Health literacy, perceived stress, and health-related quality of life in Finnish adults: differences by chronic disease burden.

Health literacy is associated with health-related quality of life (HRQoL), but the role of perceived stress and possible differences by chronic disease burden remain unclear. We used data from a cross-sectional 2024 quota-based online panel survey of 4003 Finnish adults. The path models included 3716 participants with complete data and used post-stratification weights based on age group and gender. Health literacy was assessed with the HLS-Q12, perceived stress with the PSS-10, and HRQoL with the EuroQol five-dimension, five-level instrument (EQ-5D-5L). Path analysis estimated direct, indirect, and total associations, and multigroup models compared the main associations across three chronic disease-burden groups, adjusting for age, gender, education, employment status, and financial strain. Higher health literacy was associated with lower perceived stress, and higher perceived stress with poorer HRQoL. The indirect association through perceived stress represented approximately four-fifths of the total association based on unstandardized coefficients. The negative perceived stress-HRQoL association became progressively stronger across disease-burden groups on the unstandardized metric and was approximately twice as large among adults with multiple chronic diseases as among those with no chronic disease. The health literacy-stress association was similar across groups. These findings identify a stress-related pattern within the health literacy-HRQoL association and suggest that the association between stress and HRQoL may be particularly important among adults with multiple chronic diseases. Integrated health promotion approaches combining accessible communication, navigation support, stress-sensitive care, and efforts to reduce treatment burden warrant prospective evaluation.