Does health literacy mediate the relationship between socioeconomic status and navigation in the healthcare system? The French national health literacy survey (HLS19)

Objective: Navigational health literacy (HL), a specific form of HL, refers specifically to the skills required to navigate effectively healthcare systems, access services and make informed healthcare decisions. While general and navigational HL are related and share common predictive factors, little is known about whether socioeconomic factors have a residual, specific effect on the ability to navigate the healthcare system after accounting for general HL. The aim of this study was to investigate the socioeconomic and chronic conditions variables associated with the ability to navigate the healthcare system in the French population, controlling for the mediating role of general HL. Methods A cross-sectional study, as a part of France's participation in the European Health Literacy Survey 2019-2021, involved 2 003 participants. Structural equation modeling was used to examine the direct and indirect effects of socioeconomic and health status variables on navigational HL level, considering general HL as a mediator on these relationships. Given the different healthcare needs and utilization patterns between French men and women, the analysis was stratified by gender to account for these differences. Results General HL was found to be a significant mediator for the relationships between socioeconomic factors and navigational HL in both men and women. Financial difficulties only had an indirect effect on navigational HL, completely mediated by general HL. Similarly, subjective social status showed complete mediation by general HL in women, with 64 % of the total effect mediated, whereas in men, mediation was partial, with 56 % of the total effect mediated by general HL. Conclusions