Exploring Gender Variations in Health Literacy and Herbal Medicine Use Among Malaysian Adults

Exploring Gender Variations in Health Literacy and Herbal Medicine Use Among Malaysian Adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Exploring Gender Variations in Health Literacy and Herbal Medicine Use Among Malaysian Adults Yusnaini Md Yusoff, Wardah Mustafa Din, Azlan Abdul Rahim, Halizah Omar, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7748347/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Health literacy is vital for the effectiveness of public health strategies, as it empowers individuals to access, comprehend, and utilise health information to improve their well-being and prevent diseases. The global resurgence of herbal and natural products underscores the importance of understanding the interplay between traditional health practices and modern health literacy. However, empirical research in this area is sparse, particularly in multi-ethnic, middle-income countries like Malaysia. This study aimed to evaluate health literacy levels and explore their relationships with socio-demographic variables and patterns of herbal product usage, utilising data gathered from 810 Malaysian adults. Health literacy was measured using the validated HLS-M-Q18 instrument, supplemented with questions related to herbal product usage. Associations were analysed through descriptive statistics and binary logistic regression analyses. Results indicated that 63.2% of respondents demonstrated satisfactory health literacy, classified as either sufficient or insufficient. Multivariate analysis identified male gender (OR = 1.473, p = 0.017) and absence of formal medical consultation (OR = 4.479, p < 0.001) as significant predictors of inadequate health literacy. Although the use and duration of herbal product intake did not show statistically significant results in the multivariate analyses, descriptive trends revealed that long-term herbal users (over 10 years) exhibited a higher percentage of excellent health literacy (29.6%) compared to short-term or non-users. These findings suggest that regular engagement in traditional health practices may enhance self-directed health information behaviour, although this effect is not independently predictive once adjusted. This research makes a unique contribution to the health literacy framework by integrating traditional health behaviours, emphasising the necessity for culturally responsive and gender-sensitive public health interventions. Bridging biomedical health literacy frameworks with community-based herbal practices is essential for enhancing health outcomes, promoting safe self-care, and informing national health promotion strategies in diverse healthcare settings. Health sciences/Health care Humanities/Health humanities Humanities/Medical humanities Health sciences/Medical research Health literacy gender socio-demographic healthcare utilisation traditional practices Introduction Despite a longstanding reliance on traditional herbal remedies, there remains a limited understanding of how these culturally ingrained practices relate to gender-based disparities in health literacy, a crucial factor influencing health outcomes [ 1 ]. Health literacy is defined as the ability of individuals to access, comprehend, assess, and utilise health information and services to promote and maintain good health, support informed health decisions, engage in preventive measures, and effectively manage illnesses. This competency involves more than just reading health materials; it encompasses various skills, knowledge, motivation, and the ability to critically apply information in everyday life concerning healthcare, illness prevention, and health promotion [ 2 ]. Such competencies impact broader health outcomes, including reduced hospitalisations and emergency visits, improved utilisation of preventive services, and decreased healthcare expenditures. Low health literacy is associated with adverse health outcomes, delayed access to care, and inadequate health management, particularly among older adults, individuals with lower educational attainment or income, and those with chronic illnesses. Health literacy is recognised as both an individual competency and a systemic characteristic. The health literacy environment, which encompasses the structures and policies of the healthcare system, as well as the quality of communication, plays a significant role in either facilitating or obstructing adequate health literacy [ 3 ]. Research demonstrates that health literacy varies by gender, with women generally showing higher levels of engagement in seeking health information and adopting preventive health behaviours compared to men [ 4 ]. This disparity is influenced by a combination of biological, behavioural, and socio-cultural factors [ 5 ]. In Malaysia and various Asian societies, the use of natural herbal products is a longstanding and culturally valued practice that often complements biomedical healthcare [ 6 – 7 ]. Herbal remedies are frequently employed for disease prevention, health maintenance, and as complementary therapies, reflecting well-established traditions and beliefs [ 8 – 9 ]. However, research examining the relationship between herbal usage and health literacy is limited, particularly in terms of gender differences and other socio-demographic factors. A study conducted among university students in Ghana explored health literacy within the context of health-seeking behaviours, including preferences for hospitals, self-medication, and the use of herbal medicine. This study found a positive association between health literacy and the use of health facilities; however, it did not establish a direct relationship between health literacy and self-medication or the use of herbal medicine. This suggests that different dynamics may govern the use of herbal medicine compared to conventional healthcare seeking [ 10 ]. Research conducted on elderly patients with chronic illnesses in China indicates that health literacy levels, along with the factors influencing them, vary by gender and other demographic variables. Factors such as educational attainment, income, the duration of chronic diseases, and treatment modalities (Western medicine versus a combination of Western medicine and traditional Chinese medicine) impact health literacy differently for males and females. Notably, older women with limited education and prolonged disease duration, who opted for a mixed approach to treatment, display lower levels of health literacy. This highlights the importance of assessing education, chronic illness history, and treatment preferences in relation to health literacy and the use of herbal or traditional medicine [ 5 ]. Further research highlights that socio-demographic factors, including ethnicity, age, and the affordability of healthcare, have a significant impact on health literacy and healthcare-seeking behaviours. These factors also encompass attitudes towards primary care and the potential use of traditional remedies, although they are often not studied independently in relation to herbal use [ 11 ]. Past studies have largely overlooked the complex interplay of variables such as age, ethnicity, educational level, chronic illness history, and healthcare-seeking behaviours concerning herbal use and health literacy. Differences in health literacy among ethnic groups might reflect variations in cultural health beliefs. Meanwhile, educational attainment can influence an individual's ability to critically assess health information and their likelihood of seeking guidance from healthcare professionals. Additionally, the presence of chronic illness and the pursuit of medical advice may affect health literacy trajectories and engagement with traditional remedies. This research investigates the relationship between gender, health literacy, and the use of herbal products among a multi-ethnic population of Malaysian adults aged 31 to 60 years. It includes a comprehensive analysis of demographic and health-related variables. Utilising a validated health literacy framework, this study explores culturally embedded traditional health behaviours, offering fresh valuable insights into the intersections of gendered patterns, socio-demographic characteristics, and alternative medicine practices. The findings are crucial for developing gender-sensitive, culturally responsive health promotion strategies that integrate both biomedical and traditional healthcare systems, ultimately enhancing health outcomes across diverse populations. Methodology Study Design and Participants This cross-sectional study aimed to investigate gender-based differences in health literacy and its correlation with sociodemographic characteristics and the use of natural herbal products. A total of 810 Malaysian adults were recruited through stratified sampling from a variety of urban and semi-urban communities. Participants were required to be between the ages of 31 and 60, capable of providing informed consent, and literate in either Malay or English. The study received approval from the relevant institutional ethics committee (refer Ethical Considerations), and written informed consent was obtained from all participants. Health Literacy Evaluation The evaluation of health literacy was conducted using the Malaysian adaptation of the European Health Literacy Survey Questionnaire Short Form (HLS-M-Q18), a validated instrument designed to assess an individual's ability to access, comprehend, evaluate, and utilise health-related information [12]. The HLS-M-Q18 generates a composite index that categorises health literacy into four distinct levels: inadequate, problematic, sufficient, and excellent. Sociodemographic and Herbal Use Data Participants provided details regarding their age, gender, ethnicity, educational background, and history of chronic illness. They were asked about their engagement with medical services, specifically whether they had sought advice from a doctor, as well as their use of natural herbal products. The duration of use was classified into the following categories: less than 1 year, 1–3 years, 4–6 years, 7–10 years, and more than 10 years. Data Coding For the purpose of analysis: Health literacy was divided into two groups: satisfied (those who rated it as excellent or sufficient) and unsatisfied (those who rated it as problematic or inadequate). Gender was categorised as female (the reference group) and male. We classified the duration of herbal product use and consultation behaviours based on the participants’ responses. Statistical Analysis Data were analysed using SPSS version 27. Descriptive statistics were applied to summarise demographic variables and levels of health literacy. To explore the relationships between participant characteristics and satisfaction with health literacy status, binary logistic regression was performed. The regression model included the following variables: age group, gender, race, education level, presence of chronic illness, history of seeking medical consultation, and usage of herbal products. The model's fit was assessed using the Hosmer and Lemeshow test, while the variance explained was measured through Nagelkerke R². Statistical significance was set at p < 0.05. Analysis Based on Sex Comparative analyses were performed between male and female participants for all key variables to align with the journal's emphasis on gender differences. Special attention was given to gender-specific variations in health literacy scores, trends in the use of herbal products, and engagement with the healthcare system. Ethical Considerations This study was conducted in accordance with the Guidelines for Ethical Review of Clinical Research or Research Involving Human Subjects (Medical Research and Ethics Committee [MREC], 2006) and the CIOMS International Ethical Guidelines for Health-Related Research Involving Humans (2016) [13 - 14]. The study protocol was determined to be exempt from full ethics review as it involved minimal risk and no collection of identifiable personal information. Therefore, no formal approval number was issued. Participation was entirely voluntary, and verbal informed consent was obtained from all respondents prior to participation. 1. Medical Research and Ethics Committee. (2006). Guidelines for ethical review of clinical research or research involving human subjects. Ministry of Health Malaysia. Retrieved from https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.ummc.edu.my/files/ethic/MCHRS/1%2520General/Guidelines%2520For% 2520Ethical%2520Review%2520Of%2520Clinical%2520Research%2520Or%2520Research%2520 Involving%2520Human%2520Subjects.pdf&ved=2ahUKEwifN_N94uQAxV7z6ACHe02CYoQFnoECGEQAQ&usg=AOvVaw0_tIFK_LzlraW6arg9kIpz. 2. Council for International Organizations of Medical Sciences (CIOMS). (2016). International ethical guidelines for health-related research involving humans. Geneva: CIOMS. Retrieved fromhttps://www.google.com.my/books/edition/International_ethical_guidelines_for_hea/T1ZUEQAAQBAJ?hl=en&gbpv=1 Results Demographic Characteristics Table 1 presents an analysis of health literacy levels among 810 respondents, utilising the HLS-M-Q18 instrument. The HLS-M-Q18 index, which ranges from inadequate to excellent, serves as a comprehensive measure of an individual's ability to access, understand, evaluate, and apply health information. The findings of this study indicated that the majority of respondents exhibited sufficient (37.4%) and problematic (27.7%) health literacy levels, while only 9.1% demonstrated inadequate health literacy. Notably, 25.8% of respondents achieved an excellent level of health literacy. From a descriptive standpoint, the most represented age group was 31–40 years, comprising 52.2% of respondents, followed by those aged 41–50 years at 26.7%, and 51–60 years at 21.1%. Health literacy showed a gradual improvement as age decreased, with individuals aged 31–40 years reporting the highest percentage of excellent health literacy at 27.4%. In terms of gender distribution, females made up the majority at 69.6%, with a greater likelihood of reporting sufficient (37.9%) and excellent (28.4%) literacy levels. Male respondents, who represented 30.4% of the total, exhibited a slightly lower sufficient literacy level at (36.2%) and a more noticeable gap in the excellent literacy level, achieving only 19.9%. The ethnic composition revealed that Malay respondents constituted the largest group (77.5%), followed by Chinese (11.9%), Indians (4.1%), and Others (6.5%). Notably, respondents from other ethnic backgrounds reported a higher percentage of excellent literacy (37.7%) compared to Malays (25.5%), Chinese ( 22.9%) and Indians (21.2%). Interestingly, Indians showed the highest sufficient literacy level among all racial groups at 45.5%. In terms of educational attainment, the largest group of respondents held bachelor’s degrees (43.7%), followed by those with SPM/O-Level qualifications (21.1%), diplomas (15.4%), and master's degrees (12.8%). Among respondents with PhDs, the rate of excellent health literacy was the highest at 30.4%, although this statistic may be influenced by additional factors such as knowledge or experience. A significant majority (80.5%) reported having no chronic illnesses. Interestingly, among those with a history of chronic illness, 30.4% achieved excellent health literacy, surpassing the 24.7% reported by those without chronic conditions. When asked about seeking medical advice, 64.2% of respondents chose "Not Applicable." Among those who did seek a doctor's advice, the rate of excellent health literacy was the highest at 28.9%. Additionally, 42.5% of respondents reported using herbal products; however, those who had never engaged in such practices demonstrated a higher rate of sufficient health literacy at 26.8%, compared to 24.4% among users. Notably, the percentage of respondents with sufficient health literacy was markedly higher among herbal practitioners at 39.8%, compared to 35.6% for non-practitioners. In terms of the duration of herbal product use, the majority of users fell under the "Not Applicable" category (58.0%); nonetheless, those with more extended usage periods (over 10 years) showed slightly elevated rates of excellent literacy at 29.6%. Overall, these descriptive characteristics provide a foundational understanding of the demographic and behavioural factors contributing to health literacy outcomes. Table 1 . Distribution of respondent characteristics and health literacy levels using HLS-M-Q18 (N = 810). Health Literacy Level N (%) N (%) 0 1 2 3 Age range 0 423 116 160 115 32 52.2% 27.4% 37.8% 27.2% 7.6% 1 216 53 86 56 21 26.7% 24.5% 39.8% 25.9% 9.7% 2 171 40 57 53 21 21.1% 23.4% 33.3% 31.0% 12.3% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Gender 0 564 160 214 138 52 69.6% 28.4% 37.9% 24.5% 9.2% 1 246 49 89 86 22 30.4% 19.9% 36.2% 35.0% 8.9% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Race 0 628 160 241 180 47 77.5% 25.5% 38.4% 28.7% 7.5% 1 96 22 30 29 15 11.9% 22.9% 31.3% 30.2% 15.6% 2 33 7 15 6 5 4.1% 21.2% 45.5% 18.2% 15.2% 3 53 20 17 9 7 6.5% 37.7% 32.1% 17.0% 13.2% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Highest level of education 0 171 45 55 41 30 21.1% 26.3% 32.2% 24.0% 17.5% 1 125 34 46 34 11 15.4% 27.2% 36.8% 27.2% 8.8% 2 354 86 144 108 16 43.7% 24.3% 40.7% 30.5% 4.5% 3 104 29 39 28 8 12.8% 27.9% 37.5% 26.9% 7.7% 4 23 7 9 5 2 2.8% 30.4% 39.1% 21.7% 8.7% 5 33 8 10 8 7 4.1% 24.2% 30.3% 24.2% 21.2% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Do you have a history of chronic illness? 0 158 48 52 39 19 19.5% 30.4% 32.9% 24.7% 12.0% 1 652 161 251 185 55 80.5% 24.7% 38.5% 28.4% 8.4% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Have you sought a doctor's advice for the disease mentioned? 0 235 68 89 50 28 29.0% 28.9% 37.9% 21.3% 11.9% 1 55 8 12 25 10 6.8% 14.5% 21.8% 45.5% 18.2% 2 520 133 202 149 36 64.2% 25.6% 38.8% 28.7% 6.9% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Have you ever practised the diet of natural herbal products (Even if only once)? 0 344 84 137 101 22 42.5% 24.4% 39.8% 29.4% 6.4% 1 466 125 166 123 52 57.5% 26.8% 35.6% 26.4% 11.2% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Duration of intake of natural herbal products (years) 0 27 8 10 6 3 3.30% 29.6% 37.0% 22.2% 11.1% 1 11 3 4 4 0 1.40% 27.3% 36.4% 36.4% 0.0% 2 30 7 10 11 2 3.70% 23.3% 33.3% 36.7% 6.7% 3 93 23 36 25 9 11.50% 24.7% 38.7% 26.9% 9.7% 4 179 39 80 53 7 22.10% 21.8% 44.7% 29.6% 3.9% 5 470 129 163 125 53 58.00% 27.4% 34.7% 26.6% 11.3% Total 810 209 303 224 74 100.0% 25.8% 37.4% 27.7% 9.1% Health Literacy: 0=Excellent, 1=Sufficient, 2=Problematic, 3=Inadequate Age Range: 0=31-40, 1=41-50, 2=51-60 Gender: 0=Female, 1=Male Race: 0=Malay, 1=Chinese, 2=Indians, 3=Others Highest Education Level: 0=SPM/O-level/IGCSE, 1=Diploma, 2=Bachelor, 3=Masters, 4=PhD, 5=Others Do you have a history of chronic illness?: 0=Yes, 1=No Have you sought a doctor's advice for the disease mentioned?: 0=Yes, 1=No, 2=NA Have you ever practiced the diet of natural herbal products (Even if only once)?: 0=Yes, 1=No Duration of intake of natural herbal products (years): 0=>10, 1=(7 – 10), 2=(4 – 6), 3=(1 – 3), 4=<1, 5=NA Several socio-demographic characteristics were linked to health literacy levels, as depicted in Table 2 . These characteristics included health status, health problems, and age. The logistic regression model demonstrated statistical significance, χ2 (4) = 49.285, p 0.05). A more detailed analysis using binary logistic regression uncovered significant associations between particular variables and the probability of reporting satisfactory health literacy (defined as "excellent" or "sufficient") versus unsatisfactory health literacy ("problematic" or "inadequate") (see Table 2). Male gender was significantly correlated with lower odds of achieving satisfactory health literacy (OR = 1.473, p = 0.017), suggesting that males were nearly 1.5 times less likely than females to attain satisfactory levels of health literacy. This may reflect gender-based differences in health information-seeking behaviour or engagement with digital health resources. One of the most notable findings was the correlation between health literacy and the act of seeking medical advice. Respondents who had not sought a doctor's guidance were over 4.4 times less likely to report satisfactory health literacy (OR = 4.479, p < 0.001). This suggests a potential connection between lower health literacy and decreased engagement with formal healthcare services, as those who did not seek a doctor's advice were significantly less likely to indicate satisfactory health literacy. Rather than demonstrating informed self-care, this trend may indicate a lack of confidence in navigating health information or recognising when professional medical advice is necessary. Other variables, including age range, race, educational level, chronic illness status, and herbal product use, did not demonstrate statistically significant relationships with health literacy status in the multivariate analysis. Although trends were noted in the descriptive statistics, these factors did not independently predict literacy outcomes when adjusted for other covariates. Notably, while older respondents tended to display better literacy, this relationship was not statistically validated (p > 0.05). Education, often considered a significant predictor, did not reach significance in this model, likely due to the confounding effects of other variables like health experience or access to information. Table 2 . Odds ratios (95% confidence intervals) of having satisfied health literacy vs. unsatisfied health literacy (N = 810). Health Literacy (Unsatisfied = 1) Sig. Exp(B) 95% C.I.for EXP(B) Lower Upper a Age range Age range (41-50) 0.972 1.007 0.693 1.462 Age range (51-60) 0.155 1.348 0.893 2.035 b Gender (Male) 0.017 1.473 1.071 2.026 c Race Race (Chinese) 0.157 1.400 0.879 2.232 Race (Indians) 0.911 0.957 0.445 2.059 Race (Others) 0.361 0.746 0.398 1.399 d Highest level of education Highest level of education (Diploma) 0.467 0.830 0.503 1.371 Highest level of education (Bachelor) 0.338 0.823 0.552 1.227 Highest level of education (Master's) 0.512 0.837 0.493 1.423 Highest level of education (PhD) 0.373 0.645 0.246 1.690 Highest level of education (Other) 0.579 1.246 0.573 2.705 e Do you have a history of chronic illness? (No) 0.179 0.659 0.358 1.211 f Have you sought a doctor's advice for the disease mentioned? Have you sought a doctor's advice for the disease mentioned? (No) 0.000 4.479 2.102 9.544 Have you sought a doctor's advice for the disease mentioned? (NA) 0.080 1.632 0.944 2.822 g Have you ever practised the diet of natural herbal products (Even if only once)? (No) 0.896 0.957 0.497 1.845 h Duration of intake of natural herbal products (years) Duration of intake of natural herbal products (years) (7 - 10) 0.563 1.566 0.343 7.157 Duration of intake of natural herbal products (years) (4 - 6) 0.356 1.697 0.552 5.224 Duration of intake of natural herbal products (years) (1 - 3) 0.497 1.392 0.535 3.620 Duration of intake of natural herbal products (years) (<1) 0.687 1.205 0.487 2.980 Duration of intake of natural herbal products (years) (NA) 0.437 1.529 0.524 4.456 a Respondents age range, 31-40 years used as a reference. b Female respondents were used as a reference. c Respondents who stated their race as “Malay” used as a reference. d Respondents with the highest level of education of SPM/O-level/IGCSE used as a reference. e Respondents who stated to have a history of chronic illness were used as a reference. Respondents who stated that to sought a doctor's advice for the disease mentioned used as a reference. g Respondents who stated to have ever practiced the diet of natural herbal products (Even if only once) used as a reference. h Respondents who stated to intake of natural herbal products for>10 years) used as a reference. Cells in grey colour nominated significant value (p<0.05) In summary, the regression analysis identifies gender and health-seeking behaviour as the key determinants of health literacy satisfaction levels within this dataset. The notable correlation between male gender and lower health literacy, coupled with the strong link between avoidance of medical consultations and a diminished likelihood of reporting satisfaction with health literacy, underscores the importance of health literacy promotion strategies that tackle barriers to seeking help and engaging with health information. These findings emphasise the necessity for targeted interventions that take into account gender-specific behaviours and encourage proactive health information-seeking, particularly among men and those less inclined to consult healthcare professionals. Discussion This study offers valuable insights into the gender-based differences in health literacy and the use of herbal medicine among working-age individuals in Malaysia. Utilising the validated HLS-M-Q18 test, we found that 63.2% of respondents achieved satisfactory health literacy; however, men were notably less likely than women to meet this standard. Additionally, the avoidance of formal medical consultation emerged as the most significant negative predictor of adequate health literacy. These findings highlight the behavioural and attitudinal challenges that men face, which hinder their access to health information and may worsen health outcomes. These findings align with existing literature, which indicates that women tend to exceed men in health literacy across various contexts. For instance, [ 4 ] documented similar trends among European groups with migration backgrounds, while [ 15 ] observed comparable gender differences in Asian contexts. These patterns are attributed to differences in health information-seeking behaviors, adherence to male gender norms, and lower engagement with healthcare services among men.[ 16 ] pointed out that women generally display a greater understanding and utilisation of health resources, a trend that remains evident among patients in physiotherapy and rehabilitation, where women's health literacy outpaces that of men [ 17 ]. Our findings further reinforce the existence of gender-based disparities in health literacy, suggesting that culturally influenced male norms and health practices may significantly affect literacy outcomes. In Malaysia, cultural norms and gender expectations may significantly influence men's lower utilisation of health services. [ 18 ] found that men are often less likely to seek preventive care and tend to delay medical consultations. Our study's observation of a strong correlation between the avoidance of medical consultations and lower health literacy aligns with existing literature, underscoring the urgent need for targeted interventions that address the specific barriers men face in engaging with healthcare [ 18 – 19 ]. Recognising these challenges, the Malaysian Ministry of Health has implemented the National Men's Health Plan of Action (2018–2023), aimed at closing the gender gap in health service utilisation by fostering gender-sensitive approaches and enhancing men's health outcomes [ 20 ]. Previous studies investigating health literacy and the use of herbal remedies have produced mixed findings. [ 21 ] indicate that individuals who actively seek information about the safety and interactions of herbal products are more likely to use them. In contrast, [ 22 ] underscore the dangers of unregulated reliance on herbal remedies, which can result in the spread of misinformation. Our observations suggest that extensive involvement in traditional health practices may encourage a more proactive and informed approach to health-related inquiries. Notably, we discovered that long-term users of herbal remedies (those who have been using them for over ten years) exhibit a greater proportion of excellent health literacy. This insight may identify a subset of herbal practitioners who possess a strong understanding of both conventional and alternative medicine, thereby enhancing our comprehension of the cultural practices that shape health literacy. Comparative regional studies provide valuable contextual insights. A survey on health literacy in Thailand indicated that the most significant challenge faced by disadvantaged socioeconomic groups, including individuals with lower education levels and those with hearing impairments, was accessing reliable information about herbal and food supplements. Notably, gender significantly influenced this challenge [ 23 ]. In rural Malaysia, gender disparities were evident in perceptions and attitudes toward complementary and alternative medicine (CAM), including herbal medicine. Women tended to regard CAM as beneficial and safe, a perspective less commonly held by men [ 24 ]. Our research builds on these previous findings by not only examining views and prevalence of use but also exploring the relationship between herbal usage and health literacy, particularly among long-term users. In addition, research conducted in Malaysia regarding knowledge and attitudes toward Traditional Chinese Medicine (TCM) revealed significant disparities influenced by gender, educational level, and ethnicity. Women, individuals with higher education, and certain ethnic groups demonstrated greater awareness of TCM [ 25 – 26 ]. These findings are consistent with the existing literature, highlighting the importance of socio-demographic factors. However, our study advances this understanding by incorporating these variables into a gender-based framework related to literacy outcomes. This study presents a novel integration of gender-based analysis with culturally embedded herbal medicine practices among a diverse, multi-ethnic population in Southeast Asia, while controlling for socio-demographic factors such as age, ethnicity, education, and a history of chronic illness. Previous research in Malaysia has typically examined health literacy in isolation or focused exclusively on the prevalence of herbal medicine use, often overlooking the interplay between literacy and gender differences [ 27 – 29 ]. By connecting these essential domains, this study addresses a significant gap in the literature and lays the groundwork for developing gender-sensitive, culturally responsive health promotion strategies. The multidimensional integration of gender, health literacy, herbal medicine engagement, and critical socio-demographic factors in this study represents a distinctive feature, offering a broader perspective than the unidimensional approaches commonly found in previous research. Notably, the finding that long-term herbal consumers may demonstrate higher health literacy highlights the existence of a potentially informed subgroup, suggesting that cultural practices could serve as valuable entry points for targeted literacy interventions. Furthermore, this study delivers policy-relevant insights for the development of culturally tailored and gender-responsive public health strategies by framing health literacy within the context of medical consultation behaviours and traditional practices. This evidence directly aligns with national priorities, such as Malaysia's Men's Health Plan. It highlights the urgent need to integrate biomedical and traditional healthcare systems to enhance health outcomes and equity among diverse populations. Conclusion This research offers new insights into the interplay between gender differences, health literacy, and the use of natural herbal products within a diverse Malaysian population. Utilising the HLS-M-Q18 measure, our findings reveal that being male is significantly associated with decreased odds of achieving satisfactory health literacy. At the same time, the avoidance of formal medical consultation stands out as the most prominent negative predictor. Although herbal use was not identified as an independent determinant, long-term users (those engaging for over 10 years) exhibited a higher proportion of excellent health literacy, suggesting potential benefits associated with sustained involvement in traditional health practices. The integration of gender-sensitive analysis with culturally ingrained herbal medicine practices provides a noteworthy contribution to the literature on health literacy, particularly within pluralistic healthcare systems. These findings highlight the urgency for culturally tailored, gender-sensitive interventions that address barriers to healthcare engagement among men and promote informed, safe use of herbal remedies. Such strategies may enhance preventive health behaviours, facilitate the integration of biomedical and traditional health frameworks, and inform policy measures aimed at improving health outcomes across diverse populations. Declarations Acknowledgement The research was funded by the Universiti Kebangsaan Malaysia (UKM) through the Dana Luar (Antarabangsa), grant numbers DPK-GPS-JORDAN-2024-022. Special thanks to Universiti Kebangsaan Malaysia for supporting this research. Funding This study was supported by the Universiti Kebangsaan Malaysia (UKM) through the Dana Luar (Antarabangsa), grant numbers DPK-GPS-JORDAN-2024-022. The funder provided funding to conduct surveys related to this research. Still, it did not have a significant role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. Contributions Yusnaini Md Yusoff, Wardah Mustafa Din, Azlan Abdul Rahim, Halizah Omar, Noor Sharizad Rusly, Ahmad Firdhaus Arham and Nurul Hanis Aminuddin Jafry conceptualised the study and supervised the project. Yusnaini Md Yusoff, Wardah Mustafa Din, Azlan Abdul Rahim and Ahmad Firdhaus Arham prepared the original draft, developed the methodology, validated the findings, and conducted the formal analysis. Yusnaini Md Yusoff reviewed and edited the manuscript. Yusnaini Md Yusoff, Azlan Abdul Rahim and Wardah Mustafa Din acquired funding and conducted the final review of the study. Corresponding authors Correspondence to Yusnaini Md Yusoff and Azlan Abdul Rahim. Ethics declarations Competing interests The authors declare no competing interests. Ethical approval This minimal-risk survey did not involve personal identifiers or sensitive data. It was therefore exempt from formal ethical clearance under the Guidelines for Ethical Review of Clinical Research or Research Involving Human Subjects (Medical Research and Ethics Committee [MREC]) and the CIOMS International Ethical Guidelines for Health-Related Research Involving Humans . The study adhered to institutional ethical standards, ensuring anonymity, voluntary participation, and the protection of participants’ rights. 1. Medical Research and Ethics Committee. (2006). Guidelines for ethical review of clinical research or research involving human subjects. Ministry of Health Malaysia. Retrieved from https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.ummc.edu.my /files/ethic/MCHRS/1%2520General/Guidelines%2520For%2520Ethical%2520Review%2520Of%2520Clinical%2520Research%2520Or% 2520Research%2520Involving%2520Human%2520Subjects.pdf&ved=2ahUKEwifN_N94uQAxV7z6ACHe02CYoQFnoECGEQAQ&usg=AOvVaw0_tIFK_LzlraW6arg9kIpz. 2. Council for International Organizations of Medical Sciences (CIOMS). (2016). International ethical guidelines for health-related research involving humans. Geneva: CIOMS. Retrieved fromhttps://www.google.com.my/books/edition/International_ethical_guidelines_for_hea/T1ZUEQAAQBAJ?hl=en&gbpv=1 Informed Consent Statement Participation in this study was entirely voluntary. The online questionnaire included a statement informing potential respondents about the purpose of the study and their right to withdraw at any time. Consent was implied through the completion and submission of the questionnaire. No personally identifiable information was collected. The survey was conducted by the authors between [November 2023] and [December 2023]. Data Availability Statement The datasets generated and analysed during the current study are not publicly available due to privacy considerations but are available from the corresponding author upon reasonable request. All relevant data supporting the findings are included within the manuscript. References Zaidi SF, Saeed SA, Khan MA, Khan A, Hazazi Y, Otayn M, Rabah M, Daniyal M (2022) Public knowledge, attitudes, and practices towards herbal medicines; a cross-sectional study in Western Saudi Arabia. BMC Complement Med Ther 22(1):326 Sørensen K (2019) Defining health literacy: Exploring differences and commonalities. International handbook of health literacy. Bristol University, pp 5–20 Sørensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, Falcon M (2015) Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J public health 25(6):1053–1058 Chakraverty D, Baumeister A, Aldin A, Seven ÜS, Monsef I, Skoetz N, Woopen C, Kalbe E (2022) Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis. BMJ open 12(7):e056090 Sun S, Lu J, Wang Y, Wang Y, Wu L, Zhu S, Zheng X, Lu X, Xu H (2022) Gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases: A cross-sectional study. Frontiers in Public Health, 10, p.944103 Kadier A, Ablimit M, Jie WM, Ye DX, Qi BJ, Yi LY, Run ZT, Tursun H, Ablat N (2025) The western transmission of traditional Chinese medicine: an investigation of the cultural elements of traditional Chinese medicine in biomedical systems of cross-Asia countries. Frontiers in Pharmacology, 16, p.1589275 Tengku Mohamad TAS, Islahudin F, Jasamai M, Jamal JA (2019) Preference, perception and predictors of herbal medicine use among Malay women in Malaysia. Patient preference and adherence, pp 1829–1837 Mazlan NW, Tate R, Yusoff YM, Clements C, Edrada-Ebel R (2020) Metabolomics-guided isolation of anti-trypanosomal compounds from endophytic fungi of the mangrove plant Avicennia lanata. Curr Med Chem 27(11):1815–1835 Yusoff YM, Abbott G, Young L, Edrada-Ebel R (2022) Metabolomic profiling of Malaysian and New Zealand honey using concatenated NMR and HRMS datasets. Metabolites, 12(1), p.85 Akakpo MG, Neuerer M (2024) The relationship between health literacy and health-seeking behavior amongst university students in Ghana: A cross‐sectional study. Health Sci Rep 7(5):e2153 Rata Mohan DS, Jawahir S, Manual A, Abdul Mutalib NE, Noh M, Rahim SNA, Hamid IA, J. and, Nordin A (2025) A., Gender differences in health-seeking behaviour: insights from the National Health and Morbidity Survey 2019. BMC Health Services Research, 25(1), p.900 Azlan AA, Hamzah MR, Tham JS, Ayub SH, Ahmad AL, Mohamad E (2021) Associations between health literacy and sociodemographic factors: A cross-sectional study in Malaysia utilising the HLS-M-Q18. International journal of environmental research and public health, 18(9), p.4860 Guidelines for ethical review of clinical research or research involving human subjects. Ministry of Health Malaysia. Available at https://www.google.com Medical Research and Ethics Committee, url?sa=t&source=web&rct=j&opi=89978449& (2006) url=https://www.ummc.edu.my/files/ethic/MCHRS/1%2520General/Guidelines%2520For%2520Ethical%2520Review %2520Of%2520Clinical%2520Research%2520Or%2520Research%2520Involving%2520Human%2520Subjects.pdf&ved=2ahUKEwif- N_N94uQAxV7z6ACHe02CYoQFnoECGEQAQ&usg=AOvVaw0_tIFK_LzlraW6arg9kIpz (Accessed October, 2025) Council for International Organizations of Medical Sciences (CIOMS) (2016) International ethical guidelines for health-related research involving humans. Geneva: CIOMS. Available at https://doi.org/10.56759/rgxl7405 (Accessed October, 2025) Lee HY, Lee J, Kim NK (2015) Gender differences in health literacy among Korean adults: do women have a higher level of health literacy than men? Am J Men's Health 9(5):370–379 Heizomi H, Iraji Z, Vaezi R, Bhalla D, Morisky DE, Nadrian H (2020) Gender differences in the associations between health literacy and medication adherence in hypertension: a population-based survey in Heris County, Iran. Vascular health and risk management, pp.157–166 Gökşen A, Erden Z, Kınıklı Gİ (2022) Investigation of health literacy by gender in individuals receiving physiotherapy and rehabilitation services. J Exerc Therapy Rehabilitation 9(3):205–213 Mohamed-Yassin MS, Daher AM, Ramli AS, Ramli NF, Baharudin N (2023) Health literacy-related knowledge, attitude, perceived barriers, and practice among primary care doctors in Malaysia. Scientific Reports, 13(1), p.19814 Jaafar N, Perialathan K, Krishnan M, Juatan N, Ahmad M, Mien TYS, Salleh KZ, Isa A, Mohamed SS, Hanit NHA, Hasani WSR (2021) Malaysian health literacy: scorecard performance from a national survey. International journal of environmental research and public health, 18(11), p.5813 Family Health Development Division (2025) Ministry of Health Malaysia, National Men’s Health Plan of Action Malaysia 2018–2023. Available at https://hq.moh.gov.my/bpkk/images/3.Penerbitan/2.Orang_Awam/5.Kesihatan_Dewasa/2.PDF/5Mens_Health_Plan_of_Action_Malaysia.pdf (Accessed Yusoff YM, Din WM, Jafry NHA, Rahim AA, Rusly NS, Arham AF, Aziz MF, Nazri NS, Hasim NA, Yaacob M (2024) Knowledge And Perception Regarding Safe-Use of Natural Health Products Among Undergraduates. J Ecohumanism 3(8):6552–6562 Roziman NSM, Mustafa Din W, Mahadi Z, Islahudin F, Said MM (2024) Safe use elements of finished herbal products: insights from consumers and practitioners in Malaysia. BMC Complementary Medicine and Therapies, 24(1), p.252 Khampang R, Kloyiam S, Butchon R (2022) Relationship between socioeconomic, demographic, health and social characteristics and ability to access reliable information on herbal and food supplements: analysis of Thai Health Literacy Survey 2019. BMC Public Health, 22(1), p.1054 Teow YEE, Mathialagan A, Ng SC, Tee HYO, Thomas W (2021) Gender Differences in Beliefs and Attitudes Towards Complementary and Alternative Medicine Use Among a Non-urban, Malaysian Population. J Community Health 46(4):645–652 Mohiuddin SG, Aziz S, Ahmed R, Ghadzi SMS, Iqbal MZ, Iqbal MS (2021) Use of traditional Chinese medicine in Malaysia: A knowledge and practice study among general population toward complementary and alternative medicine in relation to health and quality of life in Malaysia. J Pharm Bioallied Sci 13(1):102–107 Kumar S, Rajiah K, Veettil SK, Wei NS (2015) A cross-sectional study on knowledge and attitude toward Traditional Chinese Medicine (TCM) among adults in selected regions of Malaysia. J Complement Integr Med 12(4):317–323 Din W, Mustafa Z, Mahadi AF, Arham YM, Yusoff, Latifah Amin (2025) Construct for use and Recurring use of Natural Health Products: Qualitative Insights from Consumers in Malaysia. Int J Res Innov Social Sci 9(5):2073–2082 Din WM, Arham AF, Yusoff YM (2024) Set of data on consumers' perceived safety and efficacy towards natural health products to control or cure Covid-19 viruses in Malaysia. Data in Brief, 54, p.110548 Boon TK, Buchari NAB, Boudville HM, Balasubramaniam R, Esuthasu H, Kanapathipillai K (2023) From roots to remedies: a deep dive into customer satisfaction with herbal medicine in Klang valley, Malaysia. Eur J Public Health Stud, 6(2) Additional Declarations No competing interests reported. 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traditional herbal remedies, there remains a limited understanding of how these culturally ingrained practices relate to gender-based disparities in health literacy, a crucial factor influencing health outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Health literacy is defined as the ability of individuals to access, comprehend, assess, and utilise health information and services to promote and maintain good health, support informed health decisions, engage in preventive measures, and effectively manage illnesses. This competency involves more than just reading health materials; it encompasses various skills, knowledge, motivation, and the ability to critically apply information in everyday life concerning healthcare, illness prevention, and health promotion [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Such competencies impact broader health outcomes, including reduced hospitalisations and emergency visits, improved utilisation of preventive services, and decreased healthcare expenditures. Low health literacy is associated with adverse health outcomes, delayed access to care, and inadequate health management, particularly among older adults, individuals with lower educational attainment or income, and those with chronic illnesses. Health literacy is recognised as both an individual competency and a systemic characteristic. The health literacy environment, which encompasses the structures and policies of the healthcare system, as well as the quality of communication, plays a significant role in either facilitating or obstructing adequate health literacy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Research demonstrates that health literacy varies by gender, with women generally showing higher levels of engagement in seeking health information and adopting preventive health behaviours compared to men [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This disparity is influenced by a combination of biological, behavioural, and socio-cultural factors [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Malaysia and various Asian societies, the use of natural herbal products is a longstanding and culturally valued practice that often complements biomedical healthcare [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Herbal remedies are frequently employed for disease prevention, health maintenance, and as complementary therapies, reflecting well-established traditions and beliefs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, research examining the relationship between herbal usage and health literacy is limited, particularly in terms of gender differences and other socio-demographic factors. A study conducted among university students in Ghana explored health literacy within the context of health-seeking behaviours, including preferences for hospitals, self-medication, and the use of herbal medicine. This study found a positive association between health literacy and the use of health facilities; however, it did not establish a direct relationship between health literacy and self-medication or the use of herbal medicine. This suggests that different dynamics may govern the use of herbal medicine compared to conventional healthcare seeking [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch conducted on elderly patients with chronic illnesses in China indicates that health literacy levels, along with the factors influencing them, vary by gender and other demographic variables. Factors such as educational attainment, income, the duration of chronic diseases, and treatment modalities (Western medicine versus a combination of Western medicine and traditional Chinese medicine) impact health literacy differently for males and females. Notably, older women with limited education and prolonged disease duration, who opted for a mixed approach to treatment, display lower levels of health literacy. This highlights the importance of assessing education, chronic illness history, and treatment preferences in relation to health literacy and the use of herbal or traditional medicine [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurther research highlights that socio-demographic factors, including ethnicity, age, and the affordability of healthcare, have a significant impact on health literacy and healthcare-seeking behaviours. These factors also encompass attitudes towards primary care and the potential use of traditional remedies, although they are often not studied independently in relation to herbal use [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Past studies have largely overlooked the complex interplay of variables such as age, ethnicity, educational level, chronic illness history, and healthcare-seeking behaviours concerning herbal use and health literacy. Differences in health literacy among ethnic groups might reflect variations in cultural health beliefs. Meanwhile, educational attainment can influence an individual's ability to critically assess health information and their likelihood of seeking guidance from healthcare professionals. Additionally, the presence of chronic illness and the pursuit of medical advice may affect health literacy trajectories and engagement with traditional remedies.\u003c/p\u003e\u003cp\u003eThis research investigates the relationship between gender, health literacy, and the use of herbal products among a multi-ethnic population of Malaysian adults aged 31 to 60 years. It includes a comprehensive analysis of demographic and health-related variables. Utilising a validated health literacy framework, this study explores culturally embedded traditional health behaviours, offering fresh valuable insights into the intersections of gendered patterns, socio-demographic characteristics, and alternative medicine practices. The findings are crucial for developing gender-sensitive, culturally responsive health promotion strategies that integrate both biomedical and traditional healthcare systems, ultimately enhancing health outcomes across diverse populations.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cem\u003eStudy Design and Participants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study aimed to investigate gender-based differences in health literacy and its correlation with sociodemographic characteristics and the use of natural herbal products. A total of 810 Malaysian adults were recruited through stratified sampling from a variety of urban and semi-urban communities. Participants were required to be between the ages of 31 and 60, capable of providing informed consent, and literate in either Malay or English. The study received approval from the relevant institutional ethics committee (refer Ethical Considerations), and written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHealth Literacy Evaluation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe evaluation of health literacy was conducted using the Malaysian adaptation of the European Health Literacy Survey Questionnaire Short Form (HLS-M-Q18), a validated instrument designed to assess an individual\u0026apos;s ability to access, comprehend, evaluate, and utilise health-related information [12]. The HLS-M-Q18 generates a composite index that categorises health literacy into four distinct levels: inadequate, problematic, sufficient, and excellent.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSociodemographic and Herbal Use Data\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants provided details regarding their age, gender, ethnicity, educational background, and history of chronic illness. They were asked about their engagement with medical services, specifically whether they had sought advice from a doctor, as well as their use of natural herbal products. The duration of use was classified into the following categories: less than 1 year, 1\u0026ndash;3 years, 4\u0026ndash;6 years, 7\u0026ndash;10 years, and more than 10 years.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Coding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor the purpose of analysis:\u003c/p\u003e\n\u003cp\u003eHealth literacy was divided into two groups: satisfied (those who rated it as excellent or sufficient) and unsatisfied (those who rated it as problematic or inadequate). Gender was categorised as female (the reference group) and male. We classified the duration of herbal product use and consultation behaviours based on the participants\u0026rsquo; responses.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData were analysed using SPSS version 27. Descriptive statistics were applied to summarise demographic variables and levels of health literacy. To explore the relationships between participant characteristics and satisfaction with health literacy status, binary logistic regression was performed. The regression model included the following variables: age group, gender, race, education level, presence of chronic illness, history of seeking medical consultation, and usage of herbal products.\u003c/p\u003e\n\u003cp\u003eThe model\u0026apos;s fit was assessed using the Hosmer and Lemeshow test, while the variance explained was measured through Nagelkerke R\u0026sup2;. Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalysis Based on Sex\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eComparative analyses were performed between male and female participants for all key variables to align with the journal\u0026apos;s emphasis on gender differences. Special attention was given to gender-specific variations in health literacy scores, trends in the use of herbal products, and engagement with the healthcare system.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical Considerations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Guidelines for Ethical Review of Clinical Research or Research Involving Human Subjects (Medical Research and Ethics Committee [MREC], 2006) and the CIOMS International Ethical Guidelines for Health-Related Research Involving Humans (2016) [13 - 14]. The study protocol was determined to be exempt from full ethics review as it involved minimal risk and no collection of identifiable personal information. Therefore, no formal approval number was issued. Participation was entirely voluntary, and verbal informed consent was obtained from all respondents prior to participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Medical Research and Ethics Committee. (2006). Guidelines for ethical review of clinical research or research involving human subjects. Ministry of Health Malaysia. Retrieved from https://www.google.com/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;opi=89978449\u0026amp;url=https://www.ummc.edu.my/files/ethic/MCHRS/1%2520General/Guidelines%2520For%\u003cbr/\u003e2520Ethical%2520Review%2520Of%2520Clinical%2520Research%2520Or%2520Research%2520\u003cbr/\u003eInvolving%2520Human%2520Subjects.pdf\u0026amp;ved=2ahUKEwifN_N94uQAxV7z6ACHe02CYoQFnoECGEQAQ\u0026amp;usg=AOvVaw0_tIFK_LzlraW6arg9kIpz.\u003c/p\u003e\n\u003cp\u003e2. Council for International Organizations of Medical Sciences (CIOMS). (2016). International ethical guidelines for health-related research involving humans. Geneva: CIOMS. Retrieved fromhttps://www.google.com.my/books/edition/International_ethical_guidelines_for_hea/T1ZUEQAAQBAJ?hl=en\u0026amp;gbpv=1\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eDemographic Characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003epresents an analysis of health literacy levels among 810 respondents, utilising the HLS-M-Q18 instrument. The HLS-M-Q18 index, which ranges from inadequate to excellent, serves as a comprehensive measure of an individual\u0026apos;s ability to access, understand, evaluate, and apply health information. The findings of this study indicated that the majority of respondents exhibited sufficient (37.4%) and problematic (27.7%) health literacy levels, while only 9.1% demonstrated inadequate health literacy. Notably, 25.8% of respondents achieved an excellent level of health literacy.\u003c/p\u003e\n\u003cp\u003eFrom a descriptive standpoint, the most represented age group was 31\u0026ndash;40 years, comprising 52.2% of respondents, followed by those aged 41\u0026ndash;50 years at 26.7%, and 51\u0026ndash;60 years at 21.1%. Health literacy showed a gradual improvement as age decreased, with individuals aged 31\u0026ndash;40 years reporting the highest percentage of excellent health literacy at 27.4%. In terms of gender distribution, females made up the majority at 69.6%, with a greater likelihood of reporting sufficient (37.9%) and excellent (28.4%) literacy levels. Male respondents, who represented 30.4% of the total, exhibited a slightly lower sufficient literacy level at (36.2%) and a more noticeable gap in the excellent literacy level, achieving only 19.9%. The ethnic composition revealed that Malay respondents constituted the largest group (77.5%), followed by Chinese (11.9%), Indians (4.1%), and Others (6.5%). Notably, respondents from other ethnic backgrounds reported a higher percentage of excellent literacy (37.7%) compared to Malays (25.5%), Chinese ( 22.9%) and Indians (21.2%). Interestingly, Indians showed the highest sufficient literacy level among all racial groups at 45.5%.\u003c/p\u003e\n\u003cp\u003eIn terms of educational attainment, the largest group of respondents held bachelor\u0026rsquo;s degrees (43.7%), followed by those with SPM/O-Level qualifications (21.1%), diplomas (15.4%), and master\u0026apos;s degrees (12.8%). Among respondents with PhDs, the rate of excellent health literacy was the highest at 30.4%, although this statistic may be influenced by additional factors such as knowledge or experience. A significant majority (80.5%) reported having no chronic illnesses. Interestingly, among those with a history of chronic illness, 30.4% achieved excellent health literacy, surpassing the 24.7% reported by those without chronic conditions. When asked about seeking medical advice, 64.2% of respondents chose \u0026quot;Not Applicable.\u0026quot; Among those who did seek a doctor\u0026apos;s advice, the rate of excellent health literacy was the highest at 28.9%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, 42.5% of respondents reported using herbal products; however, those who had never engaged in such practices demonstrated a higher rate of sufficient health literacy at 26.8%, compared to 24.4% among users. Notably, the percentage of respondents with sufficient health literacy was markedly higher among herbal practitioners at 39.8%, compared to 35.6% for non-practitioners. In terms of the duration of herbal product use, the majority of users fell under the \u0026quot;Not Applicable\u0026quot; category (58.0%); nonetheless, those with more extended usage periods (over 10 years) showed slightly elevated rates of excellent literacy at 29.6%. Overall, these descriptive characteristics provide a foundational understanding of the demographic and behavioural factors contributing to health literacy outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Distribution of respondent characteristics and health literacy levels using HLS-M-Q18 (N = 810).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 363px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth Literacy Level \u003cem\u003eN\u003c/em\u003e (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eN\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e423\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e52.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e26.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e39.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e21.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e23.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e31.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e12.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e69.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e28.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e30.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e19.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e36.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e35.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e77.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e38.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e28.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e22.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e31.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e30.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e15.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e4.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e15.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e6.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e32.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e17.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e13.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"14\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest level of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e21.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e26.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e32.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e17.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e15.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e36.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e43.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e40.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e30.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e4.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e12.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e26.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e2.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e30.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e39.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e4.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e30.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you have a history of chronic illness?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e19.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e30.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e32.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e12.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e652\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e80.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e38.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e28.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you sought a doctor\u0026apos;s advice for the disease mentioned?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e29.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e28.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e11.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e6.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e14.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e64.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e38.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e28.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e6.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever practised the diet of natural herbal products (Even if only once)?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e42.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e39.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e29.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e6.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e57.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e26.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e35.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e26.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e11.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"14\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of intake of natural herbal products (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e3.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e29.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e22.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e11.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e1.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e36.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e36.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e3.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e23.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e36.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e6.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e11.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e24.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e38.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e26.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e22.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e21.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e44.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e29.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e3.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e58.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e34.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e26.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e11.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e100.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e37.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e27.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 91px;\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eHealth Literacy: 0=Excellent, 1=Sufficient, 2=Problematic, 3=Inadequate\u003c/p\u003e\n\u003cp\u003eAge Range: 0=31-40, 1=41-50, 2=51-60\u003c/p\u003e\n\u003cp\u003eGender: 0=Female, 1=Male\u003c/p\u003e\n\u003cp\u003eRace: 0=Malay, 1=Chinese, 2=Indians, 3=Others\u003c/p\u003e\n\u003cp\u003eHighest Education Level: 0=SPM/O-level/IGCSE, 1=Diploma, 2=Bachelor, 3=Masters, 4=PhD, 5=Others\u003c/p\u003e\n\u003cp\u003eDo you have a history of chronic illness?: 0=Yes, 1=No\u003c/p\u003e\n\u003cp\u003eHave you sought a doctor\u0026apos;s advice for the disease mentioned?: 0=Yes, 1=No, 2=NA\u003c/p\u003e\n\u003cp\u003eHave you ever practiced the diet of natural herbal products (Even if only once)?: 0=Yes, 1=No\u003c/p\u003e\n\u003cp\u003eDuration of intake of natural herbal products (years): 0=\u0026gt;10, 1=(7 \u0026ndash; 10), 2=(4 \u0026ndash; 6), 3=(1 \u0026ndash; 3), 4=\u0026lt;1, 5=NA\u003c/p\u003e\n\u003cp\u003eSeveral socio-demographic characteristics were linked to health literacy levels, as depicted in \u003cstrong\u003eTable 2\u003c/strong\u003e. These characteristics included health status, health problems, and age. The logistic regression model demonstrated statistical significance, \u0026chi;2 (4) = 49.285, p \u0026lt; 0.000, explaining 6.2% of the variance (Nagelkerke R2). The Hosmer and Lemeshow Test indicated that the model fit the data well, with p = 0.562 (\u0026gt;0.05). A more detailed analysis using binary logistic regression uncovered significant associations between particular variables and the probability of reporting satisfactory health literacy (defined as \u0026quot;excellent\u0026quot; or \u0026quot;sufficient\u0026quot;) versus unsatisfactory health literacy (\u0026quot;problematic\u0026quot; or \u0026quot;inadequate\u0026quot;) (see Table 2). Male gender was significantly correlated with lower odds of achieving satisfactory health literacy (OR = 1.473, p = 0.017), suggesting that males were nearly 1.5 times less likely than females to attain satisfactory levels of health literacy. This may reflect gender-based differences in health information-seeking behaviour or engagement with digital health resources.\u003c/p\u003e\n\u003cp\u003eOne of the most notable findings was the correlation between health literacy and the act of seeking medical advice. Respondents who had not sought a doctor\u0026apos;s guidance were over 4.4 times less likely to report satisfactory health literacy (OR = 4.479, p \u0026lt; 0.001). This suggests a potential connection between lower health literacy and decreased engagement with formal healthcare services, as those who did not seek a doctor\u0026apos;s advice were significantly less likely to indicate satisfactory health literacy. Rather than demonstrating informed self-care, this trend may indicate a lack of confidence in navigating health information or recognising when professional medical advice is necessary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOther variables, including age range, race, educational level, chronic illness status, and herbal product use, did not demonstrate statistically significant relationships with health literacy status in the multivariate analysis. Although trends were noted in the descriptive statistics, these factors did not independently predict literacy outcomes when adjusted for other covariates. Notably, while older respondents tended to display better literacy, this relationship was not statistically validated (p \u0026gt; 0.05). Education, often considered a significant predictor, did not reach significance in this model, likely due to the confounding effects of other variables like health experience or access to information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Odds ratios (95% confidence intervals) of having satisfied health literacy vs. unsatisfied health literacy (N = 810).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"601\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 308px;\"\u003e\n \u003cp\u003eHealth Literacy (Unsatisfied = 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003eExp(B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 147px;\"\u003e\n \u003cp\u003e95% C.I.for EXP(B)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eAge range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eAge range (41-50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eAge range (51-60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eGender (Male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e1.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003ec\u003c/sup\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eRace (Chinese)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.879\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.232\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eRace (Indians)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eRace (Others)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.746\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.399\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003ed\u003c/sup\u003eHighest level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHighest level of education (Diploma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.371\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHighest level of education (Bachelor)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHighest level of education (Master\u0026apos;s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.423\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHighest level of education (PhD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.690\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHighest level of education (Other)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.705\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003ee\u003c/sup\u003eDo you have a history of chronic illness? (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003ef\u003c/sup\u003eHave you sought a doctor\u0026apos;s advice for the disease mentioned?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHave you sought a doctor\u0026apos;s advice for the disease mentioned? (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e4.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e2.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eHave you sought a doctor\u0026apos;s advice for the disease mentioned? (NA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.822\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003eg\u003c/sup\u003eHave you ever practised the diet of natural herbal products (Even if only once)? (No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1.845\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003csup\u003eh\u003c/sup\u003eDuration of intake of natural herbal products (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDuration of intake of natural herbal products (years) (7 - 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDuration of intake of natural herbal products (years) (4 - 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDuration of intake of natural herbal products (years) (1 - 3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3.620\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDuration of intake of natural herbal products (years) (\u0026lt;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2.980\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDuration of intake of natural herbal products (years) (NA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e0.437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eRespondents age range, 31-40 years used as a reference. \u003csup\u003eb\u0026nbsp;\u003c/sup\u003eFemale respondents were used as a reference. \u003csup\u003ec\u0026nbsp;\u003c/sup\u003eRespondents who stated their race as \u0026ldquo;Malay\u0026rdquo; used as a reference. \u003csup\u003ed\u0026nbsp;\u003c/sup\u003eRespondents with the highest level of education of SPM/O-level/IGCSE used as a reference. \u003csup\u003ee\u0026nbsp;\u003c/sup\u003eRespondents who stated to have a history of chronic illness were used as a reference. Respondents who stated that to sought a doctor\u0026apos;s advice for the disease mentioned used as a reference. \u003csup\u003eg\u0026nbsp;\u003c/sup\u003eRespondents who stated to have ever practiced the diet of natural herbal products (Even if only once) used as a reference. \u003csup\u003eh\u0026nbsp;\u003c/sup\u003eRespondents who stated to intake of natural herbal products for\u0026gt;10 years) used as a reference. Cells in grey colour nominated significant value (p\u0026lt;0.05)\u003c/p\u003e\n\u003cp\u003eIn summary, the regression analysis identifies gender and health-seeking behaviour as the key determinants of health literacy satisfaction levels within this dataset. The notable correlation between male gender and lower health literacy, coupled with the strong link between avoidance of medical consultations and a diminished likelihood of reporting satisfaction with health literacy, underscores the importance of health literacy promotion strategies that tackle barriers to seeking help and engaging with health information. These findings emphasise the necessity for targeted interventions that take into account gender-specific behaviours and encourage proactive health information-seeking, particularly among men and those less inclined to consult healthcare professionals.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study offers valuable insights into the gender-based differences in health literacy and the use of herbal medicine among working-age individuals in Malaysia. Utilising the validated HLS-M-Q18 test, we found that 63.2% of respondents achieved satisfactory health literacy; however, men were notably less likely than women to meet this standard. Additionally, the avoidance of formal medical consultation emerged as the most significant negative predictor of adequate health literacy. These findings highlight the behavioural and attitudinal challenges that men face, which hinder their access to health information and may worsen health outcomes.\u003c/p\u003e\u003cp\u003eThese findings align with existing literature, which indicates that women tend to exceed men in health literacy across various contexts. For instance, [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] documented similar trends among European groups with migration backgrounds, while [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] observed comparable gender differences in Asian contexts. These patterns are attributed to differences in health information-seeking behaviors, adherence to male gender norms, and lower engagement with healthcare services among men.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] pointed out that women generally display a greater understanding and utilisation of health resources, a trend that remains evident among patients in physiotherapy and rehabilitation, where women's health literacy outpaces that of men [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Our findings further reinforce the existence of gender-based disparities in health literacy, suggesting that culturally influenced male norms and health practices may significantly affect literacy outcomes.\u003c/p\u003e\u003cp\u003eIn Malaysia, cultural norms and gender expectations may significantly influence men's lower utilisation of health services. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] found that men are often less likely to seek preventive care and tend to delay medical consultations. Our study's observation of a strong correlation between the avoidance of medical consultations and lower health literacy aligns with existing literature, underscoring the urgent need for targeted interventions that address the specific barriers men face in engaging with healthcare [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Recognising these challenges, the Malaysian Ministry of Health has implemented the National Men's Health Plan of Action (2018\u0026ndash;2023), aimed at closing the gender gap in health service utilisation by fostering gender-sensitive approaches and enhancing men's health outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevious studies investigating health literacy and the use of herbal remedies have produced mixed findings. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] indicate that individuals who actively seek information about the safety and interactions of herbal products are more likely to use them. In contrast, [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] underscore the dangers of unregulated reliance on herbal remedies, which can result in the spread of misinformation. Our observations suggest that extensive involvement in traditional health practices may encourage a more proactive and informed approach to health-related inquiries. Notably, we discovered that long-term users of herbal remedies (those who have been using them for over ten years) exhibit a greater proportion of excellent health literacy. This insight may identify a subset of herbal practitioners who possess a strong understanding of both conventional and alternative medicine, thereby enhancing our comprehension of the cultural practices that shape health literacy.\u003c/p\u003e\u003cp\u003eComparative regional studies provide valuable contextual insights. A survey on health literacy in Thailand indicated that the most significant challenge faced by disadvantaged socioeconomic groups, including individuals with lower education levels and those with hearing impairments, was accessing reliable information about herbal and food supplements. Notably, gender significantly influenced this challenge [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In rural Malaysia, gender disparities were evident in perceptions and attitudes toward complementary and alternative medicine (CAM), including herbal medicine. Women tended to regard CAM as beneficial and safe, a perspective less commonly held by men [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our research builds on these previous findings by not only examining views and prevalence of use but also exploring the relationship between herbal usage and health literacy, particularly among long-term users.\u003c/p\u003e\u003cp\u003eIn addition, research conducted in Malaysia regarding knowledge and attitudes toward Traditional Chinese Medicine (TCM) revealed significant disparities influenced by gender, educational level, and ethnicity. Women, individuals with higher education, and certain ethnic groups demonstrated greater awareness of TCM [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These findings are consistent with the existing literature, highlighting the importance of socio-demographic factors. However, our study advances this understanding by incorporating these variables into a gender-based framework related to literacy outcomes.\u003c/p\u003e\u003cp\u003eThis study presents a novel integration of gender-based analysis with culturally embedded herbal medicine practices among a diverse, multi-ethnic population in Southeast Asia, while controlling for socio-demographic factors such as age, ethnicity, education, and a history of chronic illness. Previous research in Malaysia has typically examined health literacy in isolation or focused exclusively on the prevalence of herbal medicine use, often overlooking the interplay between literacy and gender differences [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. By connecting these essential domains, this study addresses a significant gap in the literature and lays the groundwork for developing gender-sensitive, culturally responsive health promotion strategies.\u003c/p\u003e\u003cp\u003eThe multidimensional integration of gender, health literacy, herbal medicine engagement, and critical socio-demographic factors in this study represents a distinctive feature, offering a broader perspective than the unidimensional approaches commonly found in previous research. Notably, the finding that long-term herbal consumers may demonstrate higher health literacy highlights the existence of a potentially informed subgroup, suggesting that cultural practices could serve as valuable entry points for targeted literacy interventions. Furthermore, this study delivers policy-relevant insights for the development of culturally tailored and gender-responsive public health strategies by framing health literacy within the context of medical consultation behaviours and traditional practices. This evidence directly aligns with national priorities, such as Malaysia's Men's Health Plan. It highlights the urgent need to integrate biomedical and traditional healthcare systems to enhance health outcomes and equity among diverse populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research offers new insights into the interplay between gender differences, health literacy, and the use of natural herbal products within a diverse Malaysian population. Utilising the HLS-M-Q18 measure, our findings reveal that being male is significantly associated with decreased odds of achieving satisfactory health literacy. At the same time, the avoidance of formal medical consultation stands out as the most prominent negative predictor. Although herbal use was not identified as an independent determinant, long-term users (those engaging for over 10 years) exhibited a higher proportion of excellent health literacy, suggesting potential benefits associated with sustained involvement in traditional health practices. The integration of gender-sensitive analysis with culturally ingrained herbal medicine practices provides a noteworthy contribution to the literature on health literacy, particularly within pluralistic healthcare systems. These findings highlight the urgency for culturally tailored, gender-sensitive interventions that address barriers to healthcare engagement among men and promote informed, safe use of herbal remedies. Such strategies may enhance preventive health behaviours, facilitate the integration of biomedical and traditional health frameworks, and inform policy measures aimed at improving health outcomes across diverse populations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was funded by the Universiti Kebangsaan Malaysia (UKM) through the Dana Luar (Antarabangsa), grant numbers DPK-GPS-JORDAN-2024-022. Special thanks to Universiti Kebangsaan Malaysia for supporting this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Universiti Kebangsaan Malaysia (UKM) through the Dana Luar (Antarabangsa), grant numbers DPK-GPS-JORDAN-2024-022. The funder provided funding to conduct surveys related to this research. Still, it did not have a significant role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYusnaini Md Yusoff, Wardah Mustafa Din, Azlan Abdul Rahim, Halizah Omar, Noor Sharizad Rusly, Ahmad Firdhaus Arham and Nurul Hanis Aminuddin Jafry conceptualised the study and supervised the project. Yusnaini Md Yusoff, Wardah Mustafa Din, Azlan Abdul Rahim and Ahmad Firdhaus Arham prepared the original draft, developed the methodology, validated the findings, and conducted the formal analysis. Yusnaini Md Yusoff reviewed and edited the manuscript. Yusnaini Md Yusoff, Azlan Abdul Rahim and Wardah Mustafa Din acquired funding and conducted the final review of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Yusnaini Md Yusoff and Azlan Abdul Rahim.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis minimal-risk survey did not involve personal identifiers or sensitive data. It was therefore exempt from formal ethical clearance under the \u003cem\u003eGuidelines for Ethical Review of Clinical Research or Research Involving Human Subjects (Medical Research and Ethics Committee [MREC])\u003c/em\u003e and the \u003cem\u003eCIOMS International Ethical Guidelines for Health-Related Research Involving Humans\u003c/em\u003e. The study adhered to institutional ethical standards, ensuring anonymity, voluntary participation, and the protection of participants\u0026rsquo; rights.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Medical Research and Ethics Committee. (2006). Guidelines for ethical review of clinical research or research involving human subjects. Ministry of Health Malaysia. Retrieved from https://www.google.com/url?sa=t\u0026amp;source=web\u0026amp;rct=j\u0026amp;opi=89978449\u0026amp;url=https://www.ummc.edu.my\u003cbr/\u003e/files/ethic/MCHRS/1%2520General/Guidelines%2520For%2520Ethical%2520Review%2520Of%2520Clinical%2520Research%2520Or%\u003cbr/\u003e2520Research%2520Involving%2520Human%2520Subjects.pdf\u0026amp;ved=2ahUKEwifN_N94uQAxV7z6ACHe02CYoQFnoECGEQAQ\u0026amp;usg=AOvVaw0_tIFK_LzlraW6arg9kIpz.\u003c/p\u003e\n\u003cp\u003e2. Council for International Organizations of Medical Sciences (CIOMS). (2016). International ethical guidelines for health-related research involving humans. Geneva: CIOMS. Retrieved fromhttps://www.google.com.my/books/edition/International_ethical_guidelines_for_hea/T1ZUEQAAQBAJ?hl=en\u0026amp;gbpv=1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipation in this study was entirely voluntary. The online questionnaire included a statement informing potential respondents about the purpose of the study and their right to withdraw at any time. Consent was implied through the completion and submission of the questionnaire. No personally identifiable information was collected. The survey was conducted by the authors between [November 2023] and [December 2023].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available due to privacy considerations but are available from the corresponding author upon reasonable request. All relevant data supporting the findings are included within the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eZaidi SF, Saeed SA, Khan MA, Khan A, Hazazi Y, Otayn M, Rabah M, Daniyal M (2022) Public knowledge, attitudes, and practices towards herbal medicines; a cross-sectional study in Western Saudi Arabia. BMC Complement Med Ther 22(1):326\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eS\u0026oslash;rensen K (2019) Defining health literacy: Exploring differences and commonalities. International handbook of health literacy. Bristol University, pp 5\u0026ndash;20\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eS\u0026oslash;rensen K, Pelikan JM, R\u0026ouml;thlin F, Ganahl K, Slonska Z, Doyle G, Fullam J, Kondilis B, Agrafiotis D, Uiters E, Falcon M (2015) Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J public health 25(6):1053\u0026ndash;1058\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChakraverty D, Baumeister A, Aldin A, Seven \u0026Uuml;S, Monsef I, Skoetz N, Woopen C, Kalbe E (2022) Gender differences of health literacy in persons with a migration background: a systematic review and meta-analysis. BMJ open 12(7):e056090\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSun S, Lu J, Wang Y, Wang Y, Wu L, Zhu S, Zheng X, Lu X, Xu H (2022) Gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases: A cross-sectional study. Frontiers in Public Health, 10, p.944103\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKadier A, Ablimit M, Jie WM, Ye DX, Qi BJ, Yi LY, Run ZT, Tursun H, Ablat N (2025) The western transmission of traditional Chinese medicine: an investigation of the cultural elements of traditional Chinese medicine in biomedical systems of cross-Asia countries. 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Int J Res Innov Social Sci 9(5):2073\u0026ndash;2082\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eDin WM, Arham AF, Yusoff YM (2024) Set of data on consumers\u0026apos; perceived safety and efficacy towards natural health products to control or cure Covid-19 viruses in Malaysia. Data in Brief, 54, p.110548\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBoon TK, Buchari NAB, Boudville HM, Balasubramaniam R, Esuthasu H, Kanapathipillai K (2023) From roots to remedies: a deep dive into customer satisfaction with herbal medicine in Klang valley, Malaysia. Eur J Public Health Stud, 6(2)\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health literacy, gender, socio-demographic, healthcare utilisation, traditional practices","lastPublishedDoi":"10.21203/rs.3.rs-7748347/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7748347/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHealth literacy is vital for the effectiveness of public health strategies, as it empowers individuals to access, comprehend, and utilise health information to improve their well-being and prevent diseases. The global resurgence of herbal and natural products underscores the importance of understanding the interplay between traditional health practices and modern health literacy. However, empirical research in this area is sparse, particularly in multi-ethnic, middle-income countries like Malaysia. This study aimed to evaluate health literacy levels and explore their relationships with socio-demographic variables and patterns of herbal product usage, utilising data gathered from 810 Malaysian adults. Health literacy was measured using the validated HLS-M-Q18 instrument, supplemented with questions related to herbal product usage. Associations were analysed through descriptive statistics and binary logistic regression analyses. Results indicated that 63.2% of respondents demonstrated satisfactory health literacy, classified as either sufficient or insufficient. Multivariate analysis identified male gender (OR\u0026thinsp;=\u0026thinsp;1.473, p\u0026thinsp;=\u0026thinsp;0.017) and absence of formal medical consultation (OR\u0026thinsp;=\u0026thinsp;4.479, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as significant predictors of inadequate health literacy. Although the use and duration of herbal product intake did not show statistically significant results in the multivariate analyses, descriptive trends revealed that long-term herbal users (over 10 years) exhibited a higher percentage of excellent health literacy (29.6%) compared to short-term or non-users. These findings suggest that regular engagement in traditional health practices may enhance self-directed health information behaviour, although this effect is not independently predictive once adjusted. This research makes a unique contribution to the health literacy framework by integrating traditional health behaviours, emphasising the necessity for culturally responsive and gender-sensitive public health interventions. Bridging biomedical health literacy frameworks with community-based herbal practices is essential for enhancing health outcomes, promoting safe self-care, and informing national health promotion strategies in diverse healthcare settings.\u003c/p\u003e","manuscriptTitle":"Exploring Gender Variations in Health Literacy and Herbal Medicine Use Among Malaysian Adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-14 13:50:26","doi":"10.21203/rs.3.rs-7748347/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b6c02a6-c796-4400-bfa1-d1fd5c2f9e1f","owner":[],"postedDate":"December 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59464534,"name":"Health sciences/Health care"},{"id":59464537,"name":"Humanities/Health humanities"},{"id":59464541,"name":"Humanities/Medical humanities"},{"id":59464543,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-02-09T10:39:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-14 13:50:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7748347","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7748347","identity":"rs-7748347","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}