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

IF 2.9 2区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Patient Education and Counseling Pub Date : 2025-05-31 DOI:10.1016/j.pec.2025.109204

Rajae Touzani , Camelia Protopopescu , Alexandra Rouquette , Cécile Allaire , Agnès Dumas , Jean-Benoit Hardouin , Julien Mancini

{"title":"Does health literacy mediate the relationship between socioeconomic status and navigation in the healthcare system? The French national health literacy survey (HLS19)","authors":"Rajae Touzani , Camelia Protopopescu , Alexandra Rouquette , Cécile Allaire , Agnès Dumas , Jean-Benoit Hardouin , Julien Mancini","doi":"10.1016/j.pec.2025.109204","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>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.</div><div>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.</div><div>Methods</div><div>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.</div><div>Results</div><div>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.</div><div>Conclusions</div><div>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.</div></div>","PeriodicalId":49714,"journal":{"name":"Patient Education and Counseling","volume":"138 ","pages":"Article 109204"},"PeriodicalIF":2.9000,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Patient Education and Counseling","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0738399125005713","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

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.

查看原文本刊更多论文

健康素养是否在社会经济地位和医疗系统导航之间起到中介作用？法国国家健康素养调查（HLS19）

目的导航卫生素养（HL）是HL的一种特殊形式，专门指有效导航卫生保健系统、获得服务和做出知情卫生保健决策所需的技能。虽然一般HL和导航HL是相关的，并且具有共同的预测因素，但在考虑一般HL后，社会经济因素是否对导航医疗系统的能力有剩余的特定影响，我们知之甚少。本研究的目的是调查社会经济和慢性病变量与导航能力的医疗保健系统在法国人口，控制一般HL的中介作用。方法作为法国参与2019-2021年欧洲健康素养调查的一部分，一项横断面研究涉及2,003名参与者。采用结构方程模型研究了社会经济和健康状况变量对航海HL水平的直接和间接影响，认为一般HL在这些关系中起中介作用。鉴于法国男性和女性之间不同的医疗保健需求和利用模式，分析按性别分层，以解释这些差异。结果普通HL在社会经济因素与男性和女性导航HL之间具有显著的中介作用。财务困难对通航性HL仅具有间接影响，完全由一般HL介导。同样，主观社会地位在女性中被普通HL完全中介，占总效应的64% %，而在男性中，被普通HL部分中介，占总效应的56% %。结论一般HL在社会经济因素与航海HL之间起中介作用。旨在提高一般HL的干预措施可以大大提高导航医疗保健系统的能力，从而导致更有效的医疗保健导航和更好的健康结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Patient Education and Counseling 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.60

自引率

11.40%

发文量

384

审稿时长

46 days

期刊介绍： Patient Education and Counseling is an interdisciplinary, international journal for patient education and health promotion researchers, managers and clinicians. The journal seeks to explore and elucidate the educational, counseling and communication models in health care. Its aim is to provide a forum for fundamental as well as applied research, and to promote the study of organizational issues involved with the delivery of patient education, counseling, health promotion services and training models in improving communication between providers and patients.