Original Research
Health Literacy & Obesity

Limited Health Literacy and Its Associated Factors Among Overweight and Obese Housewives Living in Klang Valley Low Cost Flats: Findings from the My Body is Fit and Fabulous at Home (MyBFF@Home) Study

Background

Health literacy—the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions—has emerged as a critical determinant of health outcomes across populations worldwide. Limited health literacy has been consistently associated with poorer health status, reduced engagement in preventive health behaviours, lower rates of medication adherence, higher hospitalisation rates, and increased healthcare costs. In the context of obesity, health literacy is particularly important because successful weight management requires the ability to understand nutritional information, interpret food labels, follow dietary recommendations, and navigate the healthcare system for support and monitoring.

Malaysia faces a significant obesity epidemic, with the prevalence of overweight and obesity among adults ranking among the highest in the Asian region. Women, particularly housewives from lower socioeconomic backgrounds, represent a population subgroup at elevated risk for both obesity and limited health literacy. Housewives who are not employed outside the home may have fewer opportunities for exposure to health information through workplace health programmes, and those living in low-cost housing estates face additional disadvantages related to income, education, and access to health services and information resources.

The My Body is Fit and Fabulous at Home (MyBFF@home) study was a landmark community-based weight loss intervention programme conducted among overweight and obese housewives living in People’s Housing Project (PHP) low-cost flats in the Federal Territory of Kuala Lumpur, within the Klang Valley metropolitan area. Launched in 2014, the MyBFF@home study was a quasi-experimental intervention involving 328 housewives from 14 low-cost flat communities, making it the first and largest community-based weight loss intervention study conducted among this population in Malaysia.

This paper presents findings from the health literacy component of the MyBFF@home study, analysing the prevalence of limited health literacy and its associated factors among the study participants.

Study Design and Methods

The health literacy analysis was conducted as a sub-study of the broader MyBFF@home intervention. The study population comprised 328 overweight and obese housewives aged 18 to 59 years who were living in PHP low-cost flats in the Klang Valley area and were recruited through convenient sampling from 14 housing communities.

Health literacy was measured using the Malay language version of the Newest Vital Sign (NVS), a validated health literacy assessment tool. The NVS uses a nutrition label from an ice cream container and asks six questions that test the respondent’s ability to read and interpret numerical information, perform simple calculations, and apply the information to health-related decision-making. Scores range from 0 to 6, with a score of 2 or below indicating limited health literacy and scores above 2 indicating adequate health literacy. The NVS was validated for use in the Malay language specifically for this study population.

Socio-demographic variables assessed included age, ethnicity, education level, household income, employment status of spouse, and internet connectivity at home. Descriptive analysis, chi-square tests, and multiple logistic regression were used to identify factors associated with limited health literacy.

Principal Findings

The health literacy findings were stark. The mean NVS score was only 1.07 (SD 1.19), indicating that on average, participants could correctly answer approximately one out of six health literacy questions. An overwhelming 87.5% of participants were classified as having limited health literacy (NVS score ≤2), leaving only 12.5% with adequate health literacy. This prevalence of limited health literacy is substantially higher than rates reported in studies of general populations in developed countries, though comparable to rates found in other studies of low-income, low-education populations in developing countries.

The extremely low mean score indicates that the majority of participants had significant difficulty with the numeracy and comprehension skills required to understand basic health information such as nutritional labels—skills that are essential for making informed dietary choices and managing body weight. This finding has profound implications for the design and delivery of obesity interventions targeting this population, as standard educational materials and counselling approaches that assume functional health literacy may be largely ineffective.

Associated Factors

Bivariate analysis identified three factors significantly associated with limited health literacy: older age (45–59 years compared to younger age groups), lower educational attainment (primary education or below), and absence of internet connectivity at home.

The age association likely reflects cohort effects in educational attainment, as older women in this population were more likely to have received limited formal education. The strong association with educational level is consistent with the international health literacy literature, which consistently identifies education as the strongest socio-demographic predictor of health literacy. In this population, where the majority of participants had secondary education or below, the educational gradient in health literacy was particularly pronounced.

The association with internet connectivity is particularly noteworthy. In the multiple logistic regression analysis controlling for other factors, absence of internet connectivity at home emerged as an independent predictor of limited health literacy, with housewives lacking internet access having 2.61 times the odds of limited health literacy compared to those with internet connectivity (OR 2.61; 95% CI 1.31–5.22). This finding suggests that internet access may serve as a conduit for exposure to health information and an opportunity for self-directed health learning, and that the digital divide may exacerbate existing health literacy disparities.

Implications for Intervention Design

The extremely high prevalence of limited health literacy in this population has critical implications for the design and delivery of obesity prevention and management programmes. Interventions targeting overweight and obese housewives in low-cost housing communities must be designed with limited health literacy as the baseline assumption, employing communication strategies that minimise reliance on text-heavy materials and numerical information.

Effective approaches for low-health-literacy populations include the use of visual aids and pictorial representations, simplified and plain language in all communications, teach-back methods to verify understanding, hands-on demonstrations rather than written instructions, culturally and linguistically appropriate materials, and community health worker models that provide personal guidance and support.

The association between internet connectivity and health literacy suggests that efforts to bridge the digital divide in low-cost housing communities may have indirect benefits for health literacy and, ultimately, for health outcomes including obesity. Policy interventions to expand affordable internet access in PHP communities, combined with the development of culturally appropriate online health information resources, represent a potential strategy for addressing the health literacy deficit identified in this study.

Limitations

The study’s use of convenient sampling from a specific geographic area (Klang Valley PHP communities) limits the generalisability of findings to other populations. The NVS, while validated, primarily measures numeracy-based health literacy and may not fully capture other dimensions of health literacy such as oral communication, navigation skills, and critical appraisal of health information. The cross-sectional design precludes determination of whether limited health literacy precedes or follows the development of obesity, as the causal direction of this relationship is likely bidirectional.

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