Health literacy mediating the association between health information sources and oral health knowledge among Palestinian adolescent refugees: a cross-sectional study.

Background: Oral health diseases pose a major global and public health problem. Access to trusted sources of information might be pivotal for improving health knowledge levels. Health knowledge can be considered a consequence of having or lacking the appropriate health literacy skills. This study identified the association between the number of health information sources and oral health knowledge (OHK) mediated by health literacy.

Methods: This cross-sectional household survey targeted Palestinian adolescent refugees in Ramallah and Al-Bireh District of the West Bank, Palestine. We measured OHK using seven questions about basic oral and dental health information. We used the Arabic Health Literacy Assessment Scale for Adolescents to measure health literacy levels. We also asked the adolescents to report their sources of health information. We conducted a mediation analysis using Process Macro for SPSS.

Results: This study included 300 adolescents who live in Ramallah and Al Bireh refugee camps. Among family members, adolescents mainly consulted their parents for health information, with 86.3% seeking health information from their mothers and 66.3% from their fathers. Out of seven questions, the mean number of correct answers for the OHK scale was 5.7 (Standard Deviation [SD]1.0). The association between the number of health information sources and OHK was fully mediated by communication health literacy (significant indirect effect: 0.0203, 95% Confidence Interval [CI]: 0.007 to 0.037, and insignificant direct effect β = 0.0267, p = 0.15). This association was partially mediated by functional health literacy (significant indirect effect: -0.008, 95%CI: -0.0173 to -0.0018, and significant direct effect β = 0.0536, p = 0.003).

Conclusion: Different types of health literacy can mediate the association between the number of health information sources and OHK. Functional health literacy is necessary to gain knowledge from multiple sources, but it is insufficient. High communication health literacy fully mediated this association. Strengthening communication skills in the context of health would be highly required to effectively transform accessed information into gained knowledge.