Associations of family health and perceived social support with health literacy among middle-aged and older adults with chronic diseases: a mediation and network analysis.

Family and social contexts may play important roles in health literacy among middle-aged and older adults with chronic diseases. This study examined the associations among family health, perceived social support, and health literacy and explored their overall and dimensional relationships using mediation and network analyses. Data were obtained from 1,444 participants in the 2021 Psychology and Behavior Investigation of Chinese Residents. Family health, perceived social support, and health literacy were assessed using the Family Health Scale Short Form, Perceived Social Support Scale, and Health Literacy Survey Questionnaire Short Form 12, respectively. Family health, perceived social support, and health literacy were significantly and positively correlated (p < 0.01). Perceived social support demonstrated a statistically significant partial mediating effect in the association between family health and health literacy (indirect effect = 0.1818, 95% CI: 0.1331-0.2307), accounting for 47.38% of the total effect. Network analysis identified Family Social and Emotional Health Processes as the node with the highest strength and Family Support as the node with the highest bridge expected influence. Network structure and global strength did not differ significantly across sex, urban-rural residence, or age groups. These findings highlight the close relationships of family health and perceived social support with health literacy and provide complementary evidence from overall and dimensional perspectives for understanding health literacy among middle-aged and older adults with chronic diseases.