BACKGROUND: Health literacy is a core public health issue in relation to children and adolescents associated with multiple health behaviours and health outcomes. The aim of the study is to test the direct associations between health literacy, physical activity behaviour, health outcomes of body composition and cardiorespiratory fitness among Slovak adolescents and possible indirect effect of health literacy on health outcomes of body composition and cardiorespiratory fitness mediated by adolescents' physical activity behaviour. METHODS: Data from the Slovak Health Behaviour in School-aged Children (HBSC) study conducted in 2022 were used. For the purposes of this study, a subsample of the adolescents (n = 508; mean age = 14.50; SD = 0.82; 54.3% boys) which provided HBSC questionnaire data on health literacy, moderate-to-vigorous physical activity and vigorous physical activity and participated in body composition (InBody 230) and cardiorespiratory fitness (20-m shuttle run test) measurements. Data were analysed using linear regression analysis. RESULTS: The findings showed that higher health literacy of the adolescents was directly associated with higher frequency of physical activity represented by moderate-to-vigorous physical activity and vigorous physical activity and only with the visceral fat area in the crude model. Furthermore, there was an indirect effect of health literacy on cardiorespiratory fitness and most of the body composition variables (except the Body Mass Index) which was mediated by physical activity of the respondents. CONCLUSIONS: Health literacy is indirectly associated to body composition and cardiorespiratory fitness through higher frequency of physical activity. It seems that health literacy as cognitive and social competencies need behavioural components to be involved in the proposed causal pathway between health literacy and health outcomes. Our findings may contribute to the process of creating a framework for future health literacy interventions in adolescents.

Department of Health Psychology and Research Methodology Faculty of Medicine P J Šafárik University in Košice Trieda SNP 1 Košice 04011 Slovakia

Department of Sports Educology and Humanistics Faculty of Sports University of Prešov 17 novembra 15 Prešov 08001 Slovakia

Institute of Biology and Ecology Faculty of Science P J Šafárik University in Košice Mánesova 23 Košice 040 01 Slovakia

Medical Education Centre Faculty of Medicine P J Šafárik University in Košice Trieda SNP 1 Košice 04011 Slovakia

Olomouc University Social Health Institute Palacky University Olomouc Olomouc 771 11 Czechia

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