Health literacy in the Western Balkans: The example of Albania and Kosovo

159 Pages·2015·1.11 MB·English

by  Ervin Toçi

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The research presented in this thesis was conducted at the Department of International Health within the
School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine, and Life Sciences, Maastricht
University, which participates in the Netherlands School of Primary Care Research (CaRe) and is acknowledged
by the Royal Dutch Academy of Science (KNAW).

Part of the work for this thesis was conducted with financial support from The United Nations Population
Fund (UNFPA), Office in Kosovo.

Part of the work for this thesis was conducted with the support from University of Medicine, Tirana, Albania.

Dissertation: Health literacy in the Western Balkans: The example of Albania and Kosovo.
Author: Ervin Toçi
ISBN: 978 94 6159 424 2
Production & print: Datawyse / Universitaire Pers Maastricht

© Copyright: E. Toçi, Maastricht, the Netherlands, 2015.
All rights reserved. No part of this publication may be reproduced without permission of the copyright owner.
Health literacy in the Western Balkans
The example of Albania and Kosovo

Dissertation

to obtain the degree of Doctor
at Maastricht University,
on the authority of the Rector Magnificus, Prof.dr. L.L.G Soete
in accordance with the decision of the Board of Deans,
to be defended in public
on Thursday, 2 April 2015, at 10.00

by

Ervin Toçi

U
P
M
UNIVERSITAIRE
PERSMAASTRICHT
Supervisor
Prof. Dr. H. Brand

Co-supervisor
Prof. Dr. G. Burazeri

Assessment Committee
Prof. dr. L.M.G. Curfs (Chair)
Prof. dr. G.I.J.M. Kempen
Prof. dr. U. Laaser (University of Bielefeld, Germany)
Prof. dr. J. Scheres
Prof. dr. M.P. Weijenberg
Table of Content
CHAPTER 1 General Introduction 9
Health literacy – Introduction 11
Definitions of health literacy 12
Measurement of health literacy 15
Limitations and methodological concerns of health literacy instruments 18
Health literacy and health outcomes 20
Aims of this thesis 21
Study design 22
Outline of this thesis 23
References 24
CHAPTER 2 Socioeconomic conditions and health profile in Albania and Kosovo –
general overview 27
Introduction 29
General profile 29
Demographic and socioeconomic indicators 31
Health profile 35
Lifestyle factors 38
Health care system, reforms and financing 39
Public health 41
Conclusion 42
References 43
CHAPTER 3 Health literacy and socioeconomic characteristics of older people in
transitional Kosovo 47
Abstract 48
1. Introduction 49
2. Material and methods 49
3. Results 51
4. Conclusion 56
References 58
APPENDIX 60
5
CHAPTER 4 Health literacy, self-perceived health and self-reported chronic morbidity
among older people in Kosovo 63
Summary 64
Background 65
Methods 66
Results 68
Discussion 70
Acknowledgments 72
References 73
CHAPTER 5 Socio-economic correlates of functional health literacy among patients of
primary health care in Kosovo 77
Abstract 78
Introduction 79
Methods 79
Results 81
Discussion 84
Author statements 86
Acknowledgments 87
References 88
CHAPTER 6 Concurrent validation of two key health literacy instruments in a South
Eastern European population 91
Abstract 92
Introduction 93
Methods 94
Results 96
Discussion 100
Conclusions 101
References 103
CHAPTER 7 Health literacy in a population-based sample of adult men and women in
a South Eastern European country 105
Abstract 106
Introduction 107
Methods 108
Results 110
Discussion 113
Conclusion 116
References 117
6
CHAPTER 8 General Discussion 119
Main findings of the thesis 121
Strengths and limitations of this study 132
Conclusions 133
References 136
CHAPTER 9 Summary Samenvatting Përmbledhje Acknowledgements About the
author List of publications 139
Summary 141
Background, aim, and research questions 141
Methods 141
Results and Discussion 142
Samenvatting 145
Achtergrond, doel en onderzoeksvragen 145
Methoden 146
Resultaten en Discussie 146
Përmbledhje 149
Sfondi, Qëllimi dhe Pyetjet e Hulumtimit 149
Materiali dhe Metoda 150
Rezultatet dhe Diskutimi 150
Acknowledgements 153
About the author 155
List of publications 157

7

CHAPTER 1

General Introduction

9