multi-group causal model of health literacy and behaviors on family well-being among thai adults at risk of non-communicable diseases (ncds)

Background:we aimed to develop a causal model of family well-being with health literacy (hl) as a mediator and to compare models between male and female spouses in urban and rural communities.study design:a cross-sectional study.methods:the samples included 2000 spouses at risk ofnon-communicablediseases(ncds) by stratified randomly sampledin 2018. data were collectedlikert questionnaireswith reliabilityof 0.79-0.93, andanalyzedvia confirmatory factor analysis(cfa), and multi-groupstructural equation modeling(msem).results:a causal model for the overall group was consistent with the data .causal factors had direct effects on health behavior including socialnorms, positive attitude toward health, psychological capital, and hl(β=0.11,0.14, 0.30, and 0.41,p<0.05respectively). health behaviorand positive attitudestowardshealth had direct effects on family well-being(β=0.36and 0.42,p<0.05,respectively). all factors could predicthealth behaviorandfamily well-being with variance of 70%and 50%.invariance analysis of models showedno difference between male and female spouses.in addition,themean comparison of latent variables showed that the positive attitudes towardshealth were lower in women than men.hl and positive attitudestowardshealthofspousesinurban were lower than in rural communities.conclusion:thai adult familiesin citieswere athigher risk with ncds. therefore, health providers need to address hl and positive attitude toward healthwhich were the main causal factors.