Perception of Cardio-Kidney-Metabolic Risk and Health Literacy in Women: Quantitative and Qualitative Insights into Lifestyle and Prevention
TL;DR
Although health literacy was positively associated with CKM risk awareness, neither was significantly associated with Mediterranean diet adherence, and these findings highlight a gap between health-related knowledge and dietary practice and support preventive strategies that combine health education with behavioral and environmental support.
Abstract
Background: Women experience unique biological and life-course determinants of cardio-kidney-metabolic (CKM) health, yet the relationship between health literacy, CKM risk awareness, and preventive lifestyle behaviors remains poorly understood. We aimed to examine health literacy, CKM risk awareness, and Mediterranean diet adherence among women across different stages of adulthood and to qualitatively explore barriers and facilitators influencing the translation of health knowledge into preventive behaviors. Methods: We conducted a convergent mixed-methods study involving 198 women aged ≥18 years who completed a web-based questionnaire assessing health literacy, CKM risk awareness, Mediterranean diet adherence, and sociodemographic characteristics. Quantitative data were compared between women aged ≤50 years and >50 years using appropriate statistical tests. Two focus groups involving 14 women aged >50 years underwent inductive thematic analysis to explore perceptions of CKM health and preventive lifestyle behaviors. Results: Women older than 50 years had higher body mass index (27.79 ± 4.01 vs. 24.10 ± 4.20 kg/m2, p < 0.001), a greater prevalence of chronic disease (87.7% vs. 36.8%, p < 0.001), and higher Mediterranean Diet Scores (9.46 ± 4.54 vs. 7.99 ± 4.87, p = 0.035) than younger women, whereas health literacy (3.11 ± 0.48 vs. 3.07 ± 0.52, p = 0.599) and CKM risk awareness (26.25 ± 4.82 vs. 26.90 ± 5.33, p = 0.391) were comparable between age groups. Health literacy was moderately positively associated with CKM risk awareness (rho = 0.388, p < 0.001), whereas neither health literacy nor CKM risk awareness was significantly associated with Mediterranean diet adherence. Qualitative findings identified a persistent knowledge–behavior gap, with women demonstrating substantial experiential knowledge of chronic disease but reporting that work, caregiving responsibilities, and stress frequently impeded implementation of healthy lifestyle behaviors. Conclusions: Although health literacy was positively associated with CKM risk awareness, neither was significantly associated with Mediterranean diet adherence. These findings highlight a gap between health-related knowledge and dietary practice and support preventive strategies that combine health education with behavioral and environmental support.