Health and Nutrition Literacy among Community Health Workers in Rural and Urban Tanzania: A Comparative Study

Abstract

Introduction: Community health workers (CHWs) are vital in primary health care delivery, especially in low and middle-income countries (LMICs). However, the quality of their services is often questioned due to their limited training compared to professional healthcare providers. Despite evidence of CHWs’ contributions to health and nutrition in Tanzania, the country continues to face high levels of malnutrition and preventive diseases. This underscores the need to evaluate CHWs’ literacy in health and nutrition to enhance their role in promoting these areas. This paper aimed to assess health and nutrition literacy among Community Health Workers (CHWs) in rural and urban Tanzania while exploring factors influencing these literacy levels.
Materials and Methods: This cross-sectional study, conducted in Pwani and Dar es Salaam, Tanzania, involved 194 CHWs, who were obtained using Yamane’s formula for sample size determination. Data was collected via face-to-face interviews using the adapted European Health Literacy Questionnaire (HLS-EU-Q47) for health literacy and the Short Food Literacy Questionnaire (SFLQ) for nutrition literacy. Pearson correlation analysed the association between nutrition literacy (NL) and health literacy (HL), while multinomial logistic regression identified factors influencing HL and NL among CHWs.
Results: Our study found limited health literacy among CHWs to be higher in rural areas (24.5%) than in urban areas (17.6%), while health literacy rates were higher in urban (31.9%) compared to rural (22.9%). Regression analysis showed limited health literacy was significantly associated with age (P = 0.048, OR = 1.041, 95% CI), area of residence (P = 0.002, OR = 0.318, 95% CI) and supervision frequency (P = 0.01, OR = 5.266, 95% CI). Limited nutrition literacy was significantly associated with weekly time spent on CHW activities (P = 0.006, OR = 0.183, 95% CI), age (P = 0.013, OR = 1.050, 95% CI) and area of residence (P = 0.008, OR = 0.387, 95% CI). The correlation between health literacy and nutrition literacy had a Pearson coefficient of 0.517 (P = 0.000).
Conclusion: Our study shows a higher prevalence of limited health and nutrition literacy among rural CHWs than urban ones, with area of residence being the most decisive associated factor. The area of residence is the most substantial associated factor for NL and HL. Policymakers can use the identified factors in areas with similar social demographic characteristics to improve community-based health intervention that will, in turn, improve the health and nutrition outcomes of the community.