The effectiveness of health literacy program to reduce alcohol use among medical students in Hubei province, China

Abstract

Alcohol use has been identified as the health behavior most strongly associated with substance dependence and an increased risk of chronic disease in adulthood. Also, in China, alcohol consumption among medical students is a serious public health problem. Health literacy (HL) plays an important role in health-risk behaviors such as alcohol drinking. Individuals who have inadequate HL are a barrier to reducing the risk of alcohol and might lead to alcohol dependence, poor treatment outcomes, and relapsing. This mixed-methods research was separated into two phases. In phase 1, we aimed to assess the health literacy level and explore factors related to alcohol use among medical students in vocational colleges, the social norms of alcohol use, the experiences of stopping or reducing alcohol consumption, and the effect of alcohol use, utilizing a cross-sectional design. In the quantitative method, the sample consisted of 1146 medical students and 15 key informants (e.g., medical students with a habit of drinking alcohol, education specialists, health promotion specialists, and mental health specialists). In phase 2, we aimed to develop and evaluate the effectiveness of the health literacy program to reduce alcohol use among medical students in vocational colleges. This phase employed a cluster-randomized controlled trial design with 104 first-year medical students. The data were collected using questionnaires. The quantitative data was analyzed using frequency, percentage, mean, standard deviation, multivariate logistic regression, chi-square tests, chi-square test for trend, and an independent sample t-test. For qualitative data, we used content analysis with the MAXQDA 2020 software.

The results in phase 1 showed that the three-level factors of a socio-ecological model, such as individual-level variables (all six dimensions of health literacy, low total health literacy, male, monthly household income >5000 CNY, smoking, high PAEs), interpersonal-level variables (family member alcohol use, peer alcohol use), and community-level variables (easy access to alcohol), were related to alcohol use among medical students. A qualitative study showed that the current laws and regulations prohibiting adolescents' access to alcohol are inadequate and that strengthening supervision and changing medical students' attitudes toward alcohol consumption are two important strategies. Besides, the suggestions of alcohol use reduction intervention, such as individual and family level: improving medical students' health literacy, increasing internal drive, and proper guidance from guardians. The school level: strict enforcement of school rules prohibiting alcohol consumption, more meaningful activities to publicize the dangers of alcohol consumption, and enhanced peer education. The social level: strengthen the regulation of alcohol sellers. The national level: Introduce laws and regulations to prohibit youth from drinking alcohol. Additionally, alcohol is harmful to medical students, including occupational hazards, academic hazards, and hazards to body organs, family hazards, psychological hazards, and social hazards. In phase 2, the results revealed that we developed the health literacy program (HLP) based on Nutbeam's theory with experts in the health education, public health, or health promotion sectors, which consists of six sessions with a total of six activities. The intervention group was given 6 weeks of HLP and regular health education, while the control group was given only 6 weeks of regular health education. After the intervention, the total health literacy score and the scores of the six dimensions of the intervention group were higher than those of the control group and showed significant differences (P

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