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

Research

Pamela J Surkan¹  Yukyan Lam¹  Elena T Broaddus² 

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

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

DOI  :  10.1186/1475-9276-12-95

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

来源: Springer

【 摘 要 】

IntroductionResearch 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).MethodsFrom 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.ResultsLiteracy 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).ConclusionsFurther 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】

CC BY   
© Lam et al.; licensee BioMed Central Ltd. 2013