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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| Veröffentlicht in: | Patient education and counseling Jg. 138; S. 109204 |
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Elsevier B.V
01.09.2025
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| Abstract | 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. |
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| AbstractList | 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. 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. 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. 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.OBJECTIVENavigational 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. |
| ArticleNumber | 109204 |
| Author | Dumas, Agnès Hardouin, Jean-Benoit Allaire, Cécile Touzani, Rajae Rouquette, Alexandra Mancini, Julien Protopopescu, Camelia |
| Author_xml | – sequence: 1 givenname: Rajae orcidid: 0000-0002-2713-0943 surname: Touzani fullname: Touzani, Rajae email: rajae.touzani@inserm.fr organization: Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe Labellisée Ligue, Marseille 2019, France – sequence: 2 givenname: Camelia orcidid: 0000-0003-0164-7917 surname: Protopopescu fullname: Protopopescu, Camelia organization: Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe Labellisée Ligue, Marseille 2019, France – sequence: 3 givenname: Alexandra orcidid: 0000-0002-2473-1719 surname: Rouquette fullname: Rouquette, Alexandra organization: Public Health and Epidemiology Department, AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France – sequence: 4 givenname: Cécile surname: Allaire fullname: Allaire, Cécile organization: Santé Publique France, Saint Maurice, France – sequence: 5 givenname: Agnès surname: Dumas fullname: Dumas, Agnès organization: Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe Labellisée Ligue, Marseille 2019, France – sequence: 6 givenname: Jean-Benoit surname: Hardouin fullname: Hardouin, Jean-Benoit organization: INSERM, Université de Nantes – Université de Tours, UMR U1246 SPHERE, Methods in patient-centered outcomes and health research, Nantes, France – sequence: 7 givenname: Julien orcidid: 0000-0001-9500-8598 surname: Mancini fullname: Mancini, Julien organization: Aix Marseille Univ, INSERM, IRD, ISSPAM, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Equipe Labellisée Ligue, Marseille 2019, France |
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| Keywords | 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 |
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| Title | Does health literacy mediate the relationship between socioeconomic status and navigation in the healthcare system? The French national health literacy survey (HLS19) |
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