Original Article

Health Literacy of Rural Population of Kazakhstan


Background: To date, there is no data available of health literacy of the population in Kazakhstan. This study was aimed to assess the health literacy of the rural population for the development of the targeted health education programs.

Methods: The adapted HLS-EU-Q47 survey was carried out among 1650 respondents aged 18-76 from rural settlements in Almaty region of Kazakhstan in 2013. The health literacy competences to assess, understand, appraise and apply health information on healthcare, disease prevention and health promotion were measured. The associations between the health literacy competencies and demographic and socio-economic characteristics were shown through a multiple linear regression analysis.

Results: The overall health literacy rate of the rural population of Almaty region was problematic and inadequate. With regards to their age, sex, social and economic characteristics, the health literacy competencies differ according to health literacy domain. Respondents with low education level or perceived social status had respectively low health literacy scores, especially in appraising and applying information of disease prevention.

Conclusion: Low educated people and with lower income have lower health literacy in comparison to respondents with higher education level and higher income. Respondents with higher health literacy have higher rate of self-assessed health.





1. Nielsen-Bohlman LPA, Kinding DA (2004). Health Literacy: A Prescription to End Confu-sion. Washington DC: The National Academies Press.
2. Nutbeam D (2000). Health literacy as a pub-lic health goal: a challenge for contempo-rary health education and communication strategies into the 21st century. Health Promotion International, 15(3):259-67.
3. Sorensen K, Van den Broucke S, Fullam J et al (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 12:80.
4. World Health organization (WHO). The WHO health promotion glossary (WHO/HPR/HEP/98.1). http://www.who.int/healthpromotion/about/HPG
5. Nutbeam D (2008). The evolving concept of health literacy. Soc Sci Med, 67:2072–78.
6. Lee SY, Tsai TI, Tsai YW, Kuo KN (2010). Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health, 10:614.
7. Paasche-Orlow MK, Parker RM, Gazmarari-an JA, Nielsen-Bohlman LT, Rudd RR (2005). The prevalence of limited health literacy. J Gen Intern Med, 20(2):175–184.
8. Rudd RE (2007). Health literacy skills of U.S. adults. Am J of Health Behav, 31(1):S8–18.
9. Schaeffer D, Berens EM, Vogt D (2017). Health Literacy in the German Popula-tion. Dtsch Arztebl Int,114(4):53-60.
10. Baker DW, Parker RM, Williams MV, Clark WS (1998). Health literacy and the risk of hospital admission. J Gen Intern Med, 13(12):791–8.
11. Baker DW, Gazmararian JA, Sudanoa J, Pat-tersond M (2000). The association be-tween age and health literacy among el-derly persons. J Gerontol B Psychol Sci Soc Sci, 55(6): 368–74.
12. Barber MN, Staples M, Osborne RH et al (2009). Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. Health Promot Int, 24(3):252–61.
13. Canadian Council on Learning. Health liter-acy in Canada: Initial results from the In-ternational Adult Literacy and Skills Sur-vey (2007). Ottawa.
14. HLS-EU Consortium: Comparative report of health literacy in eight EU member states. The European Health Literacy Survey HLS-EU. 2012.
15. Pelikan J (2014). Measuring comprehensive health literacy in general populations. The HLS-EU Instrument, Taipeh, 6.-8. Oct 2014.
16. Sorensen K, Pelikan J, Roethlin F et al (2015). Health literacy in Europe: com-parative results of the European health literacy survey (HLS-EU). Eur J Public Health, 25(6):1053–58.
17. van der Heide I, Rademakers J, Schipper M et al (2013). Health literacy of Dutch adults: a cross-sectional survey. BMC Pub-lic Health, 13:179.
18. Wang J, Schmid MR, Thombs BD (2014). The Swiss health literacy survey: devel-opment and psychometric properties of a multidimensional instrument to assess competencies for health. Health Expect, 17(3):396-417
19. Ishikawa H, Nomura K, Sato M, Yano E (2008). Developing a measure of com-municative and critical health literacy: a pi-lot study of Japanese office workers. Health Promot Int, 23(3):269–274.
20. Powers BJ, Trinh JV, Bosworth HB (2010). Can this patient read and understand written health information? JAMA, 304:76–84.
21. Jordan JE, Osborne RH, Buchbinder R (2011). Critical appraisal of health literacy indices revealed variable underlying con-structs, narrow content and psychometric weaknesses. J Clin Epidemiol, 64:366–79.
22. Sorensen K, Van den Broucke S, Pelikan J et al (2013). Measuring health literacy in populations: illuminating the design and development process of HLS-EU-Q. BMC Public Health, 13:948.
23. Suka M, Odajima T, Kasai M et al (2013). The 14-item health literacy scale for Japa-nese adults (HLS-14). Environ Health Prev, 18:407–415.
24. Alimbekova G, Zhusupova A (2013). Fea-tures of perceived social health of Ka-zakhstan residents in changing condi-tions of life. In: Health of the population and social changes in post-soviet states. Eds, P Bri-gadin M et al, pp. 156-92.
25. Alimbekova G, Shabdenova A (2013). Health of Kazakhstani population – quali-ty and responsibility. In: Health of the popu-lation and social changes in post-soviet states. Eds, Brigadin et al, pp. 192-229.
26. Baibosunova GS, Turdalieva BS (2015). Medical and hygienic literacy of residents of Almaty. Demographic, socio-economic and behavioural determinants. Bulletin of KazNMU, 4:681-682
27. Karakushikova AS, Toguzbaeva KK, Dzhusupov KO et al (2015). Scientific and methodical approaches to assessment of health of rural population of south region of Kazakhstan. Almaty.
28. Krejcie RV, Morgan DV (1970). Determin-ing Sample Size for Research Activities. Educ Psychol Meas, 30: 607-10.
29. Singh-Manoux A, Marmot MG, Adler NE (2005). Does subjective social status pre-dict health and change in health status better than objective status? Psychosom Med, 67(6):855–61.
30. Cronbach LJ (1951). Coefficient alpha and internal structure of tests. Psychometrika, 16:297–334.
31. Terwee CB, Bot SD, de Boer MR et al (2007). Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epid, 60:34–42.
32. Samra B, and Randles RH (1988). A test for correlation based on Kendall's tau. Communications in Statistics. Theory and Methods, 17:3191-3205.
33. Kazakhstan: WHO country profile. 2015. https://www.who.int/gho/countries/kaz/country_profiles/en/
34. Smailov AA (2011). Kazakhstan today: Statisti-cal proceeding. Astana: Statistics agency of the Republic of Kazakhstan. Astana, Ka-zakhstan.
35. Gazmararian JA, Baker DW, Williams MV et al (1999). Health literacy among Medicare enrollees in a managed care organization. JAMA, 281(6):545–51.
36. Rothman RL, Housam R, Weiss H et al (2006). Patient understanding of food la-bels: the role of literacy and numeracy. Am J Prev Med, 31(5):391–398.
IssueVol 49 No 7 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v49i7.3580
Health literacy Rural population; Kazakhstan

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How to Cite
SHAYAKHMETOV S, TOGUZBAYEVA K, ISMAILOVA A, TABIBI R, DERBISHALIEVA Z, DZHUSUPOV KO. Health Literacy of Rural Population of Kazakhstan. Iran J Public Health. 2020;49(7):1269-1277.