The independent and moderator role of communicative health literacy on health, health behaviour and health care utilisation: a population based cross-sectional study

Objectives: The aim of the present study is to investigate the association between communicative health literacy, health behaviour and health care utilisation, as well as the moderation effect of communicative health literacy on various health-related outcomes. Study design: A total of 1205 Hungarian adults aged 18 years and older participated in this nationwide crosssectional survey, which was part of the international Health Literacy Population Survey 2019--2021 (HLS19). Methods: Data collection was carried out at the end of 2020, using a multistage probability sample of the Hungarian adult population representative by age, sex, and settlement type. Multivariate logistic regression models were performed to examine whether communicative health literacy affects the main outcomes, followed by a moderation analysis. Results: Better communicative health literacy was associated with increased odds of physical activity (OR = 2.68; 95% CI = 1.39--5.17), fruit and vegetable consumption (OR = 2.05; 95% CI = 1.13--3.70), and decreased odds of emergency (OR = 0.40; 95% CI = 0.21--0.76) and inpatient care use (OR = 0.36; 95% CI = 0.16--0.82) and limitations due to health problems (OR = 0.41; 95% CI = 0.21--0.80). Furthermore, we found a significant moderation effect between communicative health literacy and socio-demographic variables on self-perceived health status, smoking habits, use of inpatient care and limitations due to health problems. Conclusions: The study confirmed that communicative health literacy has an independent main and moderating effect on health outcomes, health behaviours and health care utilisation. The results contribute to a better understanding of the complex pathways between health literacy and health.