Health literacy mediates the relationships of cognitive and physical functions with health-related quality of life in older adults

Bik C Chow; Jiao Jiao; Tuyen V Duong; Holger Hassel; Timothy C Y Kwok; Minh H Nguyen; Huaxuan Liu

doi:10.3389/fpubh.2024.1355392

Health literacy mediates the relationships of cognitive and physical functions with health-related quality of life in older adults

Front Public Health. 2024 Mar 14:12:1355392. doi: 10.3389/fpubh.2024.1355392. eCollection 2024.

Authors

Bik C Chow^#^{1

2}, Jiao Jiao^#^{1

2}, Tuyen V Duong^{3

4}, Holger Hassel^{5

6}, Timothy C Y Kwok⁷, Minh H Nguyen^{4

8}, Huaxuan Liu⁹

Affiliations

¹ Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China.
² Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China.
³ School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan.
⁴ International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Institute for Applied Health Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany.
⁶ Berlin Institute for Health and Social Affairs, Berlin, Germany.
⁷ Department of Medicine & Therapeutic and School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
⁸ School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
⁹ School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China.

^# Contributed equally.

Abstract

Background: Declining cognitive function (CF) and physical function (PF) relate to poorer health-related quality of life (HRQoL) in older adults. As health literacy (HL) facilitates health information utilization, it may mediate links between functionality and HRQoL appraisals. This study examined HL as an intermediary between joint CF and PF contributions and HRQoL in Hong Kong older adults.

Methods: 490 older adults aged 50-80 years completed assessments from March to July 2021. Health Literacy Survey Questionnaire Short Form 12 questions (HLS-SF12), Montreal Cognitive Assessment (MoCA), Senior Fitness Test (SFT) and 12-Item Short-Form Health Survey version 2 (SF-12v2) were used to assess HL, CF, PF and HRQoL, respectively. Path analysis tested a model with HL mediating CF/PF predictors and HRQoL outcome.

Results: Results for direct effects indicated that CF significantly associated with PF (β = 0.115, SE = 0.012, p < 0.001), PF significantly connected to HL (β = 0.101, SE = 0.022, p < 0.001), and HL significantly related to HRQoL (β = 0.457, SE = 0.049, p < 0.001). Meanwhile, PF significantly linked to HRQoL directly (β = 0.156, SE = 0.025, p < 0.001) as well as indirectly (β = 0.046, 95% CI [0.028, 0.067]). Significant mediating effect of HL was found on the relationship of PF and HRQoL.

Conclusion: Findings confirm CF and PF joint impacts on HL and HRQoL in older adults, elucidating HL's mediating role in translating functionality levels into HRQoL. Fostering enduring health knowledge access may thus buffer effects of age-related declines on well-being. Results can inform interventions leveraging this pathway to promote resilient trajectories.

Keywords: cognitive function; health literacy; health-related quality of life; older adults; physical function.

MeSH terms

Exercise
Health Literacy*
Health Surveys
Quality of Life* / psychology
Surveys and Questionnaires

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the HKBU Faculty Research Niche Area grant (RC-FNRA-IG/19-20/SOSC/05), the Germany/Hong Kong Joint Research Scheme 2020/2 (G-HKBU202/20) of Research Grants Council, and Jockey Club Mus-Fit for Health Project from Hong Kong Jockey Club Charities Trust (Ref no.: 2021-0401).