The effect of health literacy on health status among residents in Qingdao, China: a path analysis

Background Health literacy is a public health goal which can be used as an independent factor of health outcomes. This study aimed to assess the association between health literacy and health status, as well as the two mediating factors of behavior and self-efficacy among residents aged 15-69 years in Qingdao. Methods A cross-sectional survey was implemented among residents aged 15-69 years (N = 3793) in Qingdao, China. A combination of stratified cluster random and proportional probability sampling methods was used to select subjects for this study. Data were collected using "The Chinese Citizen Health Literacy Questionnaire (2019)". We proposed a hypothetical model for the relationship between sociodemographic characteristics, health literacy, self-efficacy, health behavior, and health status, and used path analysis to validate the hypothesis. Results The path analysis showed that higher education (beta = 0.293) and income (beta = 0.135) are positively and directly associated with greater health literacy, which was positively associated with health status (beta = 0.057). Health literacy is a direct influencing factor of health behavior (beta = 0.070) and self-efficacy (beta = 0.099). Health behavior (beta = 0.041) and self-efficacy (beta = 0.173) exerted a positive direct effect on health status. The model explained 14.1% of variance for health literacy, 3.8% for self-efficacy, 5.7% for health behavior, and 15.0% for health status. Conclusions Health literacy was identified to be a critical factor in health status. The results emphasized that the dissemination of health knowledge, development of healthy behavior, and cultivation of self-efficacy should be jointly promoted to reinforce the level of health status among residents in future work.