Health literacy and youth’ health-related quality of life, the mediating effect of self-efficacy

Abstract Background Theory and research suggest that individuals with higher health literacy are more capable of managing health experiences, boosting their self-efficacy and impacting health-related quality of life positively. However, the potential mediating effect of general self-efficacy on the relationship between health literacy and health-related quality of life has scarcely been studied. The aim of this study was to examine the relationship between health literacy and health-related quality of life, and the potential mediating role of general self-efficacy in 13-year-old boys and girls. Methods A cross-sectional survey was conducted with 1,425 13-year-old students, (65.1% of those invited), from 48 schools across Norway. The study employed Norwegian versions of the instruments KIDSCREEN-27, Health Literacy Among School-Aged Children (HLSAC), and the General Self-Efficacy Scale (GSE-5). Causal mediation analysis, with general self-efficacy as the mediator, was used to study the relationship (total) and mediating (indirect) effects of health literacy on health-related quality of life subscale scores. Total, direct, and indirect effects were estimated for a hypothetical 10 percentage point increase in the health literacy score. Results Overall, a hypothetical increase in health literacy showed a statistically significant increase in health-related quality of life. The proportion mediated through self-efficacy was substantial for all KIDSCREEN subscales. The largest total effects for both genders were observed in School Environment. Conclusions This study contributes to the literature by demonstrating how enhancing health literacy may serve as a mechanism to strengthen health-related quality of life through general self-efficacy. Future interventions to improve health literacy among school aged adolescents should be designed and evaluated using more rigorous methodologies. Key messages • Increasing health literacy may contribute to improved health-related quality of life. • Self-efficacy appears to mediate the relationship between HL and HRQoL.