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. 2025 Apr 25;25(1):636.
doi: 10.1186/s12903-025-05836-3.

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

Mohammed B A Sarhan  1   2 , Rika Fujiya  3   4 , Junko Kiriya  5 , Akira Shibanuma  5 , Rita Giacaman  6 , Masamine Jimba  5   7
Affiliations

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

Mohammed B A Sarhan et al. BMC Oral Health. .

Abstract

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.

Keywords: Adolescents; Health information sources; Health literacy; Oral health knowledge; Palestine; Refugees.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This research complies with the Helsinki Declaration. The Research Ethics Committee of the Graduate School of Medicine, University of Tokyo (ethical approval no. 11545-[2]) and the Research Ethics Committee of Birzeit University (ethical approval no. 161013) granted us the required ethical approvals. The field workers explained the objectives of this research to the parents and their adolescents. Informed consent was obtained from parents and all participating adolescents. Voluntary participation and withdrawal were guaranteed for all adolescents. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A-C presents simple mediation models for health literacy subscales, with (a) and (b) paths representing indirect effects, (a) path indicating the association between exposure and mediator, (b) path indicating the association between mediator and outcome, and (c’) path indicating the direct effect of exposure on outcome
Fig. 2
Fig. 2
Mediation analysis results with communication health literacy as a mediator
Fig. 3
Fig. 3
Mediation analysis results with confusion health literacy as a mediator
Fig. 4
Fig. 4
Mediation analysis results with Functional health literacy as a mediator
See this image and copyright information in PMC

References

    1. World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. World Health Organization; 2022.
    1. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249–60. - PubMed
    1. Sabbah W, Folayan MO, El Tantawi M. The Link between Oral and General Health. Int J Dent [Internet]. 2019;2019(1):7862923. Available from: 10.1155/2019/7862923 - PMC - PubMed
    1. World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. regional summary of the Eastern mediterranean region. World Health Organization; 2024.
    1. Kateeb E, Zaheer K, Fisher J, Abd El Ghani A, Williams D, Dartevelle S. Promoting oral health for refugees: an advocacy guide. FDI World Dental Federation; 2020.

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