Health Literacy Mediates the Relationship Between Educational Attainment and Health Behavior: A Danish Population-Based Study

Abstract

Individuals with a lower education level frequently have unhealthier behaviors than individuals with a higher education level, but the pathway is not fully understood. The aim of this study was to investigate whether health literacy mediates the association between educational attainment and health behavior (smoking, physical inactivity, poor diet) and obesity. The study included respondents ages 25 years or older drawn from a large population-based survey conducted in 2013 (N = 29,473). Two scales from the Health Literacy Questionnaire were used: (a) Understanding health information well enough to know what to do and (b) Ability to actively engage with health care providers. Multiple mediation analyses were conducted using the Karlson-Holm-Breen method. The study showed that health literacy in general and the ability to understand health information in particular mediated the relationship between educational attainment and health behavior, especially in relation to being physically inactive (accounting for 20% of the variance), having a poor diet (accounting for 13% of the variance), and being obese (accounting for 16% of the variance). These findings suggest that strategies for improving health behavior and reducing health inequalities may benefit from adopting a stronger focus on health literacy within prevention, patient education, and other public health interventions.

Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A Systematic Review and Meta‐Analysis Based on the Theory of Planned Behaviour

“…Backholer et al., 2015; Darmon & Drewnowski, ; Giskes et al., ) is thus likely to be mediated by variables not specified in the TPB. Apart from individual‐level factors such as health literacy (Adams et al., ; Friis et al., ), such mediators could also be located within the local food environment (e.g. fast food availability; Fleischhacker et al., ).…”

“…For example, people with low health literacy may find messages/instructions on food packets less easy to understand and adhere to. This in turn could impair healthy food choices (Adams et al., ; Friis, Lasgaard, Rowlands, Osborne, & Maindal, ).…”

Social inequality in cancer survivors’ health behaviours-A Danish population-based study

“…Respondents were asked if they had any of 18 long‐term conditions or if they had had any of the long‐term conditions in the past and were still affected by one or more of the following conditions: asthma, allergy, diabetes, hypertension, myocardial infarction, angina pectoris, stroke, chronic obstructive pulmonary disease (COPD), osteoarthritis, rheumatoid arthritis, osteoporosis, cancer, migraine or recurrent headaches, mental disorders for 6 months or less, mental disorders for 6 months or longer, slipped discs or other back injuries, cataract, or tinnitus. A further description of the prevalence of each of the conditions has been published (Friis, Lasgaard, Rowlands, Osborne, & Maindal, ; Friis, Pedersen, Larsen, & Lasgaard, ). Based on these conditions (all besides cancer), we included a measure for multimorbidity and divided the measure into having 0, 1, 2–3 or 4+ additional self‐reported diseases.…”

“…A further description of the prevalence of each of the conditions has been published (Friis, Lasgaard, Rowlands, Osborne, & Maindal, 2016;Friis, Pedersen, Larsen, & Lasgaard, 2016). Based on these conditions (all besides cancer), we included a measure for multimorbidity and divided the measure into having 0, 1, 2-3 or 4+ additional self-reported diseases.…”

“…Further research is needed to establish if social inequality in cancer survival may also be partly explained by a continued unhealthy lifestyle post-diagnosis in some socio-economic groups. One model of explanation for the social gradient for smoking, physical activity and dietary habits could be that less educated individuals may have limited knowledge of the harm of unhealthy behaviour and therefore are less motivated to adopt healthy behaviours (Pampel, Krueger, & Denney, 2010;Friis, Lasgaard, Rowlands, Osborne, & Maindal, 2016;Friis, Pedersen, Larsen, & Lasgaard, 2016). Also, studies have shown that individuals with lower socio-economic status face a variety of chronic stressors in daily living and have fewer social resources to cope with these (Lantz, House, Mero, & Williams, 2005;Pampel et al, 2010).…”