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Health Literacy and Healthcare Utilization: a Study of Bhutia And ResearchOriginal ArticleArticle Health Literacy and Healthcare Utilization: A Study of Bhutia and Lepcha Mothers in Pakyong and Dzongu District of Sikkim, India Rinchen OB1*, Bal Rakshase1 and Shanti Suman Tigg2 1Centre for Health, Policy, Planning and Management, School of Health System Studies, Tata Institute of Social Sciences, Mumbai, India; 2Centre for Labour Studies and Social Protection, School of Social Sciences and Humanities, Tata Institute of Social Sciences, Guwahati, India Corresponding author: Abstract Rinchen OB, Centre for Health, Policy, Planning and Management, Background & Objective: Health Literacy is an important determinant of health School of Health System Studies, Tata alongside general literacy. An individual with limited health literacy is more likely Institute of Social Sciences, Mumbai, India, to make medication errors, and have lesser health knowledge, poor health status, Tel: 8761043039, high probability for hospitalizations, and higher health expenditure compared to an E-mail: tashiongmubhutia85@gmail. individual with adequate health literacy. The objectives of this study is to assess the com health literacy level and to analyze how the health literacy status affects the treatment- seeking behavior and utilization of healthcare services among the two tribes (Bhutia and Lepcha) of Pakyong and Dzongu district of Sikkim by testing Rapid Estimate Adult Literacy in Medicine (REALM) technique and to compare the health literacy levels to educational status and other socio-demographic characteristics. Materials & Methods: The most commonly used word recognition test (REALM) was administered to assess the HL status of 54 mothers in their reproductive age (15-49 years) mainly the expecting mothers and the mothers with a year old child in Eastern and Northern Sikkim, India. The sum of correctly pronounced words was used to assign a grade- equivalent reading level. Scores 0 to 44 recorded reading skills at or below the 6th grade level, scores from 45 to 60 indicated skills at the 7th or 8th grade level, and scores above 60 depicted skills at the high-school level or higher. Results: The results showed that in both the Lepcha and Bhutia community the Health literacy score was low based on their level of education and age. Age also showed a significant impact on Health literacy score. It was seen that mothers between the age 26-35 years in both the community (i.e. Bhutia 28.60% and Lepcha 71.40%) had significantly higher health literacy score. Conclusion: The study aimed at concluding how the individual’s level of health literacy affects the use of healthcare services. Since health literacy is of continued and increasing concern for health professionals, as it is seen as a primary factor behind health disparities. Therefore, improving health literacy is the key to any health intervention or health promotion. Keywords: Health literacy; Healthcare utilization; Treatment-seeking behaviour; Education; REALM; Health promotion; Bhutia;Lepcha; Sikkim; India Background north-eastern states after induction of NEC, Sikkim was a part of the North Eastern Region as the eighth state in the year 2002. India is a land of diverse, heterogeneous groups wherein 8.6% of the total population comprises of the tribal community. Sikkim is a small landlocked state sharing its borders with North-East India has the highest concentration of tribal Bhutan, Nepal, and Tibet and is also the least populous [1] population in the country. The north-eastern states constitute (610,577) state in India. Gangtok is the capital of Sikkim and eight states namely Nagaland, Manipur, Assam, Tripura, the only largest city. The sex ratio is 942 females for every 1,000 Mizoram, Arunachal Pradesh, Meghalaya, and Sikkim. There males (NFHS-4). The common language spoken in the state is Nepali, while Sikkimese and Lepcha are mainly spoken by the are 145 tribes, 78 of which are huge, each with a population of over 5000. The tribes in the north-east mainly live in the hilly This is an open access article distributed under the terms of the Creative Com- terrain. The tribes in the north-east vary from the tribes in other mons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to parts of India for their historical relations with the colonial and remix, tweak, and build upon the work non-commercially, as long as the author is Indian states. The states of the north-eastern region are officially credited and the new creations are licensed under the identical terms. recognized under the North Eastern Council (NEC) constituted How to Cite this Article: Rinchen OB, et al. Health Literacy and Healthcare Utilization: A Study of Bhutia and Lepcha Mothers in Pakyong and Dzongu in 1971 as the government authority for the development of the District of Sikkim, India. Ann Med Health Sci Res. 2021;11:1471-1476. 1471 © 2021 Annals of Medical and Health Sciences Research Rinchen OB, et al.: Health Literacy and Healthcare Utilization: A Study of Bhutia and Lepcha Mothers in Pakyong and Dzongu District of Sikkim, India Lepcha and Bhutia community. The general population mostly the basic concepts in health and medicine.[16,17] Subsequently, consists of Nepali. The Bhutia are indigenous people who came the urban-rural divide in terms of accessibility to services or from Tibet during the 14th century and lived in Sikkim, whereas Information Communication Technology (ICT) and the other the Lepcha are the original inhabitants of the area. The Lepcha, social barriers like caste, tribe, gender, the language which Bhutia, Sherpa are categorized as Schedule Tribes. The Bhutia further aggravates health crisis, emphasizes the need and includes the Sikkimese Bhutia, Bhutanese Bhutia, and Tibetan importance of ‘health-literacy’; While ‘health’ has been a Bhutia. There are many ethnic groups in Sikkim some of them ‘tabletop runway’ situation, therefore precision in this regard is are Limboo, Tamang, Rai, Gurung, Chettri. Among these ethnic the matter of fact and this precision is affirmed with ‘health- groups, the four ethnic groups are recognized as STs by the SC/ literacy’, with the improved patient engagement and reciprocal ST (Sikkim) Order Act of 1978. [2] And the Limboo and Tamang flow of knowledge between the provider and the beneficiary. communities were recognized as tribal groups by the SC/ST Therefore ‘Health Literacy’ plays a pivotal role and is the most Orders (Amendment) Act, 2002. significant determinant of health. A minimal amount of literacy in the domain of medicine and medical services surmounts the The State has remained detached from the rest of the country probabilities of the health complexities and the reciprocity of due to its geographical location and terrain and has fallen short knowledge enables the individual for effective utilization of the in securing equal benefits in the developmental process. Though services. ‘Good-Health’ is not only an asset to an individual the State has less industrial and economic development, it has but also immensely contribute directly towards growth & ample forest resources. Cardamom, tea, oranges, apples, ginger, development. Health is now seen as an important contributor and orchids are some of the most significant resources produced. to development rather than an end product of the development. At the same time, agriculture, horticulture, and handloom [18] Thus the improvisation and up gradations in the status of continue to be the main activities of the State. health are directly determined by the ‘Health Literacy’ and The authors took this scenario as an excellent opportunity to not literacy in general. An individual’s educational status may find an association between the DISC personality index and not always reveal his/her reading ability; they usually hide Academic performance (GPA) of dental students in a private their incompetency out of shame. [17] To overcome such issues Saudi Dental School. many tests have been conducted to measure health literacy level. One such test is the Rapid Estimate of Adult Literacy in Introduction Medicine (REALM). [19] REALM tests the individual’s ability to Health is the most significant and uncompromising element for pronounce 66 common medical words and lay terms for body any individual. In 1948 the World Health Organization defined parts and illnesses and can be administered in less than two [17,20] health as “a state of complete physical, mental, and social well- minutes. [3] being and not merely the absence of disease or infirmity”. Although low health literacy is a major global problem While the human life-cycle revolves around the wellbeing requiring utmost attention, the issue needs to be addressed and healthy lifestyle, however the key factors associated with immediately in India as ours is the world’s second–largest (1.3 wellbeing of health mentally and physically both are associated billion) populated country. Poor health literacy poses a great with one’s literacy level in health to avail the services at its danger for our economy as healthcare expenditure is increasing best rather than practicing a lifestyle at the sole deference and exorbitantly along with an increasing population growth. In conjecture of the medical practitioner. Over the years, health a country like India where overpopulation, socioeconomic literacy has gained momentum as it is considered as one of the inequalities across states, unequal distribution of resources most important social determinants of health which influences across states and within the states, differences in social status;
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