Association Between Health Literacy and Work Ability in Employees With Health-Related Risk Factors: A Structural Model

Abstract

Introduction: In workplace health promotion (WHP), health literacy and work ability are considered as outcomes of high interest. Therefore, the question arises as to what extent individual health literacy skills have an impact on work ability alongside sociodemographic influences.

Objectives: This study aimed to examine the associations between a structural model of health literacy as well as sociodemographic context factors and the work ability among employees with health-related risk factors.

Materials and methods: The study was based on baseline data of a workplace-related intervention (158 employees with health-related risk factors, 53.8% women, 48 ± 10 years). Health literacy skills were assessed with Lenartz's Questionnaire (measuring "self-perception", "proactive approach to health", "dealing with health information", "self-control", "self-regulation", and "communication and cooperation"). Work ability was measured by the German Short Form of the Work Ability Index (WAI). As sociodemographic context factors, sex, age, and educational level were assessed. The associations were examined using structural equation modeling with partial least squares (SmartPLS 2.0.M3). Common quality criteria were applied and significance level was set at α = 5%.

Results: Model's reliability, validity, and structure could be validated. Regarding the impact on work ability, "self-regulation" showed a statistically significant direct effect (ß = 0.32, t _(∞) = 4.00, p < 0.01, f ² = 0.09) and "self-perception" had a significant indirect effect (ß = 0.13, t _(∞) = 2.53, p < 0.05). The only additional association with work ability was found for age (ß = -0.25, t _(∞) = 3.82, p < 0.01, f ² = 0.04). The WAI score variance was explained to 17.5% by the health literacy skills and to 27.5% considering the additional sociodemographic context factors.

Conclusion: According to the structural model of health literacy, in employees with health-related risk factors, a target group-specific WHP approach could be the encouragement of self-regulation and self-perception. However, additional resources and conditions influencing work ability should be considered.

Keywords: PLS-SEM (partial least squares structural equation modeling); health literacy; health promotion; structural model; work ability.