The Association of Health Literacy with Physical Activity and Nutritional Behavior in Older Adults, and Its Social Cognitive Mediators

ABSTRACT

Inadequate health literacy is a common problem among older adults and is associated with poor health outcomes. Insight into the association between health literacy and health behaviors may support interventions to mitigate the effects of inadequate health literacy. The authors assessed the association of health literacy with physical activity and nutritional behavior in community-dwelling older adults. The authors also assessed whether the associations between health literacy and health behaviors are mediated by social cognitive factors. Data from a study among community-dwelling older adults (55 years and older) in a relatively deprived area in The Netherlands were used (baseline n = 643, response: 43%). The authors obtained data on health literacy, physical activity, fruit and vegetable consumption, and potential social cognitive mediators (attitude, self-efficacy, and risk perception). After adjustment for confounders, inadequate health literacy was marginally significantly associated with poor compliance with guidelines for physical activity (OR = 1.52, p = .053) but not with poor compliance with guidelines for fruit and vegetable consumption (OR = 1.20, p = .46). Self-efficacy explained 32% of the association between health literacy and compliance with physical activity guidelines. Further research may focus on self-efficacy as a target for interventions to mitigate the negative effects of inadequate health literacy.

Acknowledgments

The authors thank M.E. Walters and J. Almansa Ortiz for their valuable contribution to this article.

Notes

Note. All p values are based on chi-square tests. Rates of missing data on the social cognitive factors regarding physical activity and fruit and vegetable consumption ranged from 1.7% and 6.1%. Data on poor compliance with physical activity and fruit and vegetable consumption guidelines were missing for 2.4% and 9.5% of the participants, respectively.

^a Measured after the intervention.

^b A total of 13.9% of participants refused to report their monthly income and were excluded from this analysis.

^c p value is based on three levels.

^d p value is based on five levels.

^e Separate analyses for subgroups based on compliance with guidelines for the corresponding health behavior revealed that there was no significant association for either subgroup (all p values >.6).

Note. All analyses were adjusted for effects of condition (intervention/control), age, and gender. Associations a to c' refer to the associations that are illustrated in Figure 1.

^a Adjusted for the mediator.

^b Difference in effect size between association c and association c' calculated as follows: (OR[c] – OR[c'])/(OR[c] − 1) × 100%.

^# p < .10. *p < .05. **p < .01.