Jürgen M. Pelikan|Kristin Ganahl|Florian Roethlin
Health literacy as a determinant, mediator and/or moderator of health: empirical models using the European Health Literacy Survey dataset
University of Vienna|Gesundheit Österreich|Gesundheit Österreich
backgroundresearch question health literacy hl discourse debate ways hl impacting health three different logically nonexclusive hypotheses proposed hl specific direct social determinant health b hl mediator determinants health c hl moderator effect determinants health examples empirically testing mediator moderator hypothesis exist data european health literacy survey allow testing three hypotheses comparatively parallel functional comprehensive hl methods data collection based multistage random samples 1000 european union citizens aged 15 older computer assisted personal interviewing paper assisted personal interviewing methodology 2011 eight member states eu demographic socioeconomic indicators comprehensive european health literacy survey q47 functional newest vital sign test health literacy measure one selfassessed health variable surveyed correlation analysis multiple regression analysis path analysis performed results comprehensive hl much lesser degree functional hl relevant predictor selfassessed health also comprehensive hl limited degree mediating effects determinants selfassessed health age hl partly moderate effect health explained variance strength effects vary considerably national context conclusionsimplications comprehensive hl critical direct determinant health therefore comprehensive hl considerable potential health promotion improve population health tackle health gap comprehensive hl measurement standardised every country allow designing adequate measures specific situation country also benchmarking better understanding causal structure impact hl health longitudinal studies needed