title: Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model.
abstract: BACKGROUND
  Health literacy has been defined as the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions. Currently, few studies have validated the causal pathways of determinants of health literacy through the use of statistical modeling. The purpose of the present study was to develop and validate a health literacy model at an individual level that could best explain the determinants of health literacy and the associations between health literacy and health behaviors even health status.
  
  
  METHODS
  Skill-based health literacy test and a self-administrated questionnaire survey were conducted among 3222 Chinese adult residents. Path analysis was applied to validate the model.
  
  
  RESULTS
  The model explained 38.6% of variance for health literacy, 11.7% for health behavior and 2.3% for health status: (GFI = 0.9990; RMR = 0.0521; χ(2) = 10.2151, P = 0.1159). Education has positive and direct effect on prior knowledge (β = 0.324) and health literacy (β = 0.346). Health literacy is also affected by prior knowledge (β = 0.245) and age (β = -0.361). Health literacy is a direct influencing factor of health behavior (β = 0.101). The most important factor of health status is age (β = 0.107). Health behavior and health status have a positive interaction effect.
  
  
  CONCLUSIONS
  This model explains the determinants of health literacy and the associations between health literacy and health behaviors well. It could be applied to develop intervention strategies to increase individual health literacy, and then to promote health behavior and health status.
authors.affiliation: Department of Social Medicine and Health Education, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, PR China.
authors.forename: Xinying
authors.initials: X
authors.lastname: Sun
authors.forename: Yuhui
authors.initials: Y
authors.lastname: Shi
authors.forename: Qingqi
authors.initials: Q
authors.lastname: Zeng
authors.forename: Yanling
authors.initials: Y
authors.lastname: Wang
authors.forename: Weijing
authors.initials: W
authors.lastname: Du
authors.forename: Nanfang
authors.initials: N
authors.lastname: Wei
authors.forename: Ruiqian
authors.initials: R
authors.lastname: Xie
authors.forename: Chun
authors.initials: C
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002681:China; D015438:Health Behavior; D006266:Health Education / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017145:Models, Educational; D015203:Reproducibility of Results; D012141:Respiratory Tract Infections / Q000517:prevention & control* / Q000523:psychology*; D012923:Social Class; D011795:Surveys and Questionnaires