Health Literacy, Motivation, and Preventive Health Behaviors Among the Ultra-Orthodox Jewish Community in Israel: A Path Analysis Approach

Background Health literacy, motivation, and health care utilization are important factors for health behavior and well-being. In the ultra-Orthodox Jewish population in Israel, unique sociocultural and religious factors shape these behaviors, leading to differences in health care utilization. This study aims to examine how health literacy and motivation (intrinsic and extrinsic) influence preventive health behaviors, with a focus on gender differences. We examined how health literacy and access to healthcare affected motivation to maintain a healthy lifestyle, and how motivation in turn influenced health behaviors, including physical activity, diet, smoking, and healthcare utilization. We also examined gender differences in these relationships. Methods A cross-sectional survey was conducted among 641 ultra-Orthodox Jewish individuals in Israel (mean age = 35.6, SD = 12.9), including 304 men (47.4%) and 337 women (52.6%). Data was collected on health literacy, motivation, health behavior, and well-being indicators. An exploratory factor analysis refined the measurement scales, followed by structural equation modeling to examine the hypothesized relationships. Results Health literacy was positively related to intrinsic motivation, especially in females. Males relied more on extrinsic motivation (social pressure) for their health behaviors, while females were more self-motivated. Health care utilization was strongly influenced by motivation, with intrinsic motivation predicting healthier behaviors in females, while extrinsic motivation was a stronger predictor among males. Smoking rates were higher in males (22.0%) than in females (3.6%). Conclusions Culturally tailored interventions, particularly those supported by religious authorities, may improve health care utilization and long-term health behavior change in this population.