Structural equation modeling analysis on health literacy and cancer prevention behaviors among medically-underserved, low-income populations

Purpose: The purpose of this study was to test a hypothetical model about health literacy and cancer preventive behaviors among medically-underserved, low-income populations. Methods: Data were collected by questionnaire survey from 284 medical aid beneficiaries in three metropolitan cities from August to September 2018. Based on Von Wagner's health literacy and health outcome framework, the hypothetical model was developed which designates health literacy as the exogenous variable, cancer preventive behaviors as the endogenous variables, and knowledge, beliefs and attitudes about cancer prevention, and self-efficacy for mediating variables. Structural modeling analysis was conducted using SPSS/WIN 21.0 and AMOS 25.0 program. Results: Health literacy had a significant direct effect on knowledge, beliefs and attitude about cancer prevention, and self-efficacy but not on cancer preventive behaviors. Knowledge, beliefs and attitudes about cancer prevention, and self-efficacy, fully mediated in the relationship between health literacy and cancer preventive behaviors. Model fit indices for the hypothetical model showed good agreement. Conclusion: Health literacy among the medically-underserved, low-income populations influences cancer preventive behaviors through the full mediation of knowledge, beliefs and attitude, and self-efficacy. Therefore, to promote cancer preventive behaviors among medically-underserved, low-income populations, consideration should be given to health literacy level and development of strategies to enhance knowledge, beliefs and attitudes, and self-efficacy.