Topic: Research Report
Abstract
This study explored to find out relationship
between low literacy and low health outcome in Eltai, Jiwaka Province. The
study employed qualitative approach involved 10 participants (males and
females), purposely selected engaged in semi-structured interviews. Upon
analysis, the emerging themes were identified including; understanding importance
of education, health services utilization and lifestyles. The study generalizes
understanding on related factors like income, political decisions and economy.
The results identified the need of implementing literacy programs in meeting
NHP2011-2020 KRA7, and in-depth research into finding systematic constraints
impeding procurement of health and education services.
Key words: low literacy, Health Outcomes, Education
Table of Content
List of Tables
Table 1: Socio and demographic and demographic
characteristics of Participants……………………10
Table 2: factors showing relationship between low
literacy and health outcomes…………………..11
Table 3: showing themes and
subthemes…………………………………………………………………………………12
Table 4: showing Themes and
sub-themes………………………………………………………………………………13
Table 5: showing themes and
sub-themes……………………………………………………………………………….14
List of Abbreviation
DHMSD Department of Health Management and
System Development
DWU Divine Word University
DWUREB Divine Word University Research Ethical
Board
EC Ethical Committee
HI Health Information
HL Health Literacy
HMSD Health Management and System
Development
LHL Low Health Literacy
LHO Low Health Outcomes
HIV Human
Immunodeficiency Virus
NRI National Research Institution
NHP National Health Plan
PNG Papua New Guinea
QM Qualitative Method
ADB Asian Development Bank
VCT Voluntary Counselling and
Testing
Acknowledgement
Firstly, my sincere gratitude to Mr.
Marme, the principal supervisor and facilitator behind this research in providing
of lectures and tutorials that guided me through the research report process.
Secondly, my dearest thankyou to Ms. Semos for her utmost support in the development
of my research proposal. Thirdly, thankyou extends to DWU, FMHS Research Committee
for granting the ethical clearance for me to conduct my research. Fourthly, my appreciation
extends to my Ward Councilor for giving me the permission to carry out my research
in Eltai area. Sixthly, my sincere acknowledgement to Ms. Vicky Kama and John
Doa for their overwhelming financial support. Finally, biggest gratitude to all
individual participants who have shown interest by taking part in this
research.
Declaration
I, Paias DOA, hereby
declare that this work has not previously been submitted for a degree or
diploma in any university. To the best of my knowledge, the research contains
no material previously published by any other person except where due reference
is made in the research itself.
Signature
Chapter1: Introduction
Low literacy is a situation where
a person is unable to comprehend valuable information using reasoning and
analytical skills (Katrina, 2017). From health standpoint, means lack of
knowledge to understand valuable health information such as labels, referral notes,
posters and programs like family planning, immunization, healthy lifestyles and
family management skills, that contributes to low health outcomes (Nancy, 2013).
According to
Gilbert et al (2018), Literacy
is linked to life expectancy through heath. Those with low levels of literacy
are more likely to have poor health. Low health literacy and engage in harmful
behaviors, putting them at higher risk of living a shorter life. Low literacy
is a growing concern in PNG in rural areas. Adult
and youth literacy rates in PNG are one of the lowest in the region, with
literacy levels among women lower than those of men (ADB, 2010). Thus illiteracy outcome
has many implications on individual, and on wider level such as shortage of
skilled human capital, poor and unequal access to affordable and quality Health
and education services (ADB, 2010).
According
to NRI (2014), about 70 percent of population are illiterate, and most of them
are from rural settings. On international scale, PNG is ranked low with 64.2
percentage of illiteracy (UNESCO, 2015). PNG has one of the highest portion
of illiteracy level with 28% found less knowledgeable by not attempting to use
contraceptive methods (World Bank, 2013). Disparities between urban and rural
areas remains significant, and Highlands and Momase regions tend to report poorer
health outcomes than other regions (ADB report, 2010). Low literate people lack
essential life skills and knowledge base to better manage themselves and their
families (Kanj & Mitics, 2009).
1.3.
Significance
The
study undertaken has three significances. First it attempted to understand
current prevalence of low literacy and health outcomes. Secondly it involved creation
of new knowledge that will provide basis to seek funds necessary to deliver
health literacy programs in Jiwaka. Finally, research outcome will contribute
towards realization of NHP 2011-2020 KRA7.
What are the impacts of low
literacy having on health outcomes?
To
find out the impact of relationship between low literacy and low health
outcomes.
1. To
investigate relationship between low literacy and health outcomes.
2. To
investigate factors associated with low literacy that cause people to have low
health outcomes.
Chapter 2: Literature Review
2.1. Introduction
Low literacy is foreseen in determination of poor
health decisions, leading to poor health outcomes. According to Michael et al (2005), low
literacy is defined as inability to read, write, and use of numbers
effectively, is common and is associated with a wide range of adverse health
outcomes. However, Kanj and Mitic (2009) argue that in order to be health
literate is through education, as it plays major role in building and shaping
mindset of individual. Both health and education has greater connection that
reflect on person’s health outcome, collectively known as Heath Literacy.
2.2. Thematic analysis
The relationship between low literacy and low health
outcome are discussed under three themes as follows.
According to Doumbia (2013), education is an
important element that gives people knowledge of the world around them and
changes it into something better. It develops in them a perspective of looking
and having opinions at life (Doumbia, 2013). Doumbia also stressed that without
education people would not be able to read, write, calculate or communicate, and
perform jobs competently and accurately. Davey etal (1998), supports that
education is a major denominator that contributes to socioeconomic status that
affect morality and other health outcomes. They further emphasized that child/adult
education is the foundation/baseline factor for human development. However,
Doumbia (2013) argue that ability for adult/children to attain education is
determined by their socioeconomic level.
Education comes in two basic forms known as numeracy
and literacy. However, literacy being an overarching factor that enable person
to capitalize on numeracy skills and forms a mediation between education and
health comes (Schillinger etal, 2006). Kanj and Mitic (2009) maintained that health
literacy converges people from both health and literacy fields to have
collective knowledge for everyday living. The level of literacy affects the ability
to not only act on health information but to take control of our health (Kanj
& Mitic,2009).
2.2.2 Poor utilization of health care services/programs
According to Word Vision (2013), some people with no
education have insufficient knowledge on how to have access to essential health
information. Most people in rural areas of highlands region in PNG have limited
knowledge on diseases like HIV & TB are transmitted and appropriate
treatment methods (World Vision, 2013). Barry and Raymond (2004), low literacy
is associated with higher health care charges. It means patient with low
literacy doesn’t know where and how to get right/affordable treatment. However,
Berkman (2009) contrasted that low literate people have difficulty in comprehending
medical information like referral, prescriptions notes and medical results. Kolodziejczyk
(2014) argued that low literacy coincides with cultural and religious believes
where younger people find it difficult in accessing information regarding family
planning.
Researches have shown that poor health literacy is
frequent among low literate patients with chronic medical conditions such as
diabetes, asthma, and hypertension (Schillinger et al, 2000). They further
argued that there will be disparities between health care practices and health
outcomes when literacy issues aren’t adequately addressed. That means people
continue to remain less knowledgeable about best practices of health. However,
to receive health services, and being aware of services availability is through
knowledge gained in literacy (Nancy, 2011). She supported that literacy provides
set of skills needed to function effectively in health care environment and
place of survival. It means having right knowledge in making health care
decisions for locating and interpreting medical information.
2.2.3 Lifestyles
According to David (2005), literacy and health
established connection that enable people to learn and develop their working
broader life skills such as confidence and sociality. These skills promote
economic growth at societal level via increased productivity, and better
governance. Thus, some decisions that he/she makes add practical advantage to lifestyles,
including dietary control, budgeting, in-house arrangement and awareness of
health services availability (Katrina, 2017). Kanj & Mitics (2009), supported that level
of literacy directly affects the ability to take control of own health and family.
They further generalized that literacy helps in choosing healthy lifestyle,
knowing how to seek medical care, and taking advantage of preventive measures.
Contrarily,
Ballard, Charlotte and Neumann (1995) signifies that
children with low literate parents are identified as risk factors for acute
respiratory infections. They emphasized that low literate parents increase problem
of mild malnutrition and household crowding. Moreover, Sánchez et al (1995) generalized
that low literate mothers in developing countries are directly linked to low
child health and mortality. UNESCO report (2015), there are 40.3% and 49.5 % of
women and males respectively are literate in PNG. Thus reflect existence of
unequal distribution of literacy among gender (Sukthankar, 2006). Kolodziejczyk
(2014) compared that adult literacy rates vary throughout the country, being
considerably lower in highlands region affecting life expectancies and living
conditions of people. Thus also shaped by cultural perspective where younger
people find it difficult in accessing information about HIV & AIDS, family
planning, and STIs.
Therefore, Hemming and Langille (2006) recommended that relationship of literacy
and health should be accounted in policy frameworks to disperse myths, reduce
stigma and empower disadvantaged population in remote settings to progress in life.
The
relationship between low literacy and low health outcome is identified by many
authors from overseas (developed and developing nations). However, in PNG, the
in-depth research was very minimal. The few broad reports published by health
and education were inadequately capturing current situations of education and
health outcomes in rural areas. These reports merely account provincial
statistics for illiteracy. Thus,
Jiwaka ranked 16th out of 23 provinces for illiteracy and 2nd
in HIV & AIDS prevalence. Ever since, there hasn’t been profound study
employed exploring low literacy and health outcome in Jiwaka, therefore reflect
a gap that this study will fit in.
Chapter 3: Study Design and Methodology
3.1. Research design
The study involved
cross sectional study design. According to Kirwan & Barratt (2009) cross-sectional
studies provide snapshot of health problem or health related characteristics of
a population. The study design linked practical attitudes and behavioral
implications based on individual’s epidemiological situation to answer main
research question.
3.2. Setting
Eltai
is located in Anglimp LLG in Jiwaka Province. It has growing population of 1700
(National Census, 2011). The population is unevenly distributed with younger
and middle aged are dominated. Melpa language is widely spoken. Almost 75% of
population are heavily engaging in subsistence farming while few engage in
running trade stores and PMV’s. The health center and primary school are
located few miles away, but are not functioning effectively, sometimes closes
for indefinite periods due to shortage of funding support, staffs and medicines.
3.3. Sampling
The
study engaged 10 participants were un-randomly selected using purposive sampling
method to explore their practical experiences and perception of low literacy
and health outcomes. The selection of 10 participants included permanent
residences (married & above 18 years), while excluded seasonal/temporary
residences because they are unfamiliar to operational aspects of Eltai.
3.4. Recruitment strategies
The
researcher sought formal approval from ward councilor and elite members of
Eltai after understanding overall purpose of the study. The councilor advocate
to community member through community gatherings so that they were aware of the
research. The researcher sought permissions from few participants by having
their contacts so that they are contacted to confirm their availability.
3.5. Research techniques/Method
The
method of data collection involved qualitative approach. The qualitative
approach engaged open ended interviews. The selection of qualitative method is
determined by research question and literature review.
3.6. Materials
The
study involved semi-structured interview questionnaires. The interviews were recorded
using audio recorder including field notes.
3.7. Data management
All
data collected were handled according to DWU Guidelines. All interviews were
digitally recorded and backed up onto personal computer file protected by password.
Interviews and field notes were transcribed into Microsoft word. In one folder,
sub files were created for individual participants for easy retrieval. Also files
are named according to participant’s ID. Copies of the files were securely
stored in different location in my computer and external drive. The raw data
will be destroyed after study is complete.
3.8. Data Analysis
The
original texts were read widely with view of getting general understanding of
everyday experiences of literacy and health outcomes. Short summary of each
interviews of main idea and lesson learnt were compiled. The relevant
transcripts are grouped according to six research questions. The researcher
reread each transcripts line by line to identify codes, sub-themes and
overarching themes. The researcher constantly checked to confirm the emerging
themes. The principal supervisor was consulted couple of times for confirmation
on interpretations. Grouping themes under 3 major categories involved
generation of conclusions and recommendations. Quotes are used to describe
major and sub themes emerging from transcripts.
3.7. Ethical Consideration
The
ethical clearance from DWU Research Committee was granted as fulfillment of
research protocol in DWU under FMHS. The ethical clearance attached with
participant consent form were handed to each participants to be read and
signed. Because this study involved human being as core subject, their natural
rights were uncompromised under any circumstances.
3.8. Rigor/validity
According to Robert P
et al (2006) stated that rigor and validity are ways to demonstrate trustworthiness
and reliability in research. All researches are prone to criticisms. I have
used thematic analysis to analyze my findings by closely following necessary
steps involved. My results are checked by participants to ensure raw data are
consistence with the interpretations.
Chapter 4: Findings
4.1. Sociodemographic characteristics of participants
Table 1: Social and demographic characteristics of participants
The
sociodemographic information of participants provide generalized view of how
prevalence of education and health factors are distributed among general
population. The study consists 10 participants (5 males and 5 females). The
majority of participants are aged between 36 and 55. Two participants are
working in formal sectors while majority are subsistence farmers. The causes
and effects of low literacy and low health outcomes emerges at family involving
husband and wife. Technically, occupations and qualifications of each companions
create balance platforms to progress positively. However, imbalance trend
occurs when one partner is educated while another is uneducated or both are
uneducated resulting
in unequal access to education including households’ inability to afford school
fees (ADB, 2010).
According
to Richard et
al (2018), emphasize that one’s ability to receive, decode, and understand
information is important for performing or learning/finding of jobs.
This practice is inevitable in distribution of jobs. However, according to WHO (2009)
unemployment closes the gap of finding decent jobs by putting people at greater
risk of contracting TB and other diseases. However, issues of unemployment are contributed
by external situations like political and economic decisions. Therefore, some educated people practice
self-sustaining activities like agriculture excelled more than uneducated
counterparts. According to Richard et al (2018), farmers with reasonable
education level tended to adopt productive innovations than farmers with little
education. Thus cause dramatic differences in morbidity and mortality. These
issues are expressed in following excerpts.
Participant 01:
“Yes, I’m educated so I know about cleanliness
and applying of prevention measures. Cleanliness is important, however when I
don’t responsible with dirties/rubbish will cause disease-malaria/typhoid/pneumonia.”
Participant 03:
“I
know that education contributes to my health. However, Low level of my
education I am regretting of some things like bearing of children, family needs
and school fee problems because if I made further to higher level and get
employed will have sufficient money to look after my family’s overall health
& wellbeing.”
Viji
(2018) emphasized that education creates equality and eliminate discrimination.
It gives knowledge that constitute theoretical and practical understanding of a
subject. Empirically, studies applauded about connection between education,
income status and employment opportunity affect health outcomes.
4.2. Education
4.2.1. Understanding importance of education
Understanding
importance of education is starting to knowing values and attributes of social
and human developments. Education becomes as part of strategy of economic
development, national and international competition, and of socialization to
the beliefs of limited population (Egan, 1998). Smith etal (1998), embraced
that education contributes to socioeconomic status among diversified cultural
and social hierarchies. However, Doumbia (2013) argue that in order for adult
or children to attain education is closely determined by socioeconomic aspects.
Participant 01:
“Yes, I think education is important to
cope up with changes in all facets. Through education we can manage our
lifestyles by way of having control measures from getting sickness. When going
to hospital, we can know where and how to get right treatment and to
communicate with doctors/clinicians confidently.”
Participant 03:
“I value education because it helps me to
earn income to pay hospital/educational costs for my family, and manage daily
lifestyles.”
4.2.2. Not understanding importance of Education
However,
opposite happens when people don’t understand importance of education at first
glance. Viji (2018) stated that not-understanding education is caused by
illiteracy because Illiteracy is the bane for any societies. In this study few
participants didn’t value education when they were young. They didn’t perceive
what education owes for them in the future because their parents never realized
how helpful and best practice to send them to pursue in education.
Participant 04:
“I don’t know about education but I went
to school to as far as standard two”.
Participant 05: “I don’t understand education and health better.”
Participant 07: “I don’t know what education
was, and its connection with health.”
Participant 08: “My parents didn’t go to
any school so they didn’t push me to further my studies. When I failed in grade
10, they arranged a wife for me.”
Participant 09: “I never been taught about importance of education
when I was child.”
Their
responses give notions that having capacity to understand education was unevenly
distributed. People were deeply rooted in their cultural practices like
clansmen and tribalism that engulfed their society’s fame. Thus badly
manipulated their mind to un-digest few teachings and educational awareness
procured by early missionaries. Their behaviors were catastrophically limited
to their basic understandings.
4.3. Utilization of health services/programs
Education
is greatest determinant shaping people’s mindset to perceive relevance of
health. The technique to understand health better is the capacity of knowledge
attained in education. According to ADB (2010), poor and unequal access to healthcare
is a critical constraint to reducing poverty and inequality, as the resulting
poor health can prevent people from accessing economic opportunities. However, understanding
health information and having sufficient funds motivates individual to access
health services. Regardless of availability of health services, the power to
bring themselves to access services are paramount. However, in this study, most
participants with no educational background find it difficult to utilize
available health care services at health Facilities-Hospitals. The distance to
access these services is not a critical issue, but the problem lies with capacity
to understand and assess health needs in line with available health services.
The
participant’s attitude and behaviors towards utilization of health services
shows that there is knowledge gap in bridging patients to have fair ideas on
how and where to get essential medical treatments.
Participant 04. “When I feel sick, I never go to any health care
facility, I stay at home assuming that sick will finish somehow. Sometimes I
ask neighbors for unused medicines.”
Participant 05: “When kids get sick, I don’t have enough money to
access hospital so I boil grasses or make steam bathe to cure them. I quitted
going to hospital because I don’t properly understand nurses speak, and
sometimes I get embarrassed by their harsh treatments.”
Participant 06: “I don’t know types of services provided including
prescription notes so I only go to hospital only when having feeling badly
ill.”
Participant 09: “I don’t go to any hospital because they charge
fees. Also I fear talking with nurses. Even I can’t swallow medicine because it
smells bad”.
Their
responses entail understanding that having relevant health information about medical
services and procedure gives utilization power. Contrarily, participants with
certain education level value and understand accessing health care services.
When in dire need of health, they urgently adhere to health facilities. These
practices are stated in following excerpts;
Participant 08:
“Yes, I understand better on how and
where to get treatment. When sick, we normally go to clinic first. When they
assess that my sickness is bigger, they refer us to Mt. Hagen or Kudjip
hospital”.
Participant 10: “I fully know types
and qualities of services provided at each health facilities. For instance, my
family normally go to Kudjip because they offer quality health care services.
When badly ill, I go straight to emergency ward, but for normal sick, I follow
usual process of outpatients.”
4.4. Lifestyles
Human
beings behave uniquely to certain stimulus arising from within the settings or
external. However, their practical implications of daily practices are gauged
by level of knowledge attained in education. The daily lifestyles significantly
contribute to health outcomes. According to David (2005), education and health
established connection that enable individuals to learn, develop their working
and broader life skills such as confidence and sociality. The education
provides individual platforms to think and direct their actions in line to produce
better results (David, 2005). The lifestyle involves basic things that people do
to have better living like eating good foods, family budgets, home management
and family planning. However,
participants with no educational attainment live poor lifestyles as expressed
in following excerpts:
Participant 05:
“When I do much work in the garden, I experience
back pain. I don’t eat much food. Betel-nut and smoke I rate them as my main
food”.
Participant 07: “I eat anything I
feel it’s good to strengthen my body. I never select any food to eat. Whatever
that is something to eat, I just eat it I never know the type of food I eat that
could affect my health. I hear people talk about budget but I don’t budget.
Whatever I earn, I spend anyhow daily”.
Participant 09:
“I never understand family planning. I
hear people mention that but when my wife tells me something about family
planning, I bash her up because I feel it’s against Christian believes. I
therefore warn her not to hear cunning words from health workers or close
relatives”.
In
contrast, study shows few people experiencing effective lifestyles because they
understand concepts of managing their own life and family. They priorities in
areas like food, family budgets and health care needs so that they live in
healthy conditions that has low health risks. The following are stated in excerpts;
Participant 01: “My daily lifestyle affects my health, but depends
on how I manage it. We are living in village so we make hands meet by budgeting
our time wisely by doing subsistence farming. We plant foods crops like pawpaw,
banana, vegetables and sugar-cane that we often sell at local markets but many are
eaten in our daily meals. From crops
sales, we purchase protein foods so that we eat three meals a day, almost 5
times a week”.
Participant 02: “I practice healthy
lifestyles by not doing excessive physical work, keeping my home clean at all
times and eating healthy foods every day”.
Participant 03: “I budget ample money
for health so when sick, we use that money to pay for hospital costs. We
beautify our home and always keep things in order at all times”.
Participant 06: “We eat balanced food
every day. However, I never went to bigger school to get employed to bigger
position but little knowledge I have I do farming like cropping and piggery. Sometimes
I feel hard to move freely because of back pain and blistered fingers, I visit hospital
for medication.”
Basing
on these contrasting views, it provides understanding that education foster good
lifestyles. It gives world view and basic understanding to manage daily
lifestyles better to survive through any unfavorable situations.
Chapter 5: Discussion and Conclusion
5.1. Discussion
This
report demonstrates how issues of literacy and health affect individuals in
Eltai. It reflects low literacy as determinant of health. Thus gives notion
that low literacy is an existing problem encountered in rural areas of
PNG. However, the presentation of the
results only coming from ten participants widely representing the overall
population of Eltai. It only involved 10 participants because of limitations
like time, finance and participant’s willingness. Despite limitations, participant’s responses
are consistent with other studies, and comprehensively answering study aim and
objectives. The results provide a basis for further studies in identifying
systematic constraints complicating procurement of literacy programs.
5.1.1. Education
5.1.1.1. Understanding importance
of Education
The
participant’s responses have demonstrated mixed views but are representational
of their level of educational attainments. From respondent’s standpoint, it
gives a view that valuing and understanding the importance education is
determined by fundamental knowledge attained in education. However, half of
participants are un-educated so they lack knowledge. The practice of valuing
education enforces accessing education by way of practically attending or
sending children to get quality employment that will improve lifestyles and
foster positive developments at family and community level. According to Davey et al, (1998), education
provides guidance and enable person to understand fullness of life and the
world around. From study, participants perceive that when educated to higher
level, they would live a decent life such as living in good house, eating
quality foods and accessing quality medical services.
When
sick, unhesitatingly they’ll access health care facility as quick as possible
for full medication. Thus a direct reflection of positive image of good
socioeconomic level brought by education. Davey Smith at el (1998) confirmed
that education contributes to socioeconomic level. Contrarily, the clear
responses grappled from uneducated participants reflect their lack of understanding
about education. It means they have insufficient knowledge to understand, and even
properly explain education in simpler scope. Their responses were vague making
it very difficult to capture their inner feelings. Therefore, if they cannot rationalize
education, it’d be complicated for them to correlate education with factor like
health.
5.1.1.2. Relationship between health and education
When
fully understanding core advantages and practical implications of education,
it’ll be easy to know health better. The outcome of heath practices is determined
by education level/number of literacy programs attended. According to Emily,
Steven, and Haley (2017), education is critical to social and economic
development and has profound impact on population health. They further
emphasized that disparities in health outcomes caused unequal access to
educational resources.
Zainab et al (2017), simplified that educated
participants have better knowledge and understanding about HIV & AIDs.
In
this study, uneducated participants lack basic knowledge on diseases prevalence
by unknowingly involved in practices that alters their health. Contrarily, participants
with certain qualifications are more likely to learn and practice healthy
behaviors. Thus, educated participants are more-able to understand their health
needs, follow instructions, advocate for themselves and their families, and
communicate effectively with health providers. The Adults with higher educational
attainment live healthier and longer than less educated peers (Anna & Lawrence,
2018). Therefore, there are common boundaries between low educated and higher
educated people.
5.1.2. Utilization of health services
The utilization of health service is the only mean to be medicated, and
protected from unhealthy practices and disease outbreaks. Utilization bonds
with accessibility and availability of health care service. When there is
availability, it provides opportunity to utilize. However, Sellars
(2018), emphasized that one factor that perpetuate negative health outcomes is
lack of utilization of health services. However, he argued that individuals are
less likely to use health services due to lack of insurance coverage and cultural
beliefs. The cultural beliefs discourage trusts between health care providers
and care receivers.
According
to Word Vision (2013), some people with no education have insufficient
knowledge on how and where to have access to essential health services. The
study reflects that some participants don’t access health care services. When
they feel sick or in need of medical help, they never go to any nearby health
facilities but manage to stay at home thinking that their sickness will be
healed naturally. Even though some participants go to health facility for
medical treatment, they never understand health information such as
prescription notes, referral notes and consultation times. Few said they cannot
present their views confidently to the clinical worker because they afraid as they
might get hard or scare them. They never go for medical checkup for same
episode of the illness. This confirms Berkman (2009) studies regarding people
with low education/literacy encountering difficulties in comprehend and
accessing medical services and information. From study, few males restrict
their wives to access maternal health services because they believe it’s
against common beliefs thus might result in issues of not baring more children.
Thus reflect unequal understanding and utilization of health care services in Eltai.
5.1.3. Lifestyles
Having
manageable and conducive lifestyle characterized by comprehensive knowledge and
skills learnt from mainstream education and skills development programs. However, low literacy level affect living
condition by putting greater pressure on family health outcomes. Ballard, Charlotte and Neumann (1995) stated that
chidren whose parents are low literate are more likely to contract respiratory
diseases, and cause problem of malnutrition and household crouding that
increase mortality issue (Tubeuf & Bricard, 2017). In this study household
arrangement and overcrowding is a problem where families have large family, are
ineffectively spaced living in disorganized homes.
The
study shows that most participants don’t make practical decisions like having
concrete dietary controls, budgets and home arrangements. Choosing healthy
lifestyles like knowing how to seek medical care and procuring of healthy
practices are attached with literate people (Talos
2016). However, this current situation poses greater threat to the community’s
future because it lies in the hands of these couples. However, their mind is
not opened up to acquire new concepts and ideas to transform their livelihood. Thus
will affect community’s functions because individual people are the viable units
framing the community setting. Contrarily, study outline clear boundaries between educated
and uneducated people where educated people understand and put into practice
good living lifestyles like enforcing disciplines that guides their social and
medical behaviors.
5.2. Conclusion and Recommendation
Understanding
the contextual framework of relationship between low literacy and low health
outcomes is essential for piloting community based literacy-education programs.
The prevalence of low literacy and low health outcomes are long standing issue
encountered in rural areas of PNG. The process of attaining educational
qualification is grossly determined by socioeconomic status, environment,
political and economic decisions tabled at national and international levels. However,
these factors fall under underlying and overarching factors conceptualizing the
episode of literacy and low health outcomes. The findings generated in this
study are of great importance in enhancing and maximizing knowledge, and
locally contributing to the realization of KRA 7 of NHP 2011-2020. The study
identifies great need of implementing health literacy programs integrating with
educational programs by providing basic knowledge to many illiterate people. Also
there is a greater need for further research in investigating systematic
constraints that impede procurement of health literacy and educational services
in rural areas. In addition, in order to achieve KRA7, the assessment and
reflection research should be carried out in all rural areas to justify trends
of socioeconomic and epidemiological situation.
Chapter 6: Reference
Anna,
Z. et al (2018) The Relationship Between Education and Health:
Reducing
Disparities Through a Contextual Approach. Retrieved May 10th 2018
from
Ballard, T. Charlotte, G & Neumann, M.
(1995). The effects of Malnutrition, Parental literacy and Household Crowding
on Acute respiratory Infections in Young Kenyan Children. Journal of Trop
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Chapter 7: Appendices
Table 2: The themes showing relationship
between low literacy and low health outcomes
Key
themes
|
Sub-themes
|
Education
|
1.
Understanding the importance of Education
2.
Not understanding the importance of
education
3.
Relationship of health and education
|
Utilization
of health services
|
1. Poor
and Good utilization of health care services
|
Lifestyles
|
1. Poor
lifestyles and Good lifest\yle
|
Question
1: Can you explain how your level of education contributes to health?
Table
3: showing themes and sub-themes
Participant
ID
|
Code
(key word or phrase)
|
Theme
(Main Idea or concept)
|
01
|
I
think education contributes to my Health. Through education, I am informed
about cleanliness, prevention and curative methods
|
Understanding
importance of education
|
02
|
Health
and Education are related that will guide us to know where and how to get
medical treatments and having healthy practices to live good life
|
Understanding
importance of education, and its relationship with health
|
03
|
Low
level of my education affect my health
|
Understanding
importance of education
|
04
|
I
don’t understand health and education because I never went to school
|
Not
understanding relationship between Health and Education
|
05
|
I
don’t know about health and education
|
Not
understanding importance of education and health
|
06
|
Through
Education I get employed where I have money to pay for my medical expenses
and family needs
|
Understanding
importance of education
|
07
|
I
don’t understand
|
Not
understanding importance of education
|
08
|
Education
will pave ways for me to get right medical treatment and prevent from getting
sick by doing healthy practices
|
Understanding
importance of education
|
09
|
I
have no idea or clue about education and health because I dropped out at
standard two
|
Not
understanding health and Education
|
10
|
I
been educated to college level where I know that education connects with
health. From my knowledge I always do rational decisions for myself and
family in terms of health, finances and others
|
Understanding
importance of education
|
Question 2: Can you tell me about your
daily lifestyles that affect your health? For example; type of food you eat,
type of work you do and amount of income you earn.
Table:
4 showing codes and themes
Participant ID
|
Code
|
Theme
|
01
|
High
Level of education proven reliable in my lifestyles. I budget my time and
money by doing worthwhile things like working to get money to live good life
|
Good
lifestyles
|
02
|
Through
education, I know what to eat and minimize doing excessive physical work to
stay healthy. I eat balance meal every day
|
Good
lifestyle
|
03
|
The
little income earned from farming, I budget it for health care costs and
food. However, I sometimes work in rainy condition that affect my health, I
go to hospitals thereafter.
|
Good
lifestyles
|
04
|
I
don’t know the type of food we eat. When we are hungry we just eat any food
and later we realized that we get sick. We always fall short of money to
cater for food and other needs
|
Poor
lifestyles
|
05
|
When
I do much work in the garden, I experience back pain. I don’t even eat much
food. Betel-nut and smoke I rate them as my main food. I never understand a
person before talking with them
|
Poor
lifestyles
|
06
|
I
eat all three food groups every day. I have grade ten qualifications so I resort
to farming to earn my living
|
Lifestyles
|
07
|
I
just eat anything I feel it’s good to strengthen my body. I never select any
food or whatever to eat that can affect my health. I don’t do budgets and
even talk with and spend time with people unnecessarily.
|
Poor
lifestyles
|
08
|
My
parents arranged my marriage when I failed in Grade 10. However, my knowledge
helps me to manage my family in terms finance, behavior, social relationships
and others
|
Good
lifestyles
|
09
|
I
don’t know the type of food we eat. I never budget my money. Also I
discourage my wife to use family planning because it is against cultural and
religious belief.
|
Lack
of understanding
Poor
lifestyle
|
10
|
I
eat balance meal every day. I clean my home regularly and keep things in
order. Also prohibit my mum and wife from doing more physical work as it
might make them feel sick.
|
Good
lifestyle
|
Question 3: What are/is your
understanding on types and utilization of health care service like family
planning, contraceptive methods, STIs and HIV & AIDs awareness, malaria
prevention programs, TB interventions programs, and basic process and health
care services provided at health facilities?
Table
5: showing codes and themes
Participant
ID
|
Code
(key word or phrase)
|
Theme
(main idea/concept
|
01
|
I
discourage having many kids so me and my wife practice family planning so
that family needs are met with scares resources. Using contraceptive methods
prevent from getting HIV & AIDs and STIs.
I also discourage my kids from involving in unsafe sex practices might
destroy their health. When sick we always go to hospital to get best
treatments.
|
Utilization
of health care services
|
02
|
I
see health programs like HIV & AIDs, TB, family planning and others
equally important. Me and wife access whenever we need it. We discuss about
this on many occasions.
|
Utilization
of health services
|
03
|
I
understand that health programs are good for health especially a mother like
me so that I know how to manage my life
|
Utilization
of health programs
|
04
|
I
don’t know about family planning methods; I never use any of these or even
make an attempt to
|
Poor
utilization of health services
|
05
|
I
don’t attend to utilize these services. When I come across awareness like HIV
and family planning methods, I feel shame mostly words they speak.
|
No
utilization of heath care programs
|
06
|
I
witness few awareness like family planning but I never practice because my
husband doesn’t want it. He is so stubborn because he never went to any
school. When I wanted to discuss anything about that, he stop me completely
from talking further.
|
No
utilization of health care program
|
07
|
I
never understand doctors/nurses communicate. I feel embarrassed when they say
something about our sexual organs. Besides, the nurses are too harsh on me,
and not even treat me with respect. Also I never read labels or prescriptions
notes so doesn’t consume the prescribed medicines.
|
Lack
of understanding leads to poor utilization health care services
|
08
|
I
always go to hospital for treatments. I complete medications on time that are
prescribed
|
Good
utilization of health care services
|
09
|
I
don’t go to any hospitals because they charge fees. I fear talking with
nurses and doctors. Also I can’t swallow medicine because its smell bad
|
Poor
utilization of health care services
|
10
|
I
am informed on all health care services provided and process involved in
getting full medical help.
|
Utilization
of health care services
|
