An exploratory study in functional health literacy and health promotion behavior among foreigner students at three universities in Taipei

Background – The World Health Organization has adopted a definition of Health literacy that reflects the health promotion orientation as the cognitive and social skills that determine the motivation and ability of individuals to access understand and use information in ways that promote and maintain good health. Researches had shown that individuals with lower health literacy are more likely to engage in negative health behaviors and college students are prone in the engagement of this risky behavior. These international college students are required to embrace themselves into a new country, which involves a change in their habits, life conditions that may influence their health and lifestyle behaviors.

Objective – the aim of this study was to assess the prevalence of functional health literacy and examined its association with health promotion behaviors and to assess whether health literacy contributes, through mediation to socio-demographic characteristic in health promotion behavior.

Methods - An on-line cross-sectional survey was conducted in a convenience sample of (N=240) International college students in Taipei aged 18 years and older. The survey included socio-demographic section, Health literacy and health promotion behavior evaluation. Health literacy was measured by self-report instrument using the validate Medical Term Recognition Test (METER) and the health promotion behavior was measured by the Health-Promoting Lifestyles Profile II (HPLP II). Two step Hierarchical multiple regression analysis was used to assess for evidence of mediation.


Results- It was found that 43.3 % of participants had functional health literacy level, 40 % and 16.3% had marginal and low health literacy level respectively. The overall health-promoting behavior scores among these students were moderate, indicating an engagement in health promotion behavior. International students scored highest on interpersonal relations but lower on stress management subscales. Bivariate analysis indicated the significant association of gender, language, educational level, ethnicity and income toward health literacy score. Risk of having limitation in health literacy had been found in female, participants with English not as a first language, low educational level, being Asian and Hispanic/Latino, and low income. Male students engaged more in physical activities than did female students. Students with English as their first language reported higher score of psychosocial practice of interpersonal relations. European students presented highest score in nutrition and African students the lowest in this subscale. Students with higher monthly income reported slightly higher score in the overall health promotion behavior. The hierarchical multiple regression analyses indicated that, age, gender, educational level, and language, tended to have direct rather indirect effects through intermediate factor of health literacy on health promotion behavior. Health literacy is a significant predictor to the overall health promoting behavior, and for health responsibility, nutrition and interpersonal relations subscales.

Discussion - This study shown the relationship of health literacy and health promotion behavior. These results provide evidence that there is still a proportion of limited health literacy among international college students in Taiwan and health literacy is a significant predictor of health related behavior. The results encourage efforts to monitor health literacy in the young population and evaluate its association with the engagement in health promotion behavior.

Keywords: Functional health literacy, health promotion behavior, international college students.