Changes in Health Literacy and Subsequent Presenteeism Among Workers: A Repeated-Measures Longitudinal Database Study
Memori Fukuda, Yoshitaka Nishikawa, Yoshimitsu Takahashi, Ayako Kohno, Mayumi Toyama, Michi Sakai, Hirono Ishikawa, Takeo NakayamaAbstract
Objectives
To examine associations of changes in health literacy with subsequent changes in presenteeism and incident presenteeism among Japanese workers.
Methods
We analyzed 8 semiannual in-app surveys (June 2021-December 2024) from the DeSC database. Health literacy (HL) was measured with the 5-item Communicative and Critical Health Literacy scale (1-5), and presenteeism (Pres) with the WPAI-presenteeism item (0%-100%; higher indicating greater impairment; employed respondents only). Each observation used 3 consecutive waves: ΔHL(t-1)=HL(t-1)-HL(t-2) and subsequent ΔPres(t)=Pres(t)-Pres(t-1). Linear mixed models adjusted for prior Pres, earlier HL, and demographic, occupational, health-status, and lifestyle covariates; sensitivity analysis modeled prior Pres categorically. Additional analyses examined observations with prior presenteeism (Pres(t-1)>0), without prior presenteeism (Pres(t-1)=0) and categorical HL changes.
Results
Among 19,594 participants (60,203 observations), a 1-point more positive ΔHL was associated with more favorable subsequent ΔPres (β -1.24 percentage points; 95% confidence interval [CI], -1.52 to -0.97), with consistent sensitivity and prior-presenteeism findings; the incident odds ratio was 0.89 (0.84-0.93). Compared with unchanged HL, decreases were associated with less favorable changes (0.87; 0.46-1.27), whereas increases had a CI including zero (-0.32; -0.75 to 0.10). Increases of at least 0.6 points showed favorable exploratory associations. The individual-level association was modest (approximately -0.83 percentage points per standard deviation of ΔHL).
Conclusions
More positive HL changes were associated with modestly more favorable presenteeism outcomes. Direction-based associations were clear for decreases but not increases; larger increases showed favorable exploratory associations. Intervention effects require further study.