A Multinational Comparison Of Health Knowledge: College Students In Canada, Nigeria, And The United States

This study compares the health knowledge of first year college students attending universities/colleges in the United States, Canada and Nigeria using the health knowledge inventory (HKI), a 110 item multiple choice instrument which measures health knowledge in 11 knowledge categories. Total scores indicted a 56% average for Canadian students, a 53% average for Nigerian students, and a 60% average for American students. Post hoc analyses indicated each country's mean HKI score was significantly different from the other two countries. When looking at females, a significant difference was found comparing the three groups (F=15.32; df=2; p [is less than] .00). The total scores of Canadian [bar] x=59.30, n=60), Nigerian [bar] x=55.41, n=59), and American [bar] x=65.33, n=70) males were also significantly different from each other (F=11.80; df=2; p [is less than] .00). Implications for health education are discussed.

Introduction

Health knowledge, while not sufficient to modify health behavior, is a necessary ingredient in behavioral change. In order to make informed decisions regarding health and behaviors which impact health, one has to know and understand certain basic health principles. These basic health principles are encompassed within knowledge areas which are included in all college level personal health classes. Knowledge areas include accidents and safety, aging and death, chronic disease, communicable disease, consumer health, environmental health, human sexuality, mental health, nutrition, physical fitness, and drug use/abuse.

Adequate health knowledge is part of what is necessary to live a healthful life. Living a healthful life has potential economic benefits. Recently, Fries et al. (1998) identified thirty-two health education programs, designed to reduce health risks and control costs, which achieved reductions in health benefit claims averaging 20 percent. The authors suggest that health education and health promotion programs focused on increased personal responsibility and improvement of long-term health outcomes could significantly reduce health care spending.

Concern over rapidly rising health care expenditures is driving efforts to reform health systems in many western democracies (Saltman and Figueras 1998). While these reforms focus primarily on improving efficiency in the production and consumption of medical services, several countries have sought to improve health education and health promotion services in order to improve health status (Organization for Economic Co-operation and Development 1992). Public schools as well as colleges and universities in developed countries often include health education in their curricula.

Developing countries have fewer resources to devote to health care and often have a larger burden of infectious disease and a smaller burden of chronic disease than the advanced industrialized democracies (Ezeilo 1990, United Nations Development Program 1994). There is substantial variation in the emphasis on health education in these countries, but programs targeted at reducing the behavorial risks associated with prevalent diseases are common and health education may also be included in public school and higher education curricula.

This study compares the health knowledge of first year college students attending universities/colleges in Canada, Nigeria, and the United States using the health knowledge inventory (HKI), a 110 item multiple choice instrument which measures health knowledge in 11 knowledge categories. The HKI has been used in several studies of health knowledge in high school and college students in the United States and Canada (Nicholson, Price and Higgins 1990, Nicholson, et al 1991, Smith et al 1998).

Table 1 presents selected demographic and economic data for the three countries. While the U.S. and Canada are similar demographically and economically, Nigeria's population is, on average, younger, poorer, and less educated. Birth, death, and infant mortality rates are substantially higher in Nigeria. Similar differences exist in disease burden and causes of death. Major chronic diseases, including heart disease, cancer and stroke, are the leading causes of death in the U.S. and Canada while Nigerians experience a far greater burden of infectious diseases, such as malaria, tuberculosis, and dengue fever (World Health Organization 1995).

Table 1 Demographic and Economic Information: Canada, Nigeria and the United States

                                            Canada

Population (1995)                           28,846,761
Birth Rate/1,000 population (1995)          13.74
Death Rate/1,000 population (1995)           7.43
Infant Mortality/1,000 live births (1995)    6.8
Life Expectancy at Birth (1995)
  Total Population                          78.29 years
  Male                                      74.93
  Female                                    81.83
(*)Literacy
  Total Population                          97% (1986)
  Male                                      N/A
  Female                                    N/A
Age Structure (1995)
  0-14 years                                21%
  15-64 years                               67%
  65 years and over                         12%
Gross Domestic Product (1994)               $542 Billion
Per Capita GDP (1994)                       $19,084

                                            Nigeria

Population (1995)                           101,232,251
Birth Rate/1,000 population (1995)          43.26
Death Rate/1,000 population (1995)          12.01
Infant Mortality/1,000 live births (1995)   72.6
Life Expectancy at Birth (1995)
  Total Population                          55.98 years
  Male                                      54.69
  Female                                    57.3
(*)Literacy
  Total Population                          51% (1990)
  Male                                      62% (1990)
  Female                                    40% (1990)
Age Structure (1995)
  0-14 years                                45%
  15-64 years                               52%
  65 years and over                          3%
Gross Domestic Product (1994)               $122.6 Billion
Per Capita GDP (1994)                       $1,250

                                            United States

Population (1995)                           263,057,000
Birth Rate/1,000 population (1995)          15.25
Death Rate/1,000 population (1995)           8.38
Infant Mortality/1,000 live births (1995)    7.88
Life Expectancy at Birth (1995)
  Total Population                          75.99 years
  Male                                      72.80
  Female                                    79.70
(*)Literacy
  Total Population                          97% (1979)
  Male                                      97% (1979)
  Female                                    97% (1979)
Age Structure (1995)
  0-14 years                                22%
  15-64 years                               65%
  65 years and over                         13%
Gross Domestic Product (1994)               $6.74 Trillion
Per Capita GDP (1994)                       $25,850