Abstract

Introduction Health literacy is an important determinant for health outcomes and research among the low-income group with high risk of non-communicable disease(NCD) in this country is scarce. The purpose of this study is to determine psychosocial factors associated with Health Literacy among the low socio-economic status in the urban settings.

Methods This is a community-based house to house survey conducted from September and October 2020 at the Petaling district in Selangor state, Malaysia. A random cluster sampling was done and a total of 504 eligible head of the household were recruited. Inclusion criteria are more than 18 years old with a household income of RM 6890 and below without any present acute psychiatric illness.

Results A total of 426 respondents have completed Health Literacy questionnaires 6-items eligible for analysis (response rate of 84.5%). Participants’ mean age is 43.1 years old, the majority are Malay participants (75.1 %, n=323), married (74.7%, n=321), attained same or less than secondary level education (55.3%, n=236) with a median income of RM 2595.5. The unemployed proportion doubled (33.2%) during the COVID Pandemic. Approximately, 30.4%(n=130) of the participants having a history of Non-Communicable Diseases (NCDs). The mean score of Health Literacy (HL) was 3.0 (SD 0.6) with 31.2 % of the participants having problematic level and 6.8 % having inadequate level of health literacy. Multivariable General Linear model regression analysis revealed factors predict lower HL mean score were age (< 50y.o Vs < 30y.o, B= -.185, p<0.043), Ethnicity (Indian Vs Malay B= -.264, p< 0.012), marital status (widow Vs single B=-0.297, p<0.017) , depression score of >=5 (B= -.135 p<0.030), self-stigma (B=-.015,< p<0.008) and perceived poverty as a fatalistic effects (B=-.086,p<0.005). Other factors that improve health literacy scores were psychological resiliency, individualistic factors and owing assets (estate and jewellery).

Discussion/Conclusion Health literacy is still low among the low-income participants. The findings highlighted the need for public health psychosocial intervention which incorporate improving HL in the Malaysian low-income population.