•  
  •  
 

ORCID ID

Müjdat Yeşildal: 0000-0003-1286-903X

Yunus Emre Öztürk: 0000-0002-6178-6129

Abstract

Background: Chronic noncommunicable diseases are the leading causes of death globally and in Türkiye, emphasizing the need to explore how individual, familial, and informational factors shape health-promoting behaviors. This study examined whether family health and health literacy sequentially mediate the relationship between general self-efficacy and health-promoting behaviors among adults in Türkiye.

Methods: A cross-sectional correlational study was conducted with 1,240 adults in Konya Province, Türkiye, between November and December 2022. Participants completed the Turkish versions of the General Self-Efficacy, Family Health, Health Literacy, and Health-Promoting and Protective Behaviors Scales. Data were analyzed using descriptive statistics, Pearson correlation, and PROCESS macro Model 6 to test the serial mediation model, accounting for both direct and indirect effects.

Results: Self-efficacy, family health, and health literacy were significantly and positively associated with health-promoting behaviors (p < 0.001). The serial mediation analysis confirmed that family health and health literacy partially and sequentially mediated the relationship between self-efficacy and HPBs. Notably, the model demonstrated a substantial effect size, explaining 38.4% of the total variance in HPBs.

Conclusions: Self-efficacy influences health behaviors both directly and indirectly through its impact on family health and health literacy. Interventions should target both individual motivation and relational and informational support, especially in collectivist contexts such as the one in Türkiye.

References

  1. Türkiye İstatistik Kurumu. Death and cause of death statistics. Ankara: Türkiye İstatistik Kurumu; 2023. Turkish.
  2. Türkiye İstatistik Kurumu. The Biruni Central Distribution System Provincial and District Population Report. Ankara: Türkiye İstatistik Kurumu; 2022. Turkish.
  3. WHO Center for Health Development. A glossary of terms for community health care and services for older persons. Japan: WHO Centre for Health Development; 2004.
  4. Xie J, Liu M, Zhong Z, Zhang Q, Zhou J, Wang L, et al. Relationships among character strengths, self-efficacy, social support, depression, and psychological well-being of hospital nurses. Asian Nurs Res. 2020;14:150–7.
  5. Doumit R, Habre M, Cattan R, Kharma JA, Davis B. Health‐promoting behaviors and self‐efficacy among nursing students in times of uncertainty. Worldviews Evid Based Nurs. 2022;19:500–7.
  6. Alrimali AM. Assessment of physical activity level, self-efficacy and perceived barriers to physical activity among adult Saudi women. J Taibah Univ Med Sci. 2023;18:812–21.
  7. Setiawan D, Aisyah Durrotun Nafisah, Diana. Father’s involvement in children’s distance learning during the pandemic. Jurnal Pendidikan Usia Dini. 2022;16:149–61.
  8. Schellenberg ES, Dryden DM, Vandermeer B, Ha C, Korownyk C. Lifestyle interventions for patients with and at risk for type 2 diabetes: A systematic review and meta-analysis. Ann Intern Med. 2013;159:543–51.
  9. Bandura A. Social cognitive theory: An agentic perspective. Annu Rev Psychol. 2001;52:1–26.
  10. Muscat DM, Cvejic E, Bell K, Smith J, Morris GM, Jansen J, et al. Impact of health literacy on psychosocial and behavioral outcomes among people at low risk of cardiovascular disease. Prev Med. 2022;156:106980.
  11. Medina P, Maia AC, Costa A. Health literacy and migrant communities in primary health care. Front Public Health. 2022;9:798222.
  12. Zhang F, Or PPL, Chung JWY. How different health literacy dimensions influence health and well‐being among men and women: The mediating role of health behaviors. Health Expect. 2021;24:617–27.
  13. Wong DFK, Cheng C-W, Zhuang XY, Ng TK, Pan S-M, He X, et al. Comparing the mental health literacy of Chinese people in Australia, China, Hong Kong and Taiwan: Implications for mental health promotion. Psychiatry Res. 2017;256:258–66.
  14. Silvera-Tawil D, Hussain MS, Li J. Emerging technologies for precision health: An insight into sensing technologies for health and wellbeing. Smart Health. 2020;15:100100.
  15. Crondall A, Daines C, Hanson CL, Barnes MD. The effects of COVID‐19 stressors and family life on anxiety and depression one‐year into the COVID‐19 pandemic. Fam Process. 2022;62:336–51.
  16. Kim R, Olpin E, Novilla LK, Crandall A. The association of COVID-19 stressors and family health on overeating before and during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19:6174.
  17. Weiss-Laxer NS, Crandall A, Okano L, Riley AW. Building a foundation for family health measurement in national surveys: A modified Delphi expert process. Matern Child Health J. 2020;24:259–66.
  18. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. 3rd ed. New York: Guilford Press; 2022.
  19. Bozkurt S. Process makro ile aracılık, düzenleyicilik ve durumsal etki analizleri (SPSS uygulamalı) [Process macro mediation, moderation, and conditional process effect analyses (SPSS applied)]. Bursa: Ekin Yayınevi; 2023. Turkish.
  20. Sherer M, Maddux JE, Mercandante B, Prentice-dunn S, Jacobs B, Rogers RW. The self-efficacy scale: Construction and validation. Psychol Rep. 1982;51:663–71.
  21. Yıldırım F, İlhan İÖ. Genel öz yeterlilik ölçeği türkçe formunun geçerlilik ve güvenilirlik çalışması. Türk Psikiyatri Dergisi. 2010;21:301–8.
  22. Crandall A, Weiss-Laxer NS, Broadbent E, Holmes EK, Magnusson BM, Okano L, et al. The family health scale: Reliability and validity of a short- and long-form. Front Public Health. 2020;8:587125.
  23. Yeşildal M. Sağlığın geliştirilmesine etki eden faktörler: Yapısal eşitlik modeline dayalı bir araştırma [Factors affecting the promotion of health: A study based on structural equation modeling] [dissertation]. Türkçe: Selçuk Üniversitesi; 2023. Turkish.
  24. Suka M, Odajima T, Kasai M, Igarashi A, Ishikawa H, Kusama M, et al. The 14-item health literacy scale for Japanese adults (HLS-14). Environ Health Prev Med. 2013;18:407–15.
  25. Türkoğlu N, Kılıç D. Sağlık okuryazarlığı ölçeği’nin türkçeye uyarlanması: Geçerlilik ve güvenilirlik çalışması [adaptation of the health literacy scale into turkish: Validity and reliability study]. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2021;24:25–33. Turkish.
  26. Bostan N, Örsal Ö, Karadağ E. Sağlığı geliştirici ve koruyucu davranışlar ölçeğinin geliştirilmesi: Metodolojik çalışma [Developing promotive and protective health behaviors scale: Methodological study]. Türkiye Klin Hemşirelik Bilimleri Dergisi. 2016;8:102–11. Turkish.
  27. Tabachnick BG, Fidell LS. Using multivariate statistics. 7th ed. New York: Pearson; 2018.
  28. Karagöz Y. SPSS 23 ve AMOS 23 uygulamalı istatistiksel analizler [SPSS 23 and AMOS 23 applied statistical analyses]. Basım. Ankara: Nobel Akademik Yayıncılık; 2016. Turkish.
  29. Bandura A, National Inst of Mental Health. Social foundations of thought and action: A social cognitive theory. New Jersey: Prentice-Hall, Inc.; 1986.
  30. Zheng X, Yu H, Qiu X, Chair SY, Wong EML, Wang Q. The effects of a nurse-led lifestyle intervention program on cardiovascular risk, self-efficacy and health promoting behaviors among patients with metabolic syndrome: Randomized controlled trial. Int J Nurs Stud. 2020;109:103638.
  31. Lima-Rodríguez JS, Domínguez-Sánchez I, Lima-Serrano M. Family and social variables associated with family health. West J Nurs Res. 2022;44:920–31.
  32. Choi M. Association of eHealth use, literacy, informational social support, and health-promoting behaviors: Mediation of health self-efficacy. Int J Environ Res Public Health. 2020;17:7890.
  33. Kim KA, Kim YJ, Choi M. Association of electronic health literacy with health-promoting behaviors in patients with type 2 diabetes: A cross-sectional study. Comput Inform Nurs. 2018;36:438–47.
  34. Lee MK, Oh J. Health-related quality of life in older adults: its association with health literacy, self-efficacy, social support, and health-promoting behavior. Healthcare. 2020;8:407.
  35. Okuyan CB, Deveci E, Karasu F. health literacy, health perception, and influencing factors among immigrants. Makara J Health Res. 2025;29:8–16.

Creative Commons License

Creative Commons Attribution-Share Alike 4.0 International License
This work is licensed under a Creative Commons Attribution-Share Alike 4.0 International License.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.