The Mediating Role of Health Literacy in the Effect of Living in Rural Versus Urban Areas in Older Adults on Successful Aging

Objectives This study investigates the mediating role of health literacy in the relationship between living environments (rural/urban) and successful aging among older adults. Methods Data were collected from 400 participants aged 65 and older (51.3% women; mean age = 71.6 ± 4.3 years) residing in Sakarya Province. Participants completed a Personal Information Form, the Health Literacy Scale, and the Successful Aging Scale. Mediation analyses were conducted using regression-based approaches and bootstrapping to examine direct and indirect effects. Results Living in rural areas was associated with lower health literacy and a reduced likelihood of successful aging. Health literacy fully mediated the relationship between living environment and successful aging (β = .6953, p<.001). After including health literacy, the direct effect of living environment became non-significant, while the explained variance in successful aging increased from 2.9% to 49%. The indirect effect was significant (B = 4.28, SE = 1.01, 95% CI [2.32, 6.25]). Conclusions Higher health literacy enhances older adults’ capacity to manage chronic conditions and adopt healthier lifestyles, thereby supporting successful aging. Rural living may indirectly hinder successful aging through its negative association with health literacy. Clinical Implications : Health literacy interventions tailored to rural populations, including community-based education and digital health tools, may reduce rural–urban disparities and promote equitable successful aging outcomes.