Abstract
Background: The public health relevance of health literacy is highlighted by the fact that its higher levels can improve health outcomes and reduce health inequities. In order to design effective interventions for improving health literacy, the relationship between health literacy and other factors such as sociodemographic variables, subjective health and social support must be understood.Objective: Our aim was to test a socioecological model of the determinants of health literacy with a special focus on the effect of residence. Our study investigated geographical differences regarding the levels of health literacy and its determinants as this was not investigated before in European nationwide surveys.Methods: Data was collected by a polling company in a sample (n = 1,200) of the Hungarian adult population nationally representative by age, gender, and permanent residence in 2019 January. The questionnaire included items on sociodemographic data, subjective well-being, social support, and two health literacy scales. A recursive path model was used to outline the mediating effect of social support between sociodemographic variables and health literacy where both direct and indirect effects of the explanatory variables and multiple relationships among the variables were analyzed simultaneously. Multiple-group analysis was applied to the three pre-set categories of permanent residence (capital city, urban and rural).Results: There was no statistically significant difference by residence regarding levels of health literacy. Social support and educational attainment were the most important determinants of health literacy after adjusting for the effect of other sociodemographic variables. However, the magnitude of effect of social support and educational attainment is different between types of settlements, the strongest being in rural areas.Conclusion: Social support seems to mediate the effect of socioeconomic position on health literacy which could be taken into account when designing interventions to improve health literacy, especially in rural areas. Further studies would be needed especially in rural communities to see whether improvement of social support could be utilized in projects to increase the level of health literacy.
Highlights
An increasing number of articles reflects a growing scientific interest in health literacy (HL)
While testing for configural invariance, we focused on the extent to which path coefficients of the hypothesized model were similar across respondent’s permanent residence
Education and social support were associated with both types of HL measurements but self-perceived family wealth was only related to self-evaluated HL while perceived health was only related to performancebased health literacy
Summary
An increasing number of articles reflects a growing scientific interest in health literacy (HL). In order to design effective interventions for improving HL, the relationship between HL and other factors such as sociodemographic variables, subjective health and social support must be understood. If HL is a mediator between SEP and health status, it is potentially modifiable, and its improvement at the individual and population level can reduce health disparities [6]. The public health relevance of health literacy is highlighted by the fact that its higher levels can improve health outcomes and reduce health inequities. In order to design effective interventions for improving health literacy, the relationship between health literacy and other factors such as sociodemographic variables, subjective health and social support must be understood
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