Abstract:
 
Rising healthcare costs alongside the rapid circulation of health misinformation across digital platforms have positioned health literacy as a critical priority in public health policy, particularly in developing contexts such as Iran. This study aimed to design and empirically validate a comprehensive media-based model for enhancing community health literacy and contributing to reduced healthcare costs. A sequential mixed-methods approach was employed. In the qualitative phase, semi-structured interviews with seven experts in health communication and media studies were analyzed using axial and selective coding, yielding ten key dimensions aligned with Nutbeam’s functional, interactive, and critical health literacy framework. These findings informed a 77-item questionnaire administered to 382 hospitalized patients in Tehran. Quantitative data were analyzed using SPSS and Partial Least Squares Structural Equation Modeling (PLS-SEM), demonstrating strong reliability (Cronbach’s alpha = 0.957) and content validity. The results showed that social media exerted the strongest effect on health literacy, followed by socio-cultural factors and insurance services, with all hypothesized relationships statistically supported. The findings highlight the strategic role of culturally embedded digital media and institutional supports in shaping health literacy and provide an evidence-based framework to guide policymakers, health communicators, and media professionals in implementing targeted, cost-effective interventions in Iran.
Keywords: Health literacy; Media literacy; Health communication; Digital media; Healthcare costs; Iran
 
Introduction
Health systems worldwide are increasingly challenged by two converging phenomena: the rapid proliferation of health misinformation across digital and social media platforms, and the persistent rise in healthcare costs. These developments have elevated health literacy to a central concern for public health policy, health communication, and patient-centered care. Health literacy is defined as the ability of individuals to access, understand, critically evaluate, and apply health information to make informed decisions regarding prevention, treatment, and health promotion. Evidence consistently links limited health literacy to poorer health outcomes, increased hospitalization, inefficient healthcare utilization, and avoidable economic burdens.
In developing countries such as Iran, structural and socio-economic barriers—including disparities in healthcare access, fragmented communication infrastructures, and limited institutional support—amplify the consequences of low health literacy. Digital and social media serve as both opportunities and challenges: while they can facilitate education, engagement, and empowerment, they also propagate misinformation and reinforce inequalities. Accordingly, there is a pressing need for a comprehensive, culturally grounded model that leverages media to strengthen health literacy while accounting for social, cultural, economic, and institutional determinants. This study aims to design and empirically validate such a media-based model for Iran, drawing on Nutbeam’s three-level framework of functional, interactive, and critical health literacy, with the ultimate goal of enhancing informed health decision-making and reducing healthcare costs.
 
Materials and Methods
A sequential mixed-methods design was employed, integrating qualitative exploration with quantitative validation to ensure conceptual depth and empirical rigor. In the qualitative phase, semi-structured interviews were conducted with seven experts in health communication, public health, and media studies, selected through snowball sampling until theoretical saturation was reached. Data were transcribed and analyzed using axial and selective coding, yielding ten core dimensions influencing health literacy. These dimensions were categorized according to Nutbeam’s framework:
Functional level: social media use, internet-based health communication, patient knowledge and awareness.
Interactive level: patient engagement, competency of health journalists, physician quality and expertise.
Critical level: socio-cultural factors, insurance services, healthcare costs, and broader economic conditions.
Based on these qualitative findings, a structured 77-item questionnaire was developed and administered to 382 hospitalized patients across public and private hospitals in Tehran Province. The sample size was determined using the Krejcie and Morgan table to ensure statistical adequacy. Content validity was confirmed by expert review, and internal consistency was excellent (Cronbach’s alpha = 0.957). Quantitative data were analyzed using SPSS and SmartPLS, employing Partial Least Squares Structural Equation Modeling (PLS-SEM) to test the hypothesized relationships and evaluate the overall model fit.
 
Results and Discussion
The PLS-SEM results indicated that social media exerted the strongest influence on health literacy (β = 0.211), highlighting its central role in shaping knowledge, attitudes, and health-related behaviors. Socio-cultural factors (β = 0.201) and insurance services (β = 0.197) were the next most significant determinants. Other variables—including economic conditions, internet-based communication, patient knowledge, healthcare costs, journalist competency, physician quality, and patient participation—also had statistically significant effects. All hypothesized relationships were supported, confirming the robustness of the model.
These findings emphasize that health literacy is not solely an individual cognitive skill but a multidimensional construct embedded within media ecosystems, institutional frameworks, and socio-cultural contexts. The dominant role of social media underscores the need for culturally sensitive, evidence-based, and professionally governed digital health communication. The impact of insurance services illustrates the importance of structural supports in reducing financial barriers, enhancing access, and motivating individuals to actively seek and apply health information. Integrating media dynamics with institutional and socio-cultural determinants provides a comprehensive understanding of health literacy development and its potential to reduce unnecessary healthcare utilization and costs.