Open Access Research article

Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model

Xinying Sun1, Yuhui Shi1, Qingqi Zeng1, Yanling Wang1, Weijing Du2, Nanfang Wei2, Ruiqian Xie2 and Chun Chang1*

Author Affiliations

1 Department of Social Medicine and Health Education, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, P.R. China

2 Department of Program Management, Chinese Center of Health Education, Building 12, Block 1, Anhua Xili, Andingmenwai, Beijing, 100011, P.R. China

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BMC Public Health 2013, 13:261  doi:10.1186/1471-2458-13-261

Published: 22 March 2013



Health literacy has been defined as the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions. Currently, few studies have validated the causal pathways of determinants of health literacy through the use of statistical modeling. The purpose of the present study was to develop and validate a health literacy model at an individual level that could best explain the determinants of health literacy and the associations between health literacy and health behaviors even health status.


Skill-based health literacy test and a self-administrated questionnaire survey were conducted among 3222 Chinese adult residents. Path analysis was applied to validate the model.


The model explained 38.6% of variance for health literacy, 11.7% for health behavior and 2.3% for health status: (GFI = 0.9990; RMR = 0.0521; χ2 = 10.2151, P = 0.1159). Education has positive and direct effect on prior knowledge (β = 0.324) and health literacy (β = 0.346). Health literacy is also affected by prior knowledge (β = 0.245) and age (β = -0.361). Health literacy is a direct influencing factor of health behavior (β = 0.101). The most important factor of health status is age (β = 0.107). Health behavior and health status have a positive interaction effect.


This model explains the determinants of health literacy and the associations between health literacy and health behaviors well. It could be applied to develop intervention strategies to increase individual health literacy, and then to promote health behavior and health status.

Health literacy; Health behavior; Determinants; Causal pathways