Revisit the Effects of Health Literacy on Health Behaviors in the Context of COVID-19: The Mediation Pathways Based on the Health Belief Model.

Background: Emerging research has identified health literacy as an important resource for individual health care and disease prevention. In the context of COVID-19, People with limited HL are less likely to follow preventive measures such as wearing masks, social isolation, or taking the vaccination. However, the pathways of how health literacy affects decision-making have remained unclear. Methods: With a cross-sectional study, a total of 613 responses (mean age is 25.64 ± 6.46 years) were collected. The relationship between health literacy and health behaviors under COVID-19 was examined, and the potential mediation pathways were assessed based on the health belief model. Results: With linear regression, it was found that health literacy has a direct effect on health behaviors and three constructs in the health belief model, i.e., perceived susceptibility, perceived severity, perceived barriers, as well as an indirect effect on health behaviors via increasing perceived barriers related with COVID-19 preventive measures. The results showed that health literacy only goes through the pathway of perceived barriers to influence health behaviors, and the indirect effects via other pathways were not significant. Conclusions: The research addressed the mediation model underlying the effects of health literacy on health behaviors and identified a partial mediation role of perceived barriers. Health literacy could promote individual health behavior by reducing the perceived barriers to forming a healthy lifestyle and making health decisions. Future health promotion interventions increasing people's health literacy should be advocated to promote health initiatives in the whole population.