Association between echinococcosis-specific health literacy and behavioral intention to prevent echinococcosis among herdsmen on the Tibet Plateau in China

Abstract Background Echinococcosis is considered a neglected zoonotic disease. It has been an major worldwide health problem primarily affecting pastoral and poor rural communities with weak infrastructures, limited economic resources and poor sanitation. In general, the population in these poor areas has a low level of health literacy. This study aims to examine the association between echinococcosis-specific health literacy(ES-HL) and behavioral intention to prevent echinococcosis(BIPE) among herdsmen on the Tibet Plateauin in China. Methods A cross-sectional study of 401 Tibetan herdsmen was conducted in Gande country of Qinghai Province, China. Participants were recruited from August to September 2018 and from February to March 2019. A self-developed questionnaire was used to measure demographic information, ES-HL and BIPE. Hierarchical regression analysis was done to identify the factors associated with BIPE. Results In the hierarchical regression analysis, we entered age, sex, education level, marital state and family monthly income per capita into model 1 which explained a significant amount of variance in BIPE (Adjusted R 2 change = 0.029, P = 0.006), and sex(β= -0.125, P = 0.013) and family monthly income per capita(β= -0.133, P = 0.009) were found to be associated with BIPE. Then three factors of ES-HL was added to Model 1 to create Model 2. In Model 2, the two factors of ES-HL, perceived echinococcosis information support (β = 0.229, P < 0.001) and echinococcosis-specific self-management ability (β = 0.252, P < 0.001), were significantly associated with BIPE, while the information acquisition and evaluation ability factor (β = 0.093, P = 0.089) was not found to be associated with BIPE. The model improved significantly when ES-HL was included (Model 2) explaining 25.8% of variance of BIPE(Adjust R 2 change = 0.229, P < 0.001) Conclusions ES-HL is an important predictor of whether individuals take preventive actions against echinococcosis. ES-HL promotion action project should be developed aiming at different target population to enhance some of the specific abilities needed to prevent echinococcosis.