Sex Differences in Health Literacy and Health-Promoting Behaviors Among Community-Dwelling Older Adults With Hypertension: Implications for Home Health Nursing Practice

Background: Effective hypertension management among older adults increasingly depends on engagement in health-promoting behaviors (HPBs) within home and community settings. Health literacy is a key determinant of self-management capacity; however, limited evidence exists regarding sex differences in the relationship between health literacy and HPBs among community-dwelling older adults with hypertension, particularly in the post–COVID-19 context where home-based care has become more prominent. Methods: A cross-sectional study was conducted among 164 community-dwelling older adults aged 60 years and older with diagnosed hypertension in urban and rural communities in Thailand. Participants completed validated self-report questionnaires. Sex differences were examined using chi-square and Fisher’s exact tests. Multiple regression analyses were performed separately for men and women to identify sex-specific predictors of health-promoting behaviors. Results: Both men and women demonstrated relatively high levels of health literacy and overall health-promoting behaviors. Health literacy was a significant predictor of health-promoting behaviors for both men (β = .34, P < .001) and women (β = .32, P < .001). Women reported significantly higher engagement in smoking and alcohol avoidance behaviors than men, while physical activity levels were low across both groups. Among women, older age was positively associated with engagement in health-promoting behaviors (β = .14, P = .001); this association was not observed among men. Conclusion: Health literacy plays a critical role in supporting health-promoting behaviors among older adults with hypertension, with notable sex-specific patterns. These findings highlight the importance of integrating health literacy assessment and sex-responsive education strategies into home health nursing practice.