Health literacy and health behaviour in the context of one health approach in Morogoro, Tanzania: perceptions, attitudes, connections, and realities.

Quality population is a parameter for economic development. Inter alia, health determines the quality of a population. Evidently, attaining optimal health calls for collaboration between humans, animals, and environmental health professionals plus understanding the consequences of humans, animals and environment interactions on health. Attaining good health faces numerous challenges, health literacy inclusive. Realizing this, the government of Tanzania has put numerous efforts to improve health services and educate people to become health literate. Despite the efforts, health impairing behaviours (HIBs) some resulting in zoonotic diseases and varying preferences among Tanzanians in terms of health seeking sources have been reported. A cross-sectional study was conducted in Morogoro urban and Mvomero districts in Tanzania to assess health literacy (HL), its influence on health behaviour (HB) and healthcare-seeking behaviour (HCSB), attitudes of people on HIBs and its influence on health behaviours (HBs). Focusing on One Health Approach (OHA), this study specifically: - (i) assessed HL, (ii) analyzed HBs and HCSBs, (iii) assessed attitudes of the people on HIBs, (iv) assessed determinants of HL, HB, and HCSB, (iv) identified and assessed collaborative efforts and strategies towards attaining optimal health, (v) determined linkages between HL, HB and HCSB, and, (vi) assessed stakeholders
initiatives in building public health capacity, developing HL and empowering people to manage their health. Data were collected using a structured questionnaire from 1440 respondents obtained through multistage sampling procedure, 80 FGDs participants and 16 key informant interviewees. Health Literacy assessment tool and a Likert scale were used to assess HL and attitudes towards HB, while an index of score gauged HBs. IBM-SPSS v.20 analysed quantitative data while qualitative data were organised into themes on specific objectives to back up findings. The study revealed, about one-third of the respondents (32.9%) with adequate HL, moderate HL (30.8%) and inadequate HL(36.3%); 40% had health-enhancing behaviours and 60% with health impairing behaviours, 58.8% preferred formal and 41.2% informal health care sources, 30% had unfavourable attitudes towards health impairing behaviours, attitudes significantly associated with behaviours (p<0.001). Ordinal logistic regression indicates that health-related discussions engagement (p<0.005), health behaviour (p<0.001), interaction with medical professionals (p<0.001), political influence on health (p<0.001), local authorities involvement on health (p<0.001) and marital
status (p<0.004) to determine health literacy. Health behaviour determinants were one health concern (p<0.001), health literacy (p<0.001), local authorities involvement in health (p<0.001), prior knowledge (p=0.045) and political influence on health (p<0.003). Marital status (p<0.001), service characteristics (p<0.001) and the effectiveness of health services (p<0.001) determined healthcare seeking. Only 5% were aware and 3.8% identified collaborative efforts and strategies on OHA. There were significant associations (health literacy*health behaviour, p<0.001; health literacy*healthcare seeking, p<0.05; health behaviour*healthcare seeking, p<0.03). Only 30% perceived stakeholders’ initiatives on health and related aspects to be effective. An alternative hypothesis that Health literacy does not differ significantly among individuals exhibiting HEBs and those with HIBs under OHA was confirmed (F=795.206, p<0.001) and null hypothesis rejected. Much as low HL and ineffective efforts on health education were observed, positive attitudes towards HIBs also contributed to the observed HBs. This study recommends strengthening efforts to enhance health information dissemination through health education focusing on culture as the context that informs behaviours.