The relationship between health literacy and health outcomes among male young adults: exploring confounding effects using decomposition analysis
Previous studies indicate substantial correlations between low health literacy and poor health outcomes. However, empirical findings remain inconsistent and are theoretically challenging. In this study, we conceptually place health literacy within an established model of health inequality. Studying multiple pathways, we estimate the associations between health literacy and six health outcomes and decompose these associations with health literacy’s covariates.
Cross-sectional data from the Young Adult Survey Switzerland was used for the analyses (n = 5959, age = 18–25). Logistic regression and KHB decomposition analyses were applied to estimate health literacy’s coefficients and confounding percentages.
Eleven covariates were associated with health literacy (p < 0.001). Ten covariates reduced the naïve health literacy coefficient when included in the regression models (confounding percentages: 36.7–86.9%). In three out of six models, the confounding effects led to non-significant health literacy coefficients.
We found that health literacy’s associations with health outcomes are confounded by socioeconomic, material, psychosocial, and health-related factors. More investigations on the causal importance of health literacy, respectively, on its potential to health promotion are required.
KeywordsHealth literacy Determinants of health Health status Health behavior Decomposition analysis Young adults
No external funding involved.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Abraham C, Sheeran P (2005) The health belief model. In: Conner M, Norman P (eds) Predicting health behaviour. Research and practice with social cognition models, 2nd edn. Open University Press, Maidenhead, pp 28–80Google Scholar
- Bartley M (2017) Health inequality: an introduction to concepts, theories and methods, 2nd edn. Polity, CambridgeGoogle Scholar
- Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K (2011) Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 155(2):97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005 CrossRefGoogle Scholar
- Clancy C (2009) Health literacy measurement: mapping the terrain. In: Hernandez LM (eds) Measures of health literacy summary of roundtable on health literacy, held February 26, 2009 in Washington, DC. National Academies Press, Washington, DC, pp 6–10Google Scholar
- Conner M, Norman P (2005) Predicting health behaviour: a social cognition approach. In: Conner M, Norman P (eds) Predicting health behaviour. Research and practice with social cognition models, 2nd edn. Open University Press, Maidenhead, pp 1–27Google Scholar
- Freese J, Lutfey K (2011) Fundamental causality: challenges of an animating concept for medical sociology. In: Pescosolido BA, Martin JK, McLeod JD, Rogers A (eds) Handbook of the sociology of health, illness, and healing. A blueprint for the 21st century. Springer, New York, pp 67–81CrossRefGoogle Scholar
- GFS Bern (2016) Bevölkerungsbefragung « Erhebung Gesundheitskompetenz 2015 » . Studie im Auftrag des Bundesamts für Gesundheit BAG, Abteilung Gesundheitsstrategien. gfs.bern ag, BernGoogle Scholar
- Hofmann K, Schori D, Abel T (2013) Self-reported capabilities among young male adults in Switzerland. Translation and psychometric evaluation of a German, French and Italian version of a closed survey instrument. Soc Indic Res 114(2):723–738. https://doi.org/10.1007/s11205-012-0170-1 CrossRefGoogle Scholar
- ISCED 2011 (2012) International standard classification of education. ISCED 2011. UNESCO Institute for Statistics. MontrealGoogle Scholar
- Löckenhoff CE, Terracciano A, Ferrucci L, Costa PT Jr (2012) Five-factor personality traits and age trajectories of self-rated health: the role of question framing. J Pers Soc Psychol 80(2):375–401Google Scholar
- Mackenbach JP (2006) Health inequalities: Europe in profile. In: An independent expert report commissioned by the UK presidency of the EU. Department of Health, LondonGoogle Scholar
- Poureslami I, Nimmon L, Rootman I, Fitzgerald MJ (2016) Priorities for action: recommendations from an international roundtable on health literacy and chronic disease management. Health Promot Int 32:743–754Google Scholar
- Rammstedt B, Kemper CJ, Klein MC, Beierlein C, Kovaleva A (2013) A short scale for assessing the big five dimensions of personality. Leibniz Institute for the Social Sciences, MannheimGoogle Scholar
- Schwarzer R, Jerusalem M (1995) Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M (eds) Measures in health psychology: a user’s portfolio. Causal and control beliefs. NFER-Nelson, Windsor, pp 35–37Google Scholar
- Selden CR, Zorn M, Ratzan S, Parker RM et al (2000) Health literacy. National Library of Medicine, BethesdaGoogle Scholar
- van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E (2013) The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills Survey. J Health Commun 18:172–184. https://doi.org/10.1080/10810730.2013.825668 CrossRefGoogle Scholar
- WHO (2010) A conceptual framework for action on the social determinants of health. In: Debates, policy and practice, case studies. GenevaGoogle Scholar
- WHO Europe (2013) Health 2020. In: A European policy framework and strategy for the 21st Century. World Health Organization, GenevaGoogle Scholar