The mediating role of health literacy in the relationship between trust in public health authorities and distrust in health systems.

Background: This study addresses a gap in the literature by examining how health literacy mediates the relationship between trust in public health authorities and distrust in health systems, particularly in the Turkish context. While previous studies have examined trust and health literacy separately, few have examined trust in health systems regarding health literacy and trust in public health authorities. Therefore, the primary purpose of this study is to determine the mediating role of health literacy in the relationship between trust in public health authorities and distrust in the health system.

Methods: This research was carried out across Türkiye. In this context, 924 people over 18 years of age participated in the study. As data collection tools, the trust in public health authorities scale, the distrust in health systems scale, and the health literacy scale adapted to Turkish by the researchers were used. Data were collected online via the survey technique. Translation and back-translation methods were used in the scale's linguistic and cultural adaptation process. While content validity was assessed with expert opinions, structural validity was tested with confirmatory factor analysis (CFA). The reliability of the scale was measured with Cronbach's alpha coefficient. In addition, the relationship between trust in public health authorities and distrust in health systems was examined using structural equation modeling (SEM), and the mediating role of health literacy in this relationship was analyzed with Bootstrap methods.

Results: As a result of CFA the adequacy indices of the scale were chi-square/degrees of freedom = 2.940; GFI = 0.946; AGFI = 0.915; CFI = 0.957; NFI = 0.937; and RMSEA = 0.069. The Cronbach's alpha value of the scale was found to be 0.880. As a result of structural equation modeling, the total effect of Trust in Public Health Authorities on Distrust in Health Systems (β=-0.257; p < 0.001) and the impact on Health Literacy was found to be statistically significant (β=-0.130; p < 0.001). The indirect effects between Trust in Public Health Authorities and Distrust in Health Systems were calculated as -0.064 and - 0.096/-0.037 with a 95% confidence interval, and since these values ​​did not include the 0 range, the indirect effects were found to be statistically significant.

Conclusions: As a result of the research, it was concluded that health literacy mediates the relationship between trust in public health authorities and distrust in health systems. In this context, public health authorities can pay more attention to sharing information in clear, transparent, and plain language supported by regularly verifiable data to establish trust and communicate effectively with the public.