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

Yukyan Lam, Elena T. Broaddus, Pamela Surkan

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number95
JournalInternational Journal for Equity in Health
Volume12
Issue number1
DOIs
StatePublished - Dec 13 2013

Fingerprint

Nepal
Cross-Sectional Studies
Demography
Delivery of Health Care
Education
Decision Making
Literacy
Sexually Transmitted Diseases
Research
Health

Keywords

  • Agency
  • Care-seeking
  • Healthcare access
  • Healthcare decision-making
  • Literacy
  • Nepal
  • Social determinants of health
  • Social epidemiology
  • Women

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

@article{c4a0bba0e27441a294a6d7501ffeec61,
title = "Literacy and healthcare-seeking among women with low educational attainment: Analysis of cross-sectional data from the 2011 Nepal demographic and health survey",
abstract = "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.",
keywords = "Agency, Care-seeking, Healthcare access, Healthcare decision-making, Literacy, Nepal, Social determinants of health, Social epidemiology, Women",
author = "Yukyan Lam and Broaddus, {Elena T.} and Pamela Surkan",
year = "2013",
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language = "English (US)",
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journal = "International Journal for Equity in Health",
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TY - JOUR

T1 - Literacy and healthcare-seeking among women with low educational attainment

T2 - Analysis of cross-sectional data from the 2011 Nepal demographic and health survey

AU - Lam, Yukyan

AU - Broaddus, Elena T.

AU - Surkan, Pamela

PY - 2013/12/13

Y1 - 2013/12/13

N2 - 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.

AB - 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.

KW - Agency

KW - Care-seeking

KW - Healthcare access

KW - Healthcare decision-making

KW - Literacy

KW - Nepal

KW - Social determinants of health

KW - Social epidemiology

KW - Women

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