Literacy and healthcare-seeking among women with low educational attainment: analysis of cross-sectional data from the 2011 Nepal demographic and health survey

International Journal for Equity in Health

Pamela J Surkan²  Elena T Broaddus¹  Yukyan Lam² 

[1] Fulbright Student Research Program, United States Education Foundation, Gyaneshwor, GPO Box 380, Kathmandu, Nepal;Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E5527, Baltimore, MD 21205, USA

关键词: Social determinants of health;    Social epidemiology;    Healthcare access;    Care-seeking;    Healthcare decision-making;    Agency;    Women;    Literacy;    Nepal;   

Others  :  804300
DOI  :  10.1186/1475-9276-12-95

 received in 2013-07-08, accepted in 2013-12-01,  发布年份 2013

【 摘 要 】

Introduction

Research suggests that literacy plays a key role in mediating the relationship between formal education and care-seeking among women in developing countries. However, little research has examined literacy’s role independently from formal education. This differentiation is important, as literacy programs and formal schooling entail distinct intervention designs and resources, and may target different groups. To assess the relationship between literacy and healthcare-seeking among Nepali women of low educational attainment, we analyzed data from the 2011 Nepal Demographic and Health Survey (DHS).

Methods

From the 2011 Nepal DHS, our sample consisted of 7,020 women who had attained at most a primary school level of education, and a subsample of 4,875 women with no formal schooling whatsoever. We assessed associations between literacy and four healthcare-seeking outcomes: whether women identified “getting permission” as a barrier to accessing care; whether women identified “not wanting to go alone” as a barrier; whether among women who were married/partnered, the woman had some say in making decisions about her own health; and whether among women who experienced symptoms related to sexually-transmitted infections (STIs) in the past year, treatment was sought. We performed simple and multiple logistic regressions, which adjusted for several socio-demographic covariates.

Results

Literacy was associated with some aspects of healthcare-seeking, even after adjusting for socio-demographic covariates. Among women with no more than primary schooling, literate women’s odds of identifying “getting permission” as a barrier to healthcare were 23% less than illiterate women’s odds (p = 0.04). For married/partnered women, odds of having some say in making decisions related to their health were 37% higher (p = 0.002) in literate than illiterate women. Comparing literate to illiterate women in the subsample with no formal schooling, odds of reporting “getting permission” as a barrier were 35% lower (p = 0.01), odds of having a decision-making say were 57% higher (p < 0.001), and odds of having sought care for experiences of STI-related symptoms were 86% higher (p = 0.04).

Conclusions

Further research should be undertaken to determine whether targeted literacy programs for those past normal schooling age lead to improved healthcare-seeking among Nepali women with little or no formal education.

【 授权许可】

   
2013 Lam et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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