Does health literacy mediate the relationship between socioeconomic status and navigation in the healthcare system? The French national health literacy survey (HLS19)

Navigational health literacy (HL), a specific form of HL, refers specifically to the skills required to navigate effectively healthcare systems, access services and make informed healthcare decisions. While general and navigational HL are related and share common predictive factors, little is known...

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Vydané v:Patient education and counseling Ročník 138; s. 109204
Hlavní autori: Touzani, Rajae, Protopopescu, Camelia, Rouquette, Alexandra, Allaire, Cécile, Dumas, Agnès, Hardouin, Jean-Benoit, Mancini, Julien
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Ireland Elsevier B.V 01.09.2025
Predmet:
Adult
Aged
Cross-Sectional Studies
Female
France
Health literacy
Health Literacy - statistics & numerical data
Health Services Accessibility
HLS19
Humans
Life Sciences
Male
Mediation analysis
Middle Aged
Navigation in the healthcare
Patient Navigation - statistics & numerical data
Social Class
Socioeconomic Factors
Socioeconomic status
Surveys and Questionnaires
France
Health literacy
Socioeconomic status
HL
CFI
HLS19-Q12
HLS19
TLI
SSS
RMSEA
SRMSR
HLS19-NAV
Navigation in the healthcare
SEM
RIT
Mediation analysis
HLS
Health Literacy
ISSN:0738-3991, 1873-5134, 1873-5134
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Popis
Shrnutí:Navigational health literacy (HL), a specific form of HL, refers specifically to the skills required to navigate effectively healthcare systems, access services and make informed healthcare decisions. While general and navigational HL are related and share common predictive factors, little is known about whether socioeconomic factors have a residual, specific effect on the ability to navigate the healthcare system after accounting for general HL. The aim of this study was to investigate the socioeconomic and chronic conditions variables associated with the ability to navigate the healthcare system in the French population, controlling for the mediating role of general HL. Methods A cross-sectional study, as a part of France's participation in the European Health Literacy Survey 2019–2021, involved 2 003 participants. Structural equation modeling was used to examine the direct and indirect effects of socioeconomic and health status variables on navigational HL level, considering general HL as a mediator on these relationships. Given the different healthcare needs and utilization patterns between French men and women, the analysis was stratified by gender to account for these differences. Results General HL was found to be a significant mediator for the relationships between socioeconomic factors and navigational HL in both men and women. Financial difficulties only had an indirect effect on navigational HL, completely mediated by general HL. Similarly, subjective social status showed complete mediation by general HL in women, with 64 % of the total effect mediated, whereas in men, mediation was partial, with 56 % of the total effect mediated by general HL. Conclusions This study underscores the pivotal role of general HL as a mediator in the relationships between socioeconomic factors and navigational HL. Interventions aimed at enhancing general HL could substantially improve the ability to navigate the healthcare system, leading to more efficient healthcare navigation and better health outcomes. •First evidence linking general health literacy to navigational health literacy through mediation analysis.•Results suggest targeted health literacy programs for better healthcare system navigation.•Men and women face distinct barriers to navigational health literacy, highlighting the need for gender-sensitive programs.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0738-3991
1873-5134
1873-5134
DOI:10.1016/j.pec.2025.109204