Introduction: Health literacy is considered a determinant of several health-related behaviors and outcomes. Health literacy can be seen as a particularly relevant resource for health maintenance and promotion for young adults at the beginning of their challenging vocational training in nursing. However, the underlying mechanisms and the roles of other influencing factors such as self-efficacy remain unclear and need to be understood to successfully tailor interventions. Methods: This cross-sectional study aims to examine the relationships between health literacy, self-efficacy, health behavior and health status among 556 German trainees and students in nursing. Data were collected using paper-pencil and online questionnaires between January and June 2021. Mediation models were assessed, consisting of the direct pathways between health literacy and health status; health literacy and health behavior; and indirect pathways via self-efficacy. Results: The findings showed that health literacy positively affected self-rated health status (ß = 0.05, t = 4.35, p < 0.001) and psychological well-being (ß = 0.28, t = 3.34, p < 0.001). The effect of health literacy on psychological well-being was fully mediated through self-efficacy (Z = 265 4.91, p < 0.001) while the effect of health literacy on self-rated health status was partially mediated through self-efficacy (Z = 5.06, p < 0.001). In this cohort, there was no significant association between either health literacy or self-efficacy and health behavior. Conclusion: Self-efficacy should be taken into account when investigating health literacy and its possible relationships with health-related outcomes. Furthermore, it should be considered as an objective for health literacy interventions as well as health promotion measures for nursing students and trainees. © © 2024 Otto, Jürgensen, Nienhaus and Koch.
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