The impact of health literacy on health-related quality of life among individuals with physical disabilities: a path analysis based on the integrated model of health literacy

PURPOSE: This study examined the direct and indirect associations among health literacy (HL), its determinants, and health-related quality of life (HRQoL) in individuals with physical disabilities based on the Integrated Model of Health Literacy (IMHL). METHODS: This cross-sectional study analyzed data from 441 adults with physical disabilities obtained from the 2021 Korea Health Panel Survey. Based on the IMHL, path analysis was conducted to examine the direct and indirect associations of situational determinants (usual source of care, need for care) and societal and environmental determinants (employment status, unmet healthcare needs) on HL and HRQoL. RESULTS: Among the participants, 44.0% were classified as having inadequate HL and 22.3% as problematic. Need for care was negatively associated with both HL (β = - 0.12, p = .002) and HRQoL (β = - 0.33, p < .001). Unmet healthcare needs also had a significant negative direct association with HRQoL (β = - 0.17, p < .001). Employment status (β = 0.15, p < .001) and HL (β = 0.13, p = .005) were positively associated with HRQoL. HL partially mediated the relationship between need for care and HRQoL (β = - 0.02, p = .044). CONCLUSION: These findings highlight the role of HL in relation to HRQoL among individuals with physical disabilities. Improving HRQoL in this population may require approaches that go beyond individual-level HL promotion and also address support for care-dependent individuals and structural factors, including healthcare accessibility and employment opportunities.