Health Lit Res Pract. 2022 Jul;6(3):e213-e223. doi: 10.3928/24748307-20220718-01. Epub 2022 Sep 12.
Health literacy has often been described as an important precondition for good health decisions, healthy behaviors, and health. However, reviews reveal low evidence for intervention effectiveness through health literacy. This result calls for more investigations to be done in the pathway from health literacy to health, considering intermediate outcomes of health literacy.
This study explores an important immediate objective of health literacy, namely the decision-making ability (DMA) regarding health issues. The study's hypothesis claims the DMA to be an important mediator between health literacy and health outcomes. Furthermore, the study assumes that the effect of the DMA on different health outcomes is not only contingent on health literacy but also on contextual factors. To test the above hypotheses, six different health literacy dimensions and four health outcomes have been analyzed.
Cross-sectional data from the Young Adult Survey Switzerland was used for mediation analyses ( = 4, 569, age, 18 to 25 years, all male). Multiple regression and KHB (Karlson, Holm, and Breen) decomposition analyses were applied to estimate mediation effects between health literacy and health outcomes.
Five of six health literacy dimensions explained the DMA in a linear regression model. The coefficients of the DMA explaining health outcomes were substantially reduced when health literacy items were included into the models (6.1%-20.3%). Furthermore, the associations between health literacy and the health outcomes were fully explained by contextual factors, except in the mental health model.
The results support the hypothesis that higher health literacy levels do not necessarily lead to better health directly. Rather, health literacy is just one of multiple factors contributing to a higher DMA and, further, to favorable health outcomes. The results of this study call for more investigations in the health decision-making process and the role of contextual factors. [] Plain Language Summary: The study investigated the ability to make good health decisions while considering health literacy. The results support the intermediate function of the decision-making ability on the path to favorable health outcomes. Furthermore, it is found that the DMA as well as health literacy are highly contingent on contextual factors. The results shed light into the complex decision-making process regarding health issues.
健康素养常被描述为做出良好健康决策、采取健康行为和保持健康的重要前提。然而，健康素养干预效果的相关综述表明，目前的证据还不够充分。这一结果呼吁进一步深入研究健康素养与健康之间的关系，考虑健康素养的中间结果。
本研究旨在探索健康素养的一个重要直接目标，即健康问题决策能力（DMA）。研究假设 DMA 是健康素养与健康结果之间的重要中介。此外，研究还假设 DMA 对不同健康结果的影响不仅取决于健康素养，还取决于情境因素。为了检验上述假设，本研究分析了六个不同的健康素养维度和四个健康结果。
本研究使用瑞士青年调查的横断面数据进行中介分析（n=4569，年龄 18-25 岁，均为男性）。采用多元回归和 KHB（Karlson、Holm 和 Breen）分解分析来估计健康素养与健康结果之间的中介效应。
在线性回归模型中，六个健康素养维度中的五个维度可以解释 DMA。当将健康素养项目纳入模型时，DMA 解释健康结果的系数显著降低（6.1%-20.3%）。此外，除心理健康模型外，健康素养与健康结果之间的关联可完全由情境因素解释。
研究结果支持以下假设，即较高的健康素养水平不一定直接导致更好的健康。相反，健康素养只是导致更高 DMA 以及更有利健康结果的众多因素之一。本研究结果呼吁进一步研究健康决策过程以及情境因素的作用。
