United States adult seeking

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This paper presents data from the Program for the International Assessment of Adult Competencies with a focus on the interrelationships among health information seeking behavior HISBand health status or use of preventive health measures for U. The Internet appears to play a key role in both enhancing health status and enabling use of preventive measures for those with and without a high school diploma; although, individuals without a high school diploma who use the Internet for health information derive substantial benefit in health status.

This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Data Availability: Relevant data are within the paper and it supporting information file. Competing interests: The authors have declared that no competing interests exist. A key component of high-quality healthcare is patient-centered care PCC in which patients and their providers work together to make decisions about health care and disease management [ 1 ].

In order to participate in their care, patients must have adequate health literacy, which includes the ability to read, listen, ask questions, and draw conclusions from health-related information [ 23 ].

Health Literacy is a concept that is complex and dynamic, and takes into how people access, understand and use health information and health care in everyday life and in medical situations. There are a of individual factors age, socioeconomic status, race and societal factors health disparities, community norms, culture that can affect health literacy, however, adults with low literacy and low education status are less likely to have the basic literacy skills that correspond to adequate health literacy, and therefore are more likely to have low PCC and poor health outcomes in both primary prevention and chronic disease [ 3 — 6 ].

Adults at many education levels struggle to understand medical statistics, medication dosage requirements, and basic health concepts such as daily nutritional values [ 467 ]. We also know that seeking health information is not only related to literacy and education levels, but also has many other predisposing characteristics including gender, age, education level, general and health literacy levels, pre-existing health conditions, and race [ 789 ].

However, people who do have a high school diploma, regardless of their literacy levels and other socio-demographic factors, are more likely to seek and use health information. Education levels and literacy levels are both strongly linked to health outcomes [ 1011 ].

Health information seeking behavior HISB can be enacted through print, visual, or oral media; health information can also be accrued either actively or passively. Although there are many studies that consider HISB for specific diseases and health conditions, very few have addressed the role and influence of HISB in a population with diverse characteristics who may have no specific diagnosis or disease [ 369 ]. We are interested in knowing from which sources those with and without a high school diploma seek health information, and if there is any further association with health status and use of preventive measures.

Each country was allowed to add five minutes of questions; the United States added questions relating to health information seeking and health behaviors as part of the country data. The data provide us with a unique opportunity to understand how adults seek health information while controlling for demographic and socioeconomic factors [ 10 ]. We address this question by asking the following research questions:. Educational attainment matters for health—past studies have shown that education levels are linked with health through health knowledge and behaviors, literacy levels, employment status, insurance status, and a variety of other social and psychological factors [ 11 — 15 ].

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People with more education report having lower morbidity from common acute and chronic diseases; likewise, they are also more likely to exercise and obtain preventive care [ 16 — 18 ]. Those with higher educational attainment also tend to have higher health literacy levels, which enables them to better access, understand, and communicate actionable health information [ 8131719 — 21 ]. While acknowledging the role that genetic traits, demographic factors, and socioeconomic status have on health outcomes, we frame our study within the persistent association between educational attainment and health because of the influence of education level on accessing and understanding health information [ 1113172223 ].

One well-described and important factor that links education and health outcomes is economic status [ 111723 — 30 ]. Those with higher education are more likely to have higher income, greater wealth, more stable employment, better health insurance, and access to health care [ 1118222531 — 32 ]. While it is not clear if the pathway from education to health is causal, a consistent finding within economic, education, and health research is that those with higher incomes tend to have better self-reported health, report fewer physical and mental limitations, and are more likely to live in communities that support healthy lifestyles [ 33 — 35 ].

Those with higher education also tend to have well-developed cognitive skills e. Access to health resources provides more information about preventive health behaviors and the benefits of a healthy lifestyle. Individuals with greater access to these sources due to higher economic and education status are more likely to engage in preventive health measures and live a healthy lifestyle [ 33 — 353839 ]. Another key factor that links education and health outcomes is the development of non-cognitive skills that may promote better health outcomes through active decision making about appropriate health behaviors [ 4041 ].

For example, adults with lower educational attainment are less likely to have a developed sense of personal control, which is highly related to better health through development of traits such as delayed gratification and persistence [ 42 — 44 ]. Personal control is a key element in self-efficacy, which affects health directly through psychological factors e. Health behaviors play a strong role in explaining health and illness, particularly as they relate to illness onset, help-seeking, illness management, and health outcomes [ 4547 ]. People with less education have a high prevalence of literacy difficulties whether measured by general or health literacy tests.

There is a strong association between low reading skills and health outcomes which is thought to be primarily due to a general lack of knowledge about health and a lack of understanding about health services [ 35405152 ]. In addition, health literacy studies indicate that grade level equivalents in reading in a health context may be considerably lower than grade level equivalents in general reading [ 354852 — 55 ].

The abovementioned tests directly assess reading skills only and do not take into consideration other literacy assets such as memory, sight-reading, or problem solving.

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These more general skills may help people navigate the complex world of health and healthcare despite having low reading skills or not having a high school diploma. One general finding from the PIAAC study is that people with low literacy skills are four times more likely than those with above average literacy skills to have poor health [ 10 ]. Education levels also affect how one seeks and uses information. Information seeking skills are often learned and used when meeting certain objectives, like gathering information for a research project in school [ 5657 ].

Students learn how and where to source information in the school setting, using tools such as textbooks, resource materials, Internet searching, and other information sources [ 5657 ]. Through information acquisition, people accrue both content knowledge for and practice of problem-solving and critical thinking. Adults who have not finished high school may not have basic information seeking competencies, and may therefore not be able to know when information is needed, how to identify or locate that information, and how to use that information to problem solve [ 535658 — 60 ].

Additionally, and depending on more specific literacy competencies, they may not have the necessary cognitive or literacy skills to be able to read and comprehend the information they do find [ 56 — 5860 ]. HISB has the ability to shape health outcomes by providing access to important information for understanding and coping with a health risk, increasing involvement in medical decision making, and promoting preventive behavior and healthy behavior change [ 27 — 94861 — 63 ].

Adults who have higher levels of education are more likely to seek information which enhances a sense of personal control through mastering content and developing stronger analytic and communication skills [ 536063 ]. Knowing how adults with differing education levels engage in HISB is important because those who actively seek health information from a variety of sources are likely to use that information and be more cognitively and psycho-socially prepared to engage in medical decision-making and with the medical system [ 6465 ].

Seeking information is also a prerequisite to using information. Those with lower education levels are less likely to have the skills or knowledge to seek health information [ 5356585966 ]. Adults with less than a high school diploma are less likely to be knowledgeable about both preventive measures and management of sick behaviors because they are less likely to seek health information [ 67 ].

The high literacy, numeracy, and computer skill demands of health-related websites create problems for those who have low educational attainment [ 68 ]. Challenges also exist in when seeking information from health professionals—the complexity of medical language, discordance between language and literacy skills of patients and providers, and intercultural communication issues contribute to the difficulty that adults with low education levels have in participating fully in their health care [ 6869 ].

It is important to control for a variety of socio-economic and demographic factors when analyzing the relationship between literacy and health. People with low literacy are more likely to have low income, low levels of education, and limited English proficiency [ 11215 — 1924 ]. In addition, they are more likely to be Black, Native American, or Latino and more likely to be elderly [ 2023 ]. Those with lower levels of education may have more challenges seeking health information from written sources, and may instead choose oral sources of information across these factors [ 7071 ].

Insurance status can also confound health information seeking: those with insurance are more likely to seek health care for non-emergent and chronic conditions which puts them in contact with health professionals more than those who do not have health insurance [ 72 — 74 ].

Often, first-generation immigrants struggle when seeking health information due to language barriers and lack of cultural familiarity with the US medical and health systems [ 7576 ]. Data for this study were acquired from the PIAAC dataset using the United States country-specific background questionnaire administered to a representative sample of 5, adults between the ages of 16 and Background questionnaires were delivered in English or Spanish; the direct assessment measures of literacy, numeracy, and problem solving in technology-rich environments were delivered in English only.

Participants were only included only if there was no missing data in any of the dependent and independent variables under study in order to avoid separation of the data. Each country was allowed to add five minutes of questions to their background questionnaire. The United States included questions relating to health status, health information seeking behaviors, and use of preventive health measures.

Our sample included all PIAAC participants who reported their high school diploma status, excluding the small proportion of individuals who did not report their status 2. Within our sample, had a high school diploma and did not have a high school diploma.

Health information seeking behavior was established through the sources of health information utilized by the sample participants. Individuals rated each of the eight sources according to the response scale. We considered creating composite variables for related sources e. Based on this analysis, each source of health information was analyzed separately. Average health status score was calculated for descriptive purposes, ranging from 1 poor health to 5 excellent health.

We created composite indices of preventive measure use for practices that were highly correlated. There were no other strongly correlated preventive health measures. Gender, age, race and high school diploma status, first generation immigrant status and having medical insurance were determined using PIAAC variables. With regard to age, we used age groups of 24 and under, 25—34, 35—44, 45—54, and 55— For Educational Attainment, we created a variable to indicate whether or not a person had a high school diploma based on self-reported data. Immigrant status and medical insurance status variables were determined based on self-reported data.

The analyses were performed using SAS v. S Department of Education, All appropriate weighting macros derived by PIAAC were utilized in order to provide population-level adjusted for the sampling methods used in the study. By using random selection methods at each stage of sampling, this four-stage stratified area probability sample provided reliable statistics for the US population from the sampled data [ 10 ]. Descriptive characteristics of the sample were examined using frequencies and percentages for categorical measures.

T-tests and Mann Whitney U tests, depending on level of measurement, were performed to compare high school diploma status on the dependent measures. Ordinal logistic regression models were employed to examine the associations between high school diploma status and health information source outcomes. Binary logistic regression models were used to study the relationship between high school diploma status and HISB with the health and preventive measure outcomes.

A series of four models were performed that included 1 high school diploma status and the primary predictor of interest: 2 interaction terms of high school diploma status with the primary predictor; 3 we added demographic confounders to the model; and 4 we performed models stratified by high school diploma status to assess the magnitude of association between the primary predictors and the outcomes of interest when ificant interactions were indicated. Before specific research questions are addressed, we looked at general characteristics of our sample which are shown in Table 1.

Health information sources were the dependent variable. Table 2 shows the use of health information source by education status. Usage of text-based sources e. At high levels of usage, more people with a high school diploma used such sources; whereas, people without a HSD were more likely to report low usage. Compared to people with a high school diploma, a greater proportion of people without a high school diploma used oral information source e. The use of health professionals for health information was almost the same for those with of the ordinal logistic regression models are shown in Table 3.

Model 1 shows the association between having a high school diploma and utilization of each of the seven health information sources, controlling for other sources of health information. People with a high school diploma were more likely to report using magazines OR 1. We further examined ificant interactions between high school diploma status and each of the health information sources, controlling for demographic measures to determine use of multiple sources.

For those without a high school diploma, there was a ificant association between seeking health information from the radio and from magazines Table A in S1 File. of the HSD stratified models showed that more television usage was associated with greater odds of radio usage for health information, but of greater magnitude among those without OR 4. No ificant association between Internet usage and television usage was found among people without a high school diploma Table C in S1 File.

Among respondents without a high school diploma, those who seek health information from health professionals had 3. Among respondents with a high school diploma, those who seek health information from health professionals had 4. No other interactions between HSD with health information sources were identified. Health status was the dependent variable. The findings showed average health status scores were greater across HSD levels for individuals who frequently used magazines and the Internet for health information, with a medium effect size for the Internet.

With regard to the Internet, there is a greater spread in mean health status 0. Respondents who did not use the radio as a source of health information were more likely to get a flu shot than those who used the radio a lot 1. They were also more likely to get a mammogram if they listened to the radio some or not at all 1.

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These findings remained substantively unchanged with additional control for demographic covariates not shown. We then assessed whether there were statistical interactions between having a high school diploma and the health information sources in relation to health status and preventive measures.

Internet use was not associated with getting pap smears for those with and without high school diplomas. These are compared to respondents who use the Internet A Lot. There were several interactions for which the stratified models were inestimable. We therefore report no findings for these stratified models.

Our study explored health information seeking behavior HISB and its relationship to health status and use of preventive measures, for those with and without a high school diploma while controlling for demographic factors.

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Our general findings indicate that while there is a difference in HISB between those with and those without a high school diploma, use of the Internet is a ificant and important moderating factor. Internet use was related to better health status regardless of educational status; further, for those without a high school diploma, the health benefit of using the Internet as an information source was even greater than the benefit for those with a high school diploma.

This suggests that for people both with and without a high school diploma, there may be positive health benefits to developing health-related digital literacy skills. We first looked at the difference between uses of health information source by high school diploma status in Research Question 1. Those with a high school diploma were much more likely to use text-based sources while those without were much more likely to seek health information from oral sources e.

This relationship held true when controlling for demographic factors of age, gender, race, immigrant status, and having medical insurance.

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According to the PIAAC data, people with a high school diploma had a directly assessed mean reading literacy score of

United States adult seeking

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