Education and prevention-relevant competencies: evidence for detachment in a german regional survey
J Pangratz, J Micek, R Lutzke, L Kraemer, J Konzok, M Wester, J Pec, I Abou Tabikh, I Haiberger, C Brummer, A Herrmann, A Muehlberger, L Maier, C SchachAbstract
Background
Educational attainment is associated with health literacy at the population level, yet limited health literacy is also observed among highly educated individuals, suggesting that formal education alone may not ensure prevention-relevant competencies. [1, 2] Even when general health literacy or risk-factor knowledge is adequate, practical self-related risk knowledge (e.g., awareness of BMI) may still be limited. Using instruments applied in German population surveillance, our regional cross-sectional survey provides actionable evidence for prevention and health education strategies and remains comparable to national data. [3]
Purpose
To assess associations between educational attainment and health literacy, risk-factor knowledge, self-efficacy, and self-related risk knowledge within one prevention-focused survey, and to quantify “detachment” between education and these competencies.
Methods
Education was grouped into low (vocational/apprenticeship), middle (technician/master), and high (university degree, promotion/habilitation). Outcomes were standardized scores (0–1; higher=better): health literacy (5 items), risk-factor knowledge (4 items), self-efficacy (3 items), and self-related risk knowledge (BMI and calorie self-knowledge). Multivariable linear regression adjusted for age, sex, household income, employment status, and weekly working hours. To assess “detachment” (within-group variability beyond education), we quantified the proportion below the first quartile (Q1) of the overall distribution for health literacy, knowledge, and self-efficacy, and defined limited self-related risk knowledge as a composite self-knowledge score <0.50 (i.e., not knowing BMI/calorie needs at least roughly).
Results
Participants had a mean age of 63 ± 15 years. Among participants with education data (low n=584, middle n=312, high n=227), higher education was associated with higher mean health literacy (0.64/0.66/0.71), risk-factor knowledge (0.55/0.57/0.64), self-efficacy (0.69/0.73/0.76), and self-related risk knowledge (0.30/0.37/0.44) (all p<0.001, Table). In adjusted models, each higher education level was associated with higher health literacy (β=0.021, p=0.043), knowledge (β=0.058, p<0.001), self-efficacy (β=0.022, p=0.008), and self-related risk knowledge (β=0.042, p=0.010). Despite education gradients, 12–14% of participants in the highest education group remained below Q1 for health literacy, knowledge, and self-efficacy (detachment). Limited self-related risk knowledge was common even in the highest education group (53.3% with self-knowledge <0.50; Figure).
Conclusion
Educational attainment correlates with prevention competencies, but does not reliably identify individuals with limited health literacy, low knowledge/self-efficacy, or limited self-related risk knowledge. Prevention strategies should complement formal education with targeted health education and practical self-management content.Prevention-relevant competencies