# Associations Between Health Literacy, Environmental Factors, and Fall Prevention Behaviors Among Community-Dwelling Older Adults in Northern Thailand: A Cross-Sectional Study

## TL;DR

This study explores how health literacy and home environment factors influence fall prevention behaviors in older adults in Northern Thailand.

## Contribution

It provides novel evidence linking health literacy with environmental and behavioral fall prevention factors in an under-researched Asian community setting.

## Key findings

- Over half of older adults had limited health literacy.
- Higher health literacy was associated with regular exercise, safer home sanitation, and proper footwear.
- Health promotion should integrate health literacy improvement with environmental and behavioral interventions.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Falls among community-dwelling older adults are a major public health concern, and limited health literacy is a modifiable risk factor.This study links health literacy with home environment features and fall prevention behaviors in an Asian community setting, where evidence is scarce.

Falls among community-dwelling older adults are a major public health concern, and limited health literacy is a modifiable risk factor.

This study links health literacy with home environment features and fall prevention behaviors in an Asian community setting, where evidence is scarce.

Public health significance—Why is this work of significance to public health?
More than half of older adults exhibited limited health literacy, highlighting a substantial population-level vulnerability.Higher health literacy was associated with key protective factors, including regular exercise, safer home sanitation (sitting toilets), and proper footwear.

More than half of older adults exhibited limited health literacy, highlighting a substantial population-level vulnerability.

Higher health literacy was associated with key protective factors, including regular exercise, safer home sanitation (sitting toilets), and proper footwear.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers?
Fall prevention programs should integrate health literacy improvement with exercise promotion, home safety modifications, and safe footwear education.Policies and community interventions targeting older adults should address both individual health literacy and environmental safety to reduce fall risk.

Fall prevention programs should integrate health literacy improvement with exercise promotion, home safety modifications, and safe footwear education.

Policies and community interventions targeting older adults should address both individual health literacy and environmental safety to reduce fall risk.

Inadequate health literacy (HL) is a critical factor contributing to fall risk among older adults. However, evidence on how HL relates to home environment and fall prevention behaviors in Asian community settings remains limited. This study aimed to assess HL levels and examine their associations with sociodemographic characteristics, home environment, and fall prevention behaviors. A community-based cross-sectional study was conducted among 177 community-dwelling older adults aged 60 to 79 years. Data were collected through structured questionnaires assessing sociodemographic characteristics, home environment, fall prevention behaviors, and HL using the European Health Literacy Survey Questionnaire (HLS-EU-Q47), which cover three subdomains: healthcare, disease prevention, and health promotion. Multiple linear regression analysis was performed to examine the associations between sociodemographic factors, home environment, fall prevention behaviors, and HL. The HL score among older adults was 34.50 ± 7.50 (54.2% limited HL). A total HL score was positively associated with regular exercise (β = 2.73, 95% CI: 0.71, 4.74) and a sitting toilet (β = 6.38; 95% CI: 3.83, 8.92) and marginally associated with wearing properly fitting shoes (β = 2.54; 95% CI: 0.22, 4.86). Therefore, the health promotion aimed at improving HL in this population may benefit from concurrently promoting regular exercise, home safety modifications, and safe footwear practices.