Relationships of health literacy, health behavior, and health status regarding infectious respiratory diseases: application of a skill-based measure.

This study aimed to explain the relationships among health literacy, health behavior, and health status, using a newly developed skills-based measure of health literacy regarding respiratory infectious diseases. This instrument was designed to measure individuals' reading, understanding, and calculating ability, as well as their oral communication and Internet-based information-seeking abilities. A pilot survey was conducted with 489 residents in Beijing, China, to test the reliability and validity of the new measure. Next, a larger study with 3,222 residents in three cities with multistage stratified cluster sampling was implemented to validate a latent variable model (goodness of fit index=0.918, root mean square residual=0.076). In this model higher educational attainment (β=0.356) and more health knowledge (β=0.306) were positively and directly associated with greater health literacy skill, while age was negatively associated with it (β=-0.341). Age (β=0.201) and health knowledge (β=0.246) had positive and direct relationship with health behavior, which was, in turn, positively associated with health status (β=0.209). The results illustrate the complex relationships among these constructs and should be considered when developing respiratory intervention strategies to promote health behavior and health status.