Health literacy, self-efficacy, health locus of control, and health-related behaviors in Taiwan

Health literacy, self-efficacy, and health locus of control have been suggested as cognitive and psychosocial predictors of health behaviors. However, little empirical evidence has demonstrated the linkages. The purpose of this study is to examine the associations among health literacy, self-efficacy, and health locus of control, and whether or not those factors are associated with health-related behaviors. Data for this study were obtained from a national survey conducted by the National Health Research Institutes (NHRI) in Taiwan in 2008-2009. A total of 3526 adults completed face-to-face interviews, for a response rate of 62.06%. The Mandarin Health Literacy Scale (MHLS) was used to measure the level of health literacy. Health-related behaviors measures included having regular physical check-up, receiving flu vaccination, monitoring physical status, and checking food labels. Overall, 28% subjects had poor health literacy. Individuals with lower health literacy were more likely to hold external locus of control beliefs and had lower self-efficacy. Health literacy was independently associated with receiving flu vaccination and checking food labels. External locus of control had a positive association with physical check-up and negatively associations with monitoring physical status and checking food labels. Self-efficacy was the most prominent predictor of health-related behaviors as it was significantly related to all four behavioral measures. The study demonstrates positive associations between health literacy, self-efficacy, and internal locus of control. Of these factors, self-efficacy displays the most consistent relationship with health behaviors, suggesting that it is the perceived, rather than actual, level of individual capability that matters more in shaping health behaviors.