ArticlePublic health in practice (Oxford, England)2026
Adolescents' health literacy and health-related quality of life: The mediating role of self-efficacy.
Article in Public health in practice (Oxford, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Enhancing Health-related quality of life (HRQoL) among adolescents is a major public health goal. HRQoL is associated with the modifiable factors health literacy and self-efficacy. Theory and research suggest that individuals with higher health literacy are more capable of managing health experiences, which may strengthen self-efficacy and improve HRQoL. However, the mediating role of self-efficacy in the association between health literacy and HRQoL is scarcely studied. The overall aim of this study is to examine the relationship between self-reported health literacy and HRQoL, and the potential mediating role of self-efficacy in 13-year-old boys and girls. Study design: The study employed a cross-sectional, school-based design. Methods: Self-report data were collected from 1425 13-year-old students (71% response rate) across 48 schools in 19 municipalities across Norway. HRQoL, health literacy, and self-efficacy were assessed using KIDSCREEN-27, HLSAC, and GSE-5, respectively. Mediation analysis was conducted within a causal mediation framework to estimate the potential total, direct, and indirect effects on HRQoL associated with a hypothetical 10-percentage-point increase in the health literacy score, with general self-efficacy as the proposed mediator. Results: Overall, higher health literacy showed a significant increase in HRQoL across all subscales.The largest total effects were observed for the School Environment domain. A hypothetical 10 percentage-point increase in health literacy was associated with increases of 2.47 T-score points (95% CI 2.08-2.85) among girls and 1.86 (95% CI 1.40-2.35) among boys. The proportion potentially mediated through self-efficacy ranged from 30% to 76% across HRQoL subscales. Conclusions: This study contributes to the literature by suggesting that general self-efficacy may be a potential mediator of the association between health literacy and HRQoL. Future interventions targeting health literacy should be evaluated using longitudinal designs that can assess the temporal ordering from health literacy to general self-efficacy and subsequently to HRQoL.
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