The Association Between Family Health and Proactive Health Risk Management With the Mediating Role of Health Literacy: Nationwide Cross-Sectional Study

Abstract BackgroundModifiable unhealthy behaviors account for over two-thirds of new cases of noncommunicable diseases. Behavioral risk factor reduction is a potentially cost-effective means to improve long-term health outcomes. Although family serves as a pivotal cornerstone for fostering and maintaining individuals’ health, the associations between family health (FH) and the proactive health risk management index (PHRMI) remain unclear. ObjectiveThis study aimed to construct a comprehensive index to measure the PHRMI and examine the mediating effect of health literacy on the association between FH and the PHRMI, as well as the moderating effect of family communication on the associations among the PHRMI, health literacy, and FH. MethodsA cross-sectional questionnaire survey was conducted with 30,044 participants from 34 provinces or regions in China who were recruited using a multistage stratified sampling strategy from June 20, 2023, to August 31, 2023. This study constructed the PHRMI for the general population by encompassing BMI, physical activity (International Physical Activity Questionnaire–Short Form), depression (Patient Health Questionnaire-9), sleep quality (Brief version of the Pittsburgh Sleep Quality Index), smoking behavior, and drinking behavior. Further, we assessed FH (Short Form of the Family Health Scale), health literacy (Short-Form Health Literacy Questionnaire-4), and family communication (Family Communication Scale–Short Form). In addition, we collected the sociodemographic characteristics of the participants. We used model 4 of the IBM SPSS macro PROCESS to verify the mediating effect of health literacy between FH and the PHRMI, while model 7 was adopted to test the moderated mediation of family communication among the PHRMI, health literacy, and FH. ResultsHigher levels of FH were significantly associated with higher PHRMI levels (β=.710, 95% CI 0.669-0.752). Health literacy significantly mediated the association between FH and the PHRMI (β=.207, 95% CI 0.168-0.245), playing a partial mediating role. Family communication significantly moderated the association between FH and health literacy (β=.117, 95% CI 0.105-0.130). The simple slope analysis showed that higher levels of family communication exacerbated the effects of FH on health literacy. Subsequently, we performed a sensitivity analysis, and the main results aligned with the findings of prior studies. Nevertheless, the subgroup analysis revealed that the mediating effect of health literacy was not significant in the group aged >60 years (β=.066, 95% CI −0.024 to 0.157). ConclusionsFH can be an important target that appears to be positively linked to proactive health risk management and health literacy. FH promotion for older adults should pay more attention to family or intergenerational communication.