Exploring the development of a household cholera-focused healthliteracy scale in James Town, Accra

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Foodborne diseases are significant reasons for in-patient and out-patient morbidity in Ghana.Of the foodborne illnesses reported in the country, cholera incidence and outbreaks have resulted in food-related mortality since the disease was first reported in the 1970s. Cholera is now endemic in the country.This study attempts to develop and pilot a tool to measure household health literacy among the urbanpoor in James Town, a cholera endemic neighborhood.Methods: A survey questionnaire was developed based on four of the World Health Organization’s (WHO)recommendations on issues for measurement of health literacy in low- and middle-income countries.The instrument was administered to 401 households in the community. We undertook reliability andvalidity analyses. T-test, Kruskal Wallis test, and Mann–Whitney test were used to examine the associ-ation between the health literacy scores of the scale and subscales and the demographic characteristicsof households.Results: The reliability analyses showed that the instrument was internally consistent (Cronbachalpha = 0.762). All the subscales were reliable except the beliefs about health and healthcare subscale.Based on content and construct validity analyses, 13 items were used for further examination of healthliteracy. We found that majority of households know about the information, education, and communi-cation materials and 52% of households indicated that these materials remind them about the dangers ofcholera. About 39% of the households decide together as a unit on steps to avoid getting cholera duringan outbreak. Overall health literacy scores and the subscales were significantly associated with sex, age,marital status, and educational level of household head. Specifically, females, being married, increasingage and higher household income had a significant association with higher health literacy scores.Conclusion: Household units in James Town impacts individual health literacy through: family discus-sions; access to information, education, and communication materials on cholera; and intentional effortsmade to get information on cholera risk factors.
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Cholera, Health literacy, Household health, Food borne diseases, Infections