{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:03:07Z","timestamp":1791820987279,"version":"4.3.4"},"reference-count":78,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T00:00:00Z","timestamp":1658620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Health literacy (HL) is linked to many health outcomes, including self-management of chronic diseases. The aim of this study was to assess the association of health literacy with the prevalence of obesity, arterial hypertension (AH), and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional, single-center study included 500 patients (42.2% male and 57.8% females; median age, 63 years (interquartile range, 42\u201373)) hospitalized at General County Hospital in Po\u017eega, Croatia, between July and October 2020. The Short Assessment of Health Literacy for Croatian Adults (SAHLCA-50) questionnaire was used. Descriptive statistics (median with interquartile range (IQR), frequency, and percentages) and binary logistic regression were utilized. Results: Patients with AH had an inadequate level of health literacy as compared to those without AH (32 vs. 40 points; Mann\u2013Whitney U test, p &lt; 0.001). Patients with T2DM scored 31 points versus 39 points in patients without T2DM (Mann\u2013Whitney U test, p &lt; 0.001). Patients suffering from both AH and T2DM scored 31 points versus 33 points in those with either AH or T2DM and 41 points in patients without AH and T2DM (Kruskal\u2013Wallis test, p &lt; 0.001). There were no statistically significant differences in SAHLCA-50 scores according to the patient body mass index. Conclusions: An inadequate level of health literacy is significantly associated with AH and T2DM but not with obesity. Male gender, low level of education, rural place of residence, retirement, and older age are significant predictors of inadequate health literacy.<\/jats:p>","DOI":"10.3390\/ijerph19159002","type":"journal-article","created":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T22:49:02Z","timestamp":1658702942000},"page":"9002","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Association between Health Literacy and Prevalence of Obesity, Arterial Hypertension, and Diabetes Mellitus"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8919-2517","authenticated-orcid":false,"given":"Bo\u017eica","family":"Lovri\u0107","sequence":"first","affiliation":[{"name":"General County Hospital Po\u017eega, 34 000 Po\u017eega, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"Nursing Institute \u201cProfessor Radivoje Radi\u0107\u201d, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3544-2071","authenticated-orcid":false,"given":"Harolt","family":"Placento","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"Nursing Institute \u201cProfessor Radivoje Radi\u0107\u201d, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"General Hospital Na\u0161ice, 31 500 Na\u0161ice, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8289-0710","authenticated-orcid":false,"given":"Nikolina","family":"Far\u010di\u0107","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"Nursing Institute \u201cProfessor Radivoje Radi\u0107\u201d, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"Department of Surgery, University Hospital Centre Osijek, 31 000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Metka","family":"Lipi\u010d Baliga\u010d","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"General County Hospital Murska Sobota, 9 001 Raki\u010dan, Slovenia"},{"name":"Alma Mater Europaea, 2 000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1199-3768","authenticated-orcid":false,"given":"\u0160tefica","family":"Mik\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Nursing Institute \u201cProfessor Radivoje Radi\u0107\u201d, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marin","family":"Mami\u0107","sequence":"additional","affiliation":[{"name":"General County Hospital Po\u017eega, 34 000 Po\u017eega, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"Nursing Institute \u201cProfessor Radivoje Radi\u0107\u201d, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9862-6946","authenticated-orcid":false,"given":"Tihomir","family":"Jovanovi\u0107","sequence":"additional","affiliation":[{"name":"General County Hospital Po\u017eega, 34 000 Po\u017eega, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"},{"name":"General Hospital Pakrac and Hospital of Croatian Veterans, 34 550 Pakrac, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hrvoje","family":"Vidi\u0107","sequence":"additional","affiliation":[{"name":"General County Hospital Po\u017eega, 34 000 Po\u017eega, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31 000 Osijek, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Karabati\u0107","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases \u201cJordanovac\u201d, University Hospital Center, 10 000 Zagreb, Croatia"},{"name":"Department of Health Care, University of Applied Health Sciences, 10 000 Zagreb, Croatia"},{"name":"Faculty of Health Studies, University in Mostar, 88 000 Mostar, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Cviljevi\u0107","sequence":"additional","affiliation":[{"name":"General County 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Noncommunicable Diseases. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/noncommunicable-diseases."},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2021, April 05). Noncommunicable Diseases Progress Monitor 2020. Available online: https:\/\/www.who.int\/publications\/i\/item\/ncd-progress-monitor-2020."},{"key":"ref_3","unstructured":"GBD 2013 Risk Factors Collaborators (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990\u20132015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388, 1659\u20131724."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1136\/bmj.322.7292.977","article-title":"Cardiovascular risk factors and their effects on the decision to treat hypertesion: Evidence-based review","volume":"322","author":"Padwal","year":"2001","journal-title":"BMJ"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1016\/j.jacc.2008.12.068","article-title":"Obesity and cardiovascular disease: Risk factor, paradox, and impact of weight loss","volume":"53","author":"Lavie","year":"2009","journal-title":"J. Am. Col. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kim, H., Lim, D.H., and Kim, Y. (2021). Classification and Prediction on the Effects of Nutritional Intake on Overweight\/Obesity, Dyslipidemia, Hypertension and Type 2 Diabetes Mellitus Using Deep Learning Model: 4\u20137th Korea National Health and Nutrition Examination Survey. Int J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18115597"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1161\/CIRCRESAHA.120.316101","article-title":"Obesity phenotypes, diabetes, and cardiovascular diseases","volume":"126","author":"Tchernof","year":"2020","journal-title":"Circ. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S2213-8587(17)30292-9","article-title":"Metabolically healthy obesity: The low-hanging fruit in obesity treatment?","volume":"6","author":"Stefan","year":"2018","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"9987352","DOI":"10.1155\/2021\/9987352","article-title":"oxidative stress in association with metabolic health and obesity in young adults","volume":"2021","author":"Jakubiak","year":"2021","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9681595","DOI":"10.1155\/2021\/9681595","article-title":"Oxidative Stress Markers among Obstructive Sleep Apnea Patients","volume":"2021","author":"Stanek","year":"2021","journal-title":"Oxid Med. Cell Long."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Stanek, A., Bro\u017cyna-Tkaczyk, K., and My\u015bli\u0144ski, W. (2021). The role of obesity-induced perivascular adipose tissue (PVAT) dysfunction in vascular homeostasis. Nutrients, 13.","DOI":"10.3390\/nu13113843"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0140-6736(15)01225-8","article-title":"Blood pressure lowering for prevention of cardiovascular disease and death: A systematic review and meta-analysis","volume":"387","author":"Ettehad","year":"2016","journal-title":"Lancet"},{"key":"ref_13","first-page":"102","article-title":"Epidemiology of hypertension, stroke and myocardial infarction in Croatia","volume":"16","author":"Kralj","year":"2010","journal-title":"Medix"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/S0140-6736(05)17741-1","article-title":"Global burden of hypertension: Analysis of worldwide data","volume":"365","author":"Kearney","year":"2005","journal-title":"Lancet"},{"key":"ref_15","unstructured":"IDF (2017). IDF Diabetes Atlas, International Diabetes Federation IDF. [8th ed.]. Available online: http:\/\/www.diabetesatlas.org\/across-the-globe.html."},{"key":"ref_16","unstructured":"Croatian Institute of Public Health (2021, April 15). World Diabetes Day 2019. Available online: https:\/\/www.hzjz.hr\/aktualnosti\/svjetski-dan-secerne-bolesti-2019."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Guh, D.P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C., and Anis, A.H. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-88"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"i2156","DOI":"10.1136\/bmj.i2156","article-title":"BMI and all-cause mortality: Systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants","volume":"353","author":"Aune","year":"2016","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Li, Y.-C., Li, C.-L., Qi, J.-Y., Huang, L.-N., Shi, D., Du, S.-S., Liu, L.-Y., Feng, R.-N., and Sun, C.-H. (2016). Relationships of dietary histidine and obesity in Northern Chinese adults, an internet-based cross-sectional study. Nutrients, 8.","DOI":"10.3390\/nu8070420"},{"key":"ref_20","first-page":"1","article-title":"Prevalence of Obesity in the United States, 2009-2010","volume":"82","author":"Ogden","year":"2012","journal-title":"NCHS Data Brief"},{"key":"ref_21","unstructured":"(2021, April 12). World Health Organization Data and Statistics. Available online: https:\/\/www.euro.who.int\/en\/health-topics\/noncommunicable-diseases\/obesity\/data-and-statistics."},{"key":"ref_22","unstructured":"Croatian Institute of Public Health (2021, August 10). Department of Physical Health Promotion. Available online: https:\/\/www.hzjz.hr\/sluzba-promicanje-zdravlja\/odjel-za-prevenciju-debljine."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"508","DOI":"10.2105\/AJPH.2012.300898","article-title":"Fatty, fatty, two-by-four: Weight-teasing history and disturbed eating in young adult women","volume":"103","author":"Quick","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"501","DOI":"10.2105\/AJPH.2011.300562","article-title":"Consistency between increasing trends in added-sugar intake and body mass index among adults: The Minnesota heart survey, 1980\u20131982 to 2007\u20132009","volume":"103","author":"Wang","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_25","first-page":"211","article-title":"Fast food, race\/ethnicity, and income: A geographic analysis","volume":"27","author":"Block","year":"2004","journal-title":"Am. J. Prevent Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1177\/1359105311417191","article-title":"Residential segregation, health behavior and overweight\/obesity among a national sample of African American adults","volume":"17","author":"Corral","year":"2012","journal-title":"J. Health Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2226","DOI":"10.2337\/dc12-0412","article-title":"Determinants of racial\/ethnic disparities in incidence of diabetes in postmenopausal women in the U.S.: The women\u2019s health initiative 1993\u20132009","volume":"35","author":"Ma","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jash.2011.03.005","article-title":"Racial disparities in cardiovascular risk factors among diagnosed hypertensive subjects","volume":"5","author":"Liu","year":"2011","journal-title":"J. Am. Soc. Hypertens."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1080\/01635581.2011.607539","article-title":"Body mass index and death rate of colorectal cancer among a national cohort of U.S. adults","volume":"63","author":"Dehal","year":"2011","journal-title":"Nutr. Cancer."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1177\/1742395317718034","article-title":"Understanding untreated hypertension from patients\u2019 point of view: A qualitative study in rural Yogyakarta province, Indonesia","volume":"14","author":"Rahmawati","year":"2018","journal-title":"Chronic Illn."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.jsps.2019.06.003","article-title":"Health literacy among patients with poor understanding of prescription drug label instructions in Saudi Arabia","volume":"27","author":"AbuAlreesh","year":"2019","journal-title":"Saudi Pharm. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1093\/eurpub\/ckv043","article-title":"Health Literacy in Europe: Comparative Results of the European Health Literacy Survey (HLS-EU)","volume":"25","author":"Pelikan","year":"2015","journal-title":"Eur. J. Public Health"},{"key":"ref_33","first-page":"9","article-title":"Adolescents\u2019 Health Literacy. Holistic Approach to the Patient, Conference Proceedings, International Scientific Conference","volume":"10","year":"2018","journal-title":"Food Health Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Brangan, S., Ivani\u0161i\u0107, M., Rafaj, G., and Rowlands, G. (2018). Health literacy of hospital patients using a linguistically validated Croatian version of the Newest Vital Sign screening test (NVS-HR). PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0193079"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Placento, H., Lovri\u0107, B., Gvozdanovi\u0107, Z., Far\u010di\u0107, N., Jovanovi\u0107, T., Jovanovi\u0107, J.T., Zibar, L., Prli\u0107, N., Mik\u0161i\u0107, \u0160., and Jovanovi\u0107, N.B. (2022). Croatian version of the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50): Cross-cultural adaptation and psychometric evaluation. Healthcare, 10.","DOI":"10.3390\/healthcare10010111"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1111\/j.1475-6773.2006.00532.x","article-title":"Development of an easy-to-use Spanish Health Literacy Test","volume":"41","author":"Lee","year":"2006","journal-title":"Health Serv. Res."},{"key":"ref_37","first-page":"121","article-title":"Croatian translation and linguistic adaptation of the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50)","volume":"4","author":"Badak","year":"2020","journal-title":"Southeast. Eur. Med. J. SEEMEDJ"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Armitage, P., and Berry, G. (2001). Statistical Methods in Medical Research, WileyBlackwell.","DOI":"10.1002\/9780470773666"},{"key":"ref_39","unstructured":"(2021, April 12). MedCalc Software Ltd.: Ostend, Belgium, 2020. Available online: https:\/\/www.medcalc.org."},{"key":"ref_40","unstructured":"IBM Corp (2017). IBM SPSS Statistics for Windows, IBM Corp.. Available online: https:\/\/hadoop.apache.org."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"ESC Scientific Document Group, 2018 ESC\/ESH Guidelines for the management of arterial hypertension: The task force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)","volume":"1","author":"Williams","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_42","unstructured":"IDF (2019). IDF Diabetes Atlas, International Diabetes Federation IDF. [9th ed.]. Available online: https:\/\/www.diabetesatlas.org\/en."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1177\/0145721714540220","article-title":"Update on Health Literacy and Diabetes","volume":"40","author":"Bailey","year":"2014","journal-title":"Diabetes Educ."},{"key":"ref_44","first-page":"191","article-title":"Health literacy in diabetes care: Explanation, evidence and equipment","volume":"1","author":"Cavanaugh","year":"2011","journal-title":"Diab. Manag."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Abdullah, A., Liew, S.M., Salim, H., Ng, C.J., and Chinna, K. (2019). Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0216402"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.gerinurse.2016.12.003","article-title":"The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults","volume":"38","author":"MacLeod","year":"2017","journal-title":"Geriatr. Nurs."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2869","DOI":"10.1007\/s11136-016-1298-2","article-title":"The association between health literacy and self-management abilities in adults aged 75 and older, and its moderators","volume":"25","author":"Geboers","year":"2016","journal-title":"Qual. Life Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1442-2018.2009.00506.x","article-title":"Impact of health literacy and patient trust on glycemic control in an urban USA population","volume":"12","author":"Mancuso","year":"2010","journal-title":"Nurs. Health Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"27","DOI":"10.5993\/AJHB.31.s1.5","article-title":"Literacy and its relationship with self-efficacy, trust, and participation in medical decision making","volume":"31","author":"DeWalt","year":"2007","journal-title":"Am. J. Health Behav."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1197\/jamia.M1687","article-title":"Promoting health literacy","volume":"12","author":"McCray","year":"2005","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e000449","DOI":"10.1136\/bmjdrc-2017-000449","article-title":"Sociodemographic and behavioral characteristics associated with self-reported diagnosed diabetes mellitus in adults aged 50+ years in Ghana and South Africa: Results from the WHO-SAGE wave 1","volume":"2","author":"Tarekegne","year":"2018","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"8221","DOI":"10.1002\/jcp.27633","article-title":"Risk factors and therapies in vascular diseases: An umbrella review of updated systematic reviews and meta-analyses","volume":"234","author":"Hong","year":"2019","journal-title":"J. Cell. Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s11883-018-0740-z","article-title":"Why weight? An analytic review of obesity management, diabetes prevention, and cardiovascular risk reduction","volume":"21","author":"Igel","year":"2018","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s11906-016-0691-0","article-title":"Endoluminal treatments for obesity and related hypertension: Updates, review, and clinical perspective","volume":"18","author":"Cripps","year":"2016","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_55","unstructured":"Eurostat (2021, August 12). Over Half of Adults in the EU Are Overweight. Available online: https:\/\/ec.europa.eu\/eurostat\/web\/products-eurostat-news\/-\/ddn-20210721-2."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Kamatham, S., Trak, J., Alzouhayli, S., Fehmi, Z., Rahoui, N., Sulieman, N., Khoury, Z., Fehmi, O., Rakine, H., and El-Masri, D. (2020). Characteristics and distribution of obesity in the Arab American population of southeastern Michigan. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09782-3"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1093\/pubmed\/fdz103","article-title":"Health literacy and body mass index: A population-based study in a South-Eastern European country","volume":"43","author":"Burazeri","year":"2021","journal-title":"J. Public Health"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1681\/ASN.2020081155","article-title":"Low health literacy is associated with the onset of CKD during the life course","volume":"32","author":"Reijneveld","year":"2021","journal-title":"J. Am. Soc. Nephrol. JASN"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1016\/j.jsps.2017.04.003","article-title":"Relationship between health literacy and body mass index among Arab women with polycystic ovary syndrome","volume":"25","author":"Balkhi","year":"2017","journal-title":"Saudi Pharm. J. SPJ"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/2049-3258-72-11","article-title":"Is low health literacy associated with overweight and obesity in adolescents: An epidemiology study in a 12\u201316 years old population, Nanning, China, 2012","volume":"1","author":"Lam","year":"2014","journal-title":"Arch. Public Health"},{"key":"ref_61","first-page":"130","article-title":"Health literacy and its relationship with body mass index","volume":"29","author":"Moghaddam","year":"2019","journal-title":"J. Holist. Nurs. Midwifery"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/2049-3258-72-15","article-title":"Health literacy among university students in Greece: Determinants and association with self-perceived health, health behaviours and health risks","volume":"72","author":"Vozikis","year":"2014","journal-title":"Arch. Public Health"},{"key":"ref_63","first-page":"248","article-title":"The study of health literacy of staff about risk factors of chronic diseases in 2014","volume":"22","author":"Pirdehghan","year":"2015","journal-title":"Avicenna J. Clin. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1111\/hex.13208","article-title":"How different health literacy dimensions influences health and well-being among men and women: The mediating role of health behaviours","volume":"24","author":"Zhang","year":"2021","journal-title":"Health Expect."},{"key":"ref_65","first-page":"723","article-title":"Health literacy in Germany: Findings of a representative follow-up survey","volume":"118","author":"Schaeffer","year":"2021","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1177\/0956797617700622","article-title":"Global increases in individualism","volume":"28","author":"Santos","year":"2017","journal-title":"Psychol. Sci."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"645074","DOI":"10.3389\/fped.2021.645074","article-title":"Trends of healthy lifestyles among adolescents: An analysis of more than half a million participants from 32 countries between 2006 and 2014","volume":"25","author":"Marconcin","year":"2021","journal-title":"Front. Pediatr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.1017\/S1368980017001483","article-title":"Health literacy and fruit and egetable intake in rural Australia","volume":"20","author":"Lim","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1001\/jama.281.6.545","article-title":"Health literacy among medicare enrollees in a managed care organization","volume":"281","author":"Gazmararian","year":"1999","journal-title":"JAMA"},{"key":"ref_70","first-page":"13","article-title":"Systematic review and conceptual framework for health literacy training in health professions education","volume":"5","author":"Saunders","year":"2019","journal-title":"Health Prof. Educ."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Kaper, M.S., de Winter, A.F., Bevilacqua, R., Giammarchi, C., McCusker, A., Sixsmith, J., Koot, J.A.R., and Reijneveld, S.A. (2019). Positive outcomes of a comprehensive health literacy communication training for health professionals in three European countries: A multi-centre pre-post intervention study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16203923"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Harzheim, L., Lorke, M., Woopen, C., and J\u00fcnger, S. (2020). Health literacy as communicative action\u2014A qualitative study among persons at risk in the context of predictive and preventive medicine. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051718"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Li, C., and Guo, Y. (2021). The effect of socio-economic status on health information literacy among urban older adults: Evidence from western China. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18073501"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Gvozdanovi\u0107, Z., Far\u010di\u0107, N., \u0160imi\u0107, H., Buljanovi\u0107, V., Gvozdanovi\u0107, L., Katalini\u0107, S., Pa\u010dari\u0107, S., Gvozdanovi\u0107, D., Dujmi\u0107, \u017d., and Mi\u0161ki\u0107, B. (2021). The impact of education, COVID-19 and risk factors on the quality of life in patients with type 2 diabetes. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18052332"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Finbr\u00e5ten, H.S., Guttersrud, \u00d8., Nordstr\u00f6m, G., Pettersen, K.S., Trollvik, A., and Wilde-Larsson, B. (2020). Explaining variance in health literacy among people with type 2 diabetes: The association between health literacy and health behaviour and empowerment. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-8274-z"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Rondia, K., Adriaenssens, J., Van Den Broucke, S., and Kohn, L. (2021, August 10). Health Literacy: What Lessons Can Be Learned from the Experiences of Other Countries?. Available online: https:\/\/kce.fgov.be\/sites\/default\/files\/atoms\/files\/KCE_322_Health_Literacy_Report.pdf.","DOI":"10.1002\/hpm.3382"},{"key":"ref_77","unstructured":"Berkman, N.D., Dewalt, D.A., Pignone, M.P., Sheridan, S.L., Lohr, K.N., Lux, L., Sutton, S.F., Swinson, T., and Bonito, A.J. (2021, August 15). Literacy and health outcomes: Summary, AHRQ Evidence Report Summaries, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK11942."},{"key":"ref_78","unstructured":"(2021, August 10). Cost of Non-Communicable Diseases in the EU. Available online: https:\/\/knowledge4policy.ec.europa.eu\/health-promotion-knowledge-gateway\/cost-non-communicable-diseases-eu_e."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9002\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:55:47Z","timestamp":1760140547000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,24]]},"references-count":78,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph19159002"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19159002","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,24]]}}}