health Center. International Conference on Eurasian Economies, 822-831.

Özdelikar, A., Ağaçdiken Alkan, Ş., & Mumcu, N. (2018). Determination of Health Perception, Health Anxiety, and Affecting Factors among Nursing Students. Bakırköy Medical Journal, 14,275-282.

Özkan, S. (2018). Research on Turkey Health Literacy Level and Related Factors. Ministry of Health of the Republic of Turkey, Ankara.

Rasu, R.S., Bawa, W.A., Suminski, R., Snella, K., Warady, B., (2015). Health literacy impact on National Health Care Utilizationand Expenditure. International Journal of Health Policy and Management, 4(11), 747-755.

Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Palacios, J., Sullivan, G.D., Bindman, A.B., (2002). Association of Health Literacy With Diabetes Outcomes. JAMA, 288 (4), 475-482.

Simon, D., Kriston, L., Loh, A., Spies, C., Scheibler, F., Wills, C., & Härter, M. (2010). Confirmatory factor analysis and recommendations for improvement of the Autonomy‐Preference‐Index (API). Health expectations, 13(3), 234-243.

Smith, K.V. & Goldman, N. (2011). Measuring Health Status: Self-, Interviewer, and Physician Reports of Overall Health. Journal of Aging and Health, 23(2), 242–266.

Souto, T.S., Ramires, A., Leite, A., Santosi, V., Santo, R.E. (2018). Health Perception: Validation of a Scale for the Portuguese Population. Trends Psychol., 26(4), 2185-2201.

Suka, M., Odajima, T., Kasai, M., Igarashi, A., Ishikawa, H., Kusama, M., Nakayama, T., Sumitani, M., Sugimoru, H., (2013). The 14-Item Health Literacy Scale for Japanese Adults (HLS-14). Environ Health Prev Med, 18, 407–415.

Sykes, S., Wills, J., Rowlands, G., Popple, K., (2013). Understanding Critical Health Literacy: a Concept Analysis. BMC Public Health, 13,150.

Tuğut, N. and Bekar, M. (2008). The Relationship Between University Students' Health Perceptions and Healthy Lifestyle Behaviors. Atatürk University School of Nursing Journal, 11(3), 17-26.

Türkoğlu, N. and Kılıç, D. (2021). Adaptation of the Health Literacy Scale into Turkish: Validity and Reliability Study, Anadolu Journal of Nursing and Health Sciences, 24(1), 25-33.

Wannemethee, G. ve Shoper, A.G. (1991). Self-Assessment of Health Status and Death Conditions in Middle Aged British Men. Int. J. Epidemiol, 20 (1), 239-245.

Ware, JE, Jr (1976). Scales for Measuring General Health Perceptions. Health Care Research, 11 (4), 396–415.

Yalnızoğlu, Çaka, S., Topal, S., Karakaya, Suzan, Ö., Çınar, N., Altınkaynak, S. (2017). The Relationship Between Nursing Students' Health Perception and Self-Confidence. J. Hum. Rhythm, 3 (4),199-203.