Association between health literacy and crisis-related self-care skills among Iranian adults: a national cross-sectional study

Background Although health literacy has been found to be an established determinant of self-care, little is known about the impact of health literacy in crises. During a crisis, the increased cognitive burden, psychological distress, and spread of misinformation pose challenges not captured by normal self-care models. Considering the high risk of crises in countries such as Iran, this study sought to examine the association between health literacy and crisis self-care skills. Methods In this cross-sectional study, 5,054 adult Iranians (ages between 18 and 65) were conveniently recruited using social media platforms including Telegram, WhatsApp, and Instagram. The data were collected using the following instruments: demographic form, HELIA-SF scale, PHQ-4 scale, and a researcher-made ten-item questionnaire related to crisis self-care. This last tool had an acceptable content validity index (CVR = 0.64-1.00; CVI = 0.82–0.96), and ICC = 0.89. Multiple linear regressions were performed to analyze the association between health literacy and crisis self-care while controlling sociodemographic and depression and anxiety factors. Results Among 5,054 participants, most were aged 35–65 years (67.6%), male (75.1%), and urban residents (83.6%). Higher mean health literacy scores were observed among older participants, females, healthcare workers, individuals with higher education or socioeconomic status, and those without depression or anxiety. Mean health literacy increased across crisis self-care tertiles, from 71.53% in the lowest tertile to 82.81% in the highest tertile. In linear regression, health literacy was positively associated with crisis self-care in the crude model (β = 0.16, 95% CI: 0.15, 0.17, p < 0.001) and remained independently associated after adjustment for age, sex, residence, occupation, education, socioeconomic status, depression, and anxiety (β = 0.12, 95% CI: 0.11, 0.14, p < 0.001). Conclusions Higher health literacy was independently associated with better crisis self-care skills. Strengthening health literacy may improve public health preparedness and adaptive self-care during crises.