Health literacy and unhealthy lifestyle behaviors in older adults: does social connectedness matter?

Abstract Background Given the high prevalence of low health literacy (HL), the lifestyle-related morbidity, and the importance of the social environment in later life, we aimed to investigate the association between HL and unhealthy lifestyle behaviors and explore the moderating role of social connectedness in this relationship in a population-based sample of adults aged 58+. Methods We used data from 1,455 respondents to Wave 8 (2019/2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) in Switzerland. Current smoking, risky alcohol consumption, suboptimal daily consumption of fruits/vegetables, and lack of engagement in physical activity were considered to derive the number of unhealthy behaviors. Three HL categories were defined based on the HLS-EU-Q16 score: inadequate, problematic, and sufficient. Social connectedness was assessed using the Social Connectedness Scale. Associations were examined using Poisson regression models, controlling for sociodemographic and health characteristics and including an interaction term between HL and social connectedness to test the moderation hypothesis. Results Overall, 72.2% of respondents reported at least one unhealthy behavior, 6.6% had inadequate HL, and 19.8% were socially isolated. Respondents who had inadequate HL were more likely to have a higher number of unhealthy behaviors than those with sufficient HL (Average marginal effect (AME)=0.22, p < 0.01). We found a significant interaction between HL and social connectedness (p = 0.04), with a stronger positive association between inadequate HL and the number of unhealthy behaviors in socially isolated individuals (AME=0.34, p < 0.05). Conclusions Greater social connectedness seems to buffer the positive association of low HL with unhealthy lifestyle behaviors in older adults. Implementing tailored interventions aimed at improving HL may foster the adoption of healthy lifestyles, especially in socially isolated older individuals. Key messages • Social connectedness may mitigate the negative impact of low HL on the number of unhealthy behaviors, highlighting the importance of social reserve in making healthy lifestyle choices in later life. • Implementing HL-tailored health-promoting lifestyle interventions, including family or community components, would help tackle the double burden of low HL and unhealthy behaviors in older adults.