Algılanan stresin aracılık rolü: sağlık okuryazarlığı ile sağlıklı yaşam farkındalığı arasındaki ilişkinin incelenmesi

Abstract

Amaç: Bu çalışmanın amacı, algılanan stresin sağlık okuryazarlığı ve sağlıklı yaşam tarzı farkındalığı arasındaki ilişkiye aracılık etkisini araştırmaktır. Sağlık okuryazarlığının, algılanan stres düzeylerini azaltarak hem doğrudan hem de dolaylı olarak sağlıklı yaşam tarzı farkındalığını olumlu yönde yordayacağı varsayılmıştır. Yöntemler: Bu araştırma kesitsel ve korelasyonel bir tasarım benimsemiştir. Örneklem Konya, Türkiye'de ikamet eden 1.150 yetişkinden oluşmaktadır. Veri toplama araçları Sağlık Okuryazarlığı, Algılanan Stres ve Sağlıklı Yaşam Farkındalığı ölçeklerini içermektedir. Tanımlayıcı analizler ve Pearson korelasyon katsayıları hesaplanmış, ardından yapısal eşitlik modellemesi yoluyla aracılık testleri yapılmıştır. Dolaylı etkilerin önemi, 5.000 yeniden örneklem ve %95 güven aralığıyla bootstrapping kullanılarak değerlendirilmiştir. Sonuçlar: Örneklem, Konya'da ikamet eden ve yaş ortalaması 30,48 olan 1.150 yetişkinden oluşmuştur. Çoğunluğu kadın (%54.3), bekar (%59.7) ve üniversite mezunudur (%59.1). Bulgular, sağlık okuryazarlığının sağlıklı yaşam tarzı farkındalığını pozitif yönde (β = .43, p < .001) ve algılanan stresi negatif yönde (β = -.21, p < .001) yordadığını göstermiştir. Buna karşılık, algılanan stres sağlıklı yaşam tarzı farkındalığını negatif yönde yordamıştır (β = -.19, p < .001). Aracılık analizi, sağlık okuryazarlığının algılanan stres aracılığıyla sağlıklı yaşam tarzı farkındalığı üzerinde anlamlı bir dolaylı etkisi olduğunu ortaya koymuştur (β = .02, %95 CI [.01, .04]). Bu sonuçlar hipotezlenen aracı modeli desteklemiştir. Sonuç: Bu çalışma, algılanan stresin sağlık okuryazarlığı ile sağlıklı yaşam tarzı farkındalığı arasındaki ilişkiye kısmen aracılık ettiğini kanıtlamaktadır. Sağlık okuryazarlığının geliştirilmesi algılanan stresi azaltarak bireylerin sağlıklı yaşam anlayışını geliştirebilir. Bu bulgular, bütüncül refahı teşvik etmek için stres yönetimi ve sağlık okuryazarlığı eğitiminin üniversite sağlık programlarına dahil edilmesinin önemini vurgulamaktadır.

Keywords

• Sağlık Okuryazarlığı
• Stres
• Farkındalık
• Sağlık Davranışı

The mediating role of perceived stress: an examination of the relationship between health literacy and healthy living awareness

Abstract

Aims: This study aimed to explore the mediating effect of perceived stress on the relationship between health literacy and healthy lifestyle awareness. It was hypothesized that health literacy would positively predict healthy lifestyle awareness, directly and indirectly, by reducing levels of perceived stress. Methods: This research adopted a cross-sectional and correlational design. The sample consisted of 1,150 adults residing in Konya, Turkiye. Data collection instruments included validated measures of Health Literacy, Perceived Stress, and Healthy Life Awareness. Descriptive analyses and Pearson correlation coefficients were calculated, followed by mediation testing through structural equation modeling. The significance of indirect effects was assessed using bootstrapping with 5,000 resamples and 95% confidence intervals. Results: The sample consisted of 1,150 adults residing in Konya, with a mean age of 30.48. The majority were female (54.3%), single (59.7%), and university graduates (59.1%). The findings demonstrated that health literacy positively predicted healthy lifestyle awareness (β=0.43, p<0.001) and negatively predicted perceived stress (β=-0.21, p<0.001). In turn, perceived stress negatively predicted healthy lifestyle awareness (β=-0.19, p<0.001). Mediation analysis revealed a significant indirect effect of health literacy on healthy lifestyle awareness through perceived stress [β=0.02, 95% CI (0.01-0.04)]. These results supported the hypothesized mediating model. Conclusion: The study proves that perceived stress partially mediates the relationship between health literacy and healthy lifestyle awareness. Improving health literacy may reduce perceived stress, enhancing individuals’ understanding of healthy living. These findings highlight the importance of incorporating stress management and health literacy education into university health programs to promote holistic well-being.

Keywords

• Health literacy
• stress
• awareness
• health behavior

References

1. İskender H, Dokumacıoğlu E, Kanbay Y, Kılıç N. Üniversite öğrencilerinde sağlıklı yaşam ve depresyon puan düzeyleri ile ilgili faktörlerin belirlenmesi. ACU Sağlık Bil Derg. 2018;9(4):414-423. doi:10. 31067/0.2018.64
2. Quaye ES, Mokgethi K, Ameyibor LEK. Health self-identity–based motivations and behavioral intentions: a predictive model and segmentation analysis. Soc Market Quarterly. 2021;27(4):347-369. doi:10. 1177/15245004211053853
3. Gayef A. Healthy living behaviors in university students and related factors. Anatol JFM. 2019. doi:10.5505/anatoljfm.2018.43534
4. Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. doi:10.1186/1471-2458-12-80
5. Yu X, Luo M, Wu S, et al. Developing a questionnaire to evaluate the health information literacy in China. Front Public Health. 2023;11: 1068648. doi:10.3389/fpubh.2023.1068648
6. Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67(12):2072-2078. doi:10.1016/j.socscimed.2008.09.050
7. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31(Suppl 1): S19-S26. doi:10.5555/ajhb.2007.31.supp.S19
8. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. doi:10.7326/0003-4819-155-2-201107190-00005

9. Yang P, Ou Y, Yang H, et al. Research on influencing factors and dimensions of health literacy in different age groups: before and after the COVID-19 era in Chongqing, China. Front Public Health. 2021;9: 690525. doi:10.3389/fpubh.2021.690525
10. Bektas İ, Kudubeş AA, Ayar D, Bektas M. Predicting the healthy lifestyle behaviors of Turkish adolescents based on their health literacy and self-efficacy levels. J Pediatr Nurs. 2021;59:e20-e25. doi:10.1016/j.pedn.2021.01.016
11. Elkin N. The relationship between health literacy and healthy lifestyle behaviors: a meta-analysis. Medicine. 2024;103(43):e40260. doi:10.1097/MD.0000000000040260
12. Sudore RL, Mehta KM, Simonsick EM, et al. Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc. 2006;54(5):770-776. doi:10.1111/j.1532-5415.2006.00691.x
13. Lazarus R, Folkman S. Stress, Appraisal, and Coping. Springer US; 1984.
14. Devran H, Beyazit Üçgün A, Yürekli MV, Uskun E. Yaşam kalitesinin yordayıcısı olarak sağlıklı yaşam biçimi davranışları: tıp fakültesi öğretim elemanları örneği. Turk Halk Sağl Derg. 2021;19(1):55-68. doi: 10.20518/tjph.763355
15. Wang D, Sun X, He F, Liu C, Wu Y. The mediating effect of family health on the relationship between health literacy and mental health: a national cross-sectional survey in China. Int J Soc Psychiatry. 2023;69(6):1490-1500. doi:10.1177/00207640231166628
16. Gouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immun Allergy Clin North Am. 2011;31(1):81-93. doi:10.1016/j.iac.2010.09.010
17. Hirooka N, Kusano T, Kinoshita S, Nakamoto H. Influence of perceived stress and stress coping adequacy on multiple health-related lifestyle behaviors. IJERPH. 2021;19(1):284. doi:10.3390/ijerph19010284
18. Algren MH, Ekholm O, Nielsen L, Ersbøll AK, Bak CK, Andersen PT. Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study. BMC Public Health. 2018;18(1):250. doi:10.1186/s12889-018-5170-x
19. Bandura A. Self-Efficacy: The Exercise of Control. W H Freeman/Times Books/ Henry Holt & Co; 1997:ix, 604.
20. Bozkurt S. Process Makro Ile Aracılık, Düzenleyicilik ve Durumsal Aracılık Etki Analizleri (SPSS Uygulamalı). 1. Basım. Ekin Basım Yayın; 2023.
21. Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Third edition. The Guilford Press; 2022.
22. Pelikan JM, Röthlin F, Ganahl K. Measuring comprehensive health literacy in general populations: Validation of instrument, indices and scales of the HLS-EU study. In: Proceedings of the 6th Annual Health Literacy Research Conference. 2014.
23. Yeşildal M. Validity and reliability of the Turkish version of the HLS-EU-Q6 questionnaire. BMC Public Health. 2025;25(1):2633. doi:10. 21203/rs.3.rs-5145103/v1
24. Kocapınar F, Ekşi H. Turkish adaptation study of the Perceived Stress Scale short form. In: IKSAD Publications; 2024:554-563.
25. Schäfer SK, Von Boros L, Göritz AS, et al. The Perceived Stress Scale 2&2: a two-factorial German short version of the Perceived Stress Scale. Front Psychiatry. 2023;14:1195986. doi:10.3389/fpsyt.2023.1195986
26. Özer E, Yilmaz N. Healthy life awareness: a scale development study. J Tradit Complem Med. 2020;3(1):47-60. doi:10.5336/jtracom.2019-72138
27. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259-267. doi:10.1093/heapro/15.3.259
28. Liu Y, Meng H, Tu N, Liu D. The relationship between health literacy, social support, depression, and frailty among community-dwelling older patients with hypertension and diabetes in China. Front Public Health. 2020;8:280. doi:10.3389/fpubh.2020.00280
29. Rababah JA, Al-Hammouri MM, Drew BL. The impact of health literacy on college students’ psychological disturbances and quality of life: a structural equation modeling analysis. Health Qual Life Outcomes. 2020;18(1):292. doi:10.1186/s12955-020-01541-7
30. Pappadis MR, Sander AM, Juengst SB, et al. The relationship of health literacy to health outcomes among individuals with traumatic brain injury: a traumatic brain injury model systems study. J Head Trauma Rehabil. 2024;39(2):103-114. doi:10.1097/HTR.0000000000000912
31. Ishikawa H, Yano E. Patient health literacy and participation in the health-care process. Health Expectations. 2008;11(2):113-122. doi:10. 1111/j.1369-7625.2008.00497.x
32. Zhang H, Li Y, Peng S, Jiang Y, Jin H, Zhang F. The effect of health literacy on COVID-19 vaccine hesitancy: the moderating role of stress. Vaccine. 2022;40(32):4473-4478. doi:10.1101/2021.06.16.21258808
33. Cohen S, Kamarck T, Mermelstein R. A Global measure of perceived stress. J Health Soc Behav. 1983;24(4):385. doi:10.2307/2136404
34. McEwen BS. Stress, adaptation, and disease: allostasis and allostatic load. Ann New York Acad Sci. 1998;840(1):33-44. doi:10.1111/j.1749-6632.1998.tb09546.x
35. Ng DM, Jeffery RW. Relationships between perceived stress and health behaviors in a sample of working adults. Health Psychol. 2003;22(6):638-642. doi:10.1037/0278-6133.22.6.638
36. Ülker İ. Obezitenin hastalık sürecinde yaşam kalitesine etkisi: COVID-19 örneği. Adnan Menderes Üniv Sağ Bil Fak Derg. 2023;7(3): 682-691. doi:10.46237/amusbfd.1338547
37. Yeşil Bayülgen M, Altıok M. Healthy lifestyle behaviours of percutaneous transluminal coronary angioplasty patients and the affecting factors. J Cardiovasc Nurs. 2017;8(16):45-54. doi:10.5543/khd.2017.28199
38. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Person Soc Psychol. 1986;51(6):1173-1182. doi:10.1037/ 0022-3514.51.6.1173
39. Angermayr L, Melchart D, Linde K. Multifactorial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitus-a systematic review of randomized controlled trials. Ann Behav Med. 2010;40(1):49-64. doi:10.1007/s12160-010-9206-4
40. McKenzie SH, Harris MF. Understanding the relationship between stress, distress and healthy lifestyle behaviour: a qualitative study of patients and general practitioners. BMC Fam Pract. 2013;14(1):166. doi: 10.1186/1471-2296-14-166
41. Gazmararian JA. Health literacy among medicare enrollees in a managed care organization. JAMA. 1999;281(6):545. doi:10.1001/jama. 281.6.545
42. Jordan TR, Khubchandani J, Wiblishauser M. The impact of perceived stress and coping adequacy on the health of nurses: a pilot investigation. Nurs Res Pract. 2016;2016:1-11. doi:10.1155/2016/5843256