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

Health Literacy, Motivation, and Preventive Health Behaviors Among the Ultra-Orthodox Jewish Community in Israel: A Path Analysis Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health Literacy, Motivation, and Preventive Health Behaviors Among the Ultra-Orthodox Jewish Community in Israel: A Path Analysis Approach Riki Tesler, Moti Zwilling, Dganit Fhcima, Noa Shtainmetz, Avi Zigdon, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8637002/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract 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. Health literacy motivation preventive healthcare Ultra-Orthodox Jewish community gender differences health behaviors Figures Figure 1 Introduction The ultra-Orthodox Jewish community represents a unique sociocultural and religious minority in Israel, characterized by distinct lifestyle patterns, communal structures, and adherence to religious principles that influence health behaviors. This population group is growing rapidly and accounts for approximately 13% of the Israeli population, with projections that it will reach 16% by 2030 (Malach & Cahaner, 2022 ). The demographic composition, socioeconomic challenges, and religious values of this community contribute to health behaviors, including disparities in health care utilization and participation in health-promoting activities (Bayram & Donchin, 2019 ; Simhi et al., 2020 ). Despite the growing importance placed on preventive healthcare in Israel, research suggests that there are still disparities in health literacy, motivation, and access to healthcare services among the ultra-Orthodox compared to the general Jewish population (Neter et al., 2021 ). Health Literacy and Preventive Health Behavior Health literacy, defined as the ability to access, understand, and apply health information, plays a fundamental role in the utilization of health services and adherence to preventive measures (Nutbeam, 2008 ; Pelizzari et al., 2025 ). Studies have indicated that people with higher health literacy have more confidence when it comes to making informed health decisions and show higher motivation to engage in health-promoting behaviors (Paasche & Wolf, 2010). However, in the ultra-Orthodox Jewish community, cultural and religious considerations may influence the impact of health literacy on health care utilization. Research suggests that traditional health knowledge, reliance on rabbinic authority, and limited access to secular education contribute to unique patterns of health literacy within this community (Levin, 2013; Simhi et al., 2020 ). Motivation as a Mediator of Health Literacy and Behavior Motivation is one of the most important determinants for the adoption and maintenance of health behavior. Self-determination theory (Deci & Ryan, 1985 ) distinguishes between intrinsic motivation (determined by personal values and enjoyment) and extrinsic motivation (influenced by external pressures, such as social expectations or religious norms). Empirical evidence suggests that intrinsic motivation promotes long-term maintenance of health behaviors, while extrinsic motivation can serve as a short-term catalyst for behavior change (Teixeira et al., 2012 ). Within the ultra-Orthodox Jewish community, men and women may experience different motivational influences: men are often under social and religious pressure to maintain their health, while women are more intrinsically motivated (Benyamini et al., 2014; Neter et al., 2021 ). Understanding these gender-specific motivational pathways is essential for the development of culturally sensitive health interventions. Gender Differences in Health Behaviors and Preventive Care Gender differences in health behavior are well documented, particularly in relation to physical activity, smoking, and dietary habits. Females tend to engage in healthier behaviors and show greater motivation for preventive health care than males, who tend to engage in riskier health behaviors (Connell, 2012 ; Courtenay, 2000 ). Within the ultra-Orthodox Jewish community, these patterns are further influenced by religious norms that dictate gender roles and access to health-related information (Gendler et al., 2025 ). For example, females’ engagement in health-promoting behaviors, such as balanced diets and health screenings, may be shaped by their role as caregivers, while males are less proactive in seeking preventive care unless motivated by religious or community expectations (Levin, 2013; Simhi et al., 2020 ). Despite the growing body of research on health literacy and motivation, few studies have specifically examined how these factors interact in the unique sociocultural context of the ultra-Orthodox Jewish community. The present study aims to fill this gap by examining the relationships among health literacy, motivation (intrinsic and extrinsic), and preventive health behaviors among ultra-Orthodox individuals in Israel. Using a path analytic approach, this study examined: 1) the relationship between health literacy and motivation to maintain a healthy lifestyle; 2) the role of intrinsic and extrinsic motivation in shaping preventive health behaviors; 3) gender differences in the associations among health literacy, motivation, and health behaviors; and 4) the mediating effects of motivation on the relationship between health literacy and preventive health care utilization. we aimed to provide a nuanced understanding of health behaviors in the ultra-Orthodox Jewish community in Israel. Materials and Methods Sample and Sampling Procedure The data for this study were obtained from a survey of 641 Ultra-Orthodox Jews in Israel (mean age: 35.6 years; standard deviation [SD]: 12.9 years; age range 18–86 years), of whom 304 (47.4%) were male. The majority (n = 309; 48.2%) were from Jerusalem and the surrounding area; 172 (26.8%) were from Tel Aviv and the surrounding area, and the rest (n = 160; 25%) were from the north, south, or coastal regions of Israel. All respondents ticked the "ultra-Orthodox" option when asked about their religious affiliation, ensuring that all respondents belonged to the target population. For overall physical activity, we developed a weighted scale that combined all three levels of physical activity (W: Low=.25, Moderate=.5, High = 1; M = 141.58, SD = 194.94) multiplied by their weekly frequency. The combined exercise minutes measured the weekly minutes devoted to physical activity at different intensity levels presented in Table 1 . Table 1 Various background characteristics compared between men and women Men Women N % N % Test p-Value Gender 304 47.4 337 52.6 Z = 1.31 .192 Family Status Married 261 85.9 266 78.9 χ 2 (1) = 5.24 .022 Otherwise 43 14.1 71 21.1 Physical Practice Yes 284 93.4 319 94.7 χ 2 (1) = 0.44 .508 No 20 6.6 18 5.3 Smoking Yes 67 22.0 12 3.6 χ 2 (1) = 50.51 < .001 No 237 78.0 325 96.4 Mean SD Mean SD Age 35.3 12.1 35.8 13.6 t=-0.49 .627 Number of Children 1 4.0 3.5 3.9 3.5 t = 0.08 .936 Body Mass Index (BMI) 3 27.4 5.6 26.5 5.3 t = 1.89 .060 Overall Health State (1–5) 4.07 0.87 4.06 0.66 t = 0.15 .883 Health Awareness Physical Activity (Minutes) Low Intensity 32.8 60.5 41.2 65.0 t=-1.62 .106 Moderate Intensity 27.1 23.6 35.1 36.2 t=-2.88 .002 High Intensity 40.6 38.5 39.1 19.6 t = 0.47 .642 Weighted Practice 2 132.1 203.1 150.1 187.2 t=-1.17 .241 Healthy Lifestyle Fruit and Vegetable Sweet Products 1 Only positive number of children was compared (number < 14); 2 weighed total practicing minutes, low=.25, moderate=.5, high = 1; 3 Missing or wrongfully written values were excluded, especially the height (25% were missing or incorrect values). Study Design and Participants In this study, a cross-sectional survey was conducted to examine the relationships between health literacy, motivation, and preventive health behaviors among ultra-Orthodox Jewish adults in Israel. The study was conducted between [2023–2024], using structured self-report questionnaires distributed in different ultra-Orthodox communities. Participants were recruited through ultra-Orthodox educational institutions, community centers, and religious networks to ensure a representative sample of the population. The inclusion criteria included identification as an ultra-Orthodox Jew, 18 years or older, and residence in Israel at the time of data collection. We excluded individuals who did not self-identify as ultra-Orthodox Jews, were under the age of 18, or did not reside in Israel during the data collection period. Measures Health Literacy : Health literacy was assessed using a modified version of the Health Literacy Questionnaire (Sørensen et al., 2012 ), which was adapted for the ultra-Orthodox Jewish population. The scale measures the ability to access and understand health information (e.g., “I can find reliable health information that concerns me”) and confidence in navigating the healthcare system (e.g., “I know how to make an appointment with a doctor if I need to”). Responses were recorded on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with higher scores indicating higher health literacy. Motivation for Health Behavior : Motivation for healthy behavior was assessed based on self-determination theory (Deci & Ryan, 1985 ), distinguishing between intrinsic motivation (e.g., “I exercise because I enjoy it”) and extrinsic motivation (e.g., “I eat healthily because my family expects me to”). The items were rated on a 5-point Likert scale, with higher scores indicating greater motivation. Preventive Health Behaviors : Participants reported their engagement in four key preventive health behaviors: physical activity – frequency and duration of weekly moderate and vigorous exercise; diet – consumption of fruits, vegetables, and processed foods; smoking – current and past smoking habits; and health care utilization – frequency of medical checkups, vaccinations, and screenings. Each behavior was categorized based on standard public health recommendations (e.g., World Health Organization physical activity guidelines). Demographic and Socioeconomic Variables : Demographic information included age, gender, marital status, number of children, level of education, and geographical location. Socioeconomic status was determined based on household income and employment status. Data Collection Procedure Participants were given written informed consent and were assured anonymity and confidentiality. Paper questionnaires were distributed at community centers, and online surveys were distributed via ultra-Orthodox digital platforms (filtered internet networks). The questionnaires took approximately 15–20 minutes to complete, and participation was voluntary. Data collection was conducted between February 2023 to May 2023. Data Analysis Data were analyzed using SPSS (version 28) for structural equation modeling. Analytical procedures included descriptive statistics to summarize sample characteristics and exploratory factor analysis (EFA) to validate the scale constructs. We conducted Pearson correlations to examine bivariate relationships and path analysis (structural equation modeling) to examine direct and indirect effects between health literacy, motivation, and preventive health behavior. Statistical significance was set at p < 0.05, with Bonferroni corrections applied for multiple comparisons. Ethical Considerations Participants gave informed consent prior to their participation, and all data were anonymized to maintain confidentiality. No financial incentives were offered to participants. Ethical approval was obtained from the Ariel University Ethics Committee prior to data collection. Results In this investigation, we wanted to assess awareness of health. We begin with a brief reminder of the research hypotheses: (H1) Health literacy and the availability of health services are positively related to motivation to maintain a healthy lifestyle; (H2) Motivation for a healthy lifestyle, whether internal (self-motivated) or external (socially motivated), is positively related to activities associated with a healthy lifestyle; (H3) Motivation will be positively associated with positive feelings; (H4) Availability and knowledge of health will be indirectly associated through motivation with actual activity to maintain a healthy lifestyle; (H5) Similar to H4, motivation will play a role in how the availability of health and knowledge of health affects activity and positive feelings. To test these hypotheses, we developed a two-stage analysis plan in which the first stage involved an EFA (extraction method: principal axis factoring, PAF; rotation: Promax (Hefetz & Liberman, 2017) to detect items that loaded poorly on the factor; and in the second stage, we applied a path analysis model to test theoretical hypotheses. Path analysis is a special case of structural equation modeling, but does not use latent factors, only observed or calculated indicators. One advantage of the path analysis modeling approach is the assessment of the indirect effect, i.e., the impact of independent indicators on outcomes through a mediating indicator. Exploratory Factor Analyses A first approach for the creation of scales is exploratory factor analysis, especially when the validation of survey instruments is unclear. Several indicators were constructed based on the EFA results. Table 2 provides a description and reliability measures of the outcome indicators. In contrast to the general gender similarities in personal characteristics, the research indicators showed significant differences; female had higher health awareness, although their access to health services was lower than they self-reported. Males felt more social pressure to lead a healthy life, while females were more confident in their motivation to lead a healthy life. Females were more inclined to consume healthy foods (fruit and vegetables) than males. Regardless of their lower levels of healthy behaviors, such as lower levels of physical activity, males, on average, reported higher monthly positive affect compared to the feelings reported by females. Table 2. Potential research indicators, descriptive statistics, reliability, and comparisons by gender Gender Mean SD # Items Alpha p 1 Health awareness Male 2.93 0.54 9 .861 .007 Female 3.04 0.53 Accessibility of health services Male 2.21 0.91 8 .855 .001 Female 2.00 0.74 Social pressure to retain a healthy life Male 4.10 1.26 7 .835 .024 Female 3.88 1.23 Self-pressure to retain a healthy life Male 5.77 1.03 5 .755 <.001 Female 6.04 0.83 Positive Affect (during the last month) Male 4.79 0.83 5 .864 <.001 Female 4.45 0.90 Healthy Food Consumption Male 3.69 1.26 2 .796 <.001 Female 4.14 1.26 1 p for a two-tailed significance level based on the two-independent sample t-test. Abbreviation: SD, standard deviation. The correlation coefficients provide an initial indication of possible model results (Table 3). The correlation coefficients were found to be reasonable, but not high. We found that health status was positively associated with positive feelings (i.e., subjective and relatively objective states were correlated). These correlation coefficients were calculated for the entire sample. Table 3: Pearson’s correlation coefficients across research indicators Pearson’s r p-Value (2) (3) (4) (5) (6) (7) (8) (9) (10) Age (1) -.274 -.045 .143 .079 -.060 -.016 .186 .037 .013 <.001 .256 <.001 .046 .133 .692 <.001 .346 .738 Health State (2) .074 .076 .079 .026 .181 -.046 .124 .299 .061 .054 .046 .518 <.001 .241 .002 <.001 Physical Activity (3) .090 .094 -.070 .029 .087 .145 .000 .023 .018 .079 .457 .027 <.001 .993 Health awareness (4) .700 -.082 .167 .069 .263 .125 <.001 .040 <.001 .08 <.001 .001 Ease of search (5) -.061 .14 0.052 .232 .103 .124 <.001 0.187 <.001 .009 Service Accessibility (6) -.118 -0.138 -.180 -.015 .003 <.001 .001 .714 Sense of belonging (7) 0.161 .195 .327 <.001 <.001 <.001 Social pressure (8) .188 -.039 <.001 .326 Self-pressure (9) .145 <.001 Positive Feeling (10) In Figure 1, we show this structure of direct and indirect paths, with solid lines representing direct effects and dashed lines representing indirect effects. An indirect effect can be complete if no significant direct effect was found, and a complementary one, i.e., partial, if it provides a complementary path from the independent indicator to the outcome indicator. Figure 1. A conceptual path analysis model Modeling Results Table 4 shows the results of the path analysis models. The overall goodness of fit is shown, which means that the path analysis was performed for both subgroups. Although the overall quality of the model fit was high with respect to the usual fit thresholds, the breakdown of the χ2 by gender shows a better fit for females compared to males (the smaller the χ2, the better). Both subjective and objective health literacy and health awareness were positively associated with self-motivation for healthy living for males (β=.21, p<.001; β=.26, p<.001; respectively), while accessibility was positively associated with social pressure to maintain a healthy life (β=.20, p<.001). This was not as clear for females, where only health literacy was positively associated with self-motivation (β=.28, p<.001). male’s health literacy was also positively associated with positive feelings (β=.23, p<.001), while accessibility to health services was positively associated with healthy food consumption (β=.17, p<.01). Among female, we found that self-motivation was positively associated with all three outcomes (feeling positive: β=.20, p<.001; healthy food consumption: β=.22, p<.001; physical activity: β=.16, p<.001). In other words, females not only had a stronger self-motivation to lead a healthy life compared to males, but this motivation was highly associated with actual better health behaviors and feelings. Table 4. Path analysis results, gender comparison, and standardized estimates External Motivation Internal Motivation Positive Feeling Healthy Food Physical Activity Male Accessible Services .07 (.06) .21*** (.05) .23*** (.06) .02 (.06) -.04 (.05) Health Literacy .20*** (.05) .26*** (.06) .07 (.06) .17** (.06) .06~ (.04) External Motivation -.08 (.06) .07 (.06) .03 (.06) Internal Motivation .20*** (.05) .14* (.07) .09 (.06) .07 (.06) Positive Feeling - - Healthy Food - R 2 .12** .05* .06~ .09** .02 Female Accessible Services .09 (.06) .28*** (.06) .03 (.06) .10 (.06) .14~ (.07) Health Literacy .08 (.07) .01 (.06) -.02 (.06) .05 (.06) .02 (.10) External Motivation -.15** (.06) .10~ (.06) .08(.05) Internal Motivation .16** (.05) .20** (.07) .22*** (.06) .16*** (.04) Positive Feeling - .06 (.041) Healthy Food .070 (.05) R 2 .02 .08* .06~ .09** .07* Model goodness of fit: χ 2 =4.10, df=4, p=.392; CFI=.999, TLI=.995, RMSEA=.000, 95%CI[.000,.086]; SRMR=.014; Male’s χ 2 : 4.04, Female’s χ 2 : 0.07; *** p<.001, ** p<.01, * p<.05, ~ p<.10. Shaded cells for correlations; standard errors in parentheses. An additional analysis of the path model related to the indirect role of motivation (social and self) in mediating the effect of literacy and accessibility on behavioral outcomes. We show all possible indirect effects in Table 5. However, for males, there were only two indirect pathways leading from literacy and accessibility to positive feelings. In the first, i.e., Health Literacy, Internal Motivation, Positive Feeling, this complemented the direct effect, while in the second, Accessible Services, Internal Motivation, Positive Feeling, this was a replacement as the direct effect was not significant. This means that self-motivation, which had no direct effect on outcomes, acted as a mediator to express the effects of literacy and accessibility on outcomes. Indirect effects were also found for the female. Self-motivation was found to mediate the effect of health literacy on outcomes beyond the direct effect described above (See Table 5). Table 5. Indirect effects of health literacy and health service accessibility on subjective and objective outcomes Pathways Indirect 95% Confidence Interval Total Effect: Direct, Indirect Male Health Literacy à External Motivation à Weighted Physical Activity .002 -.004, .021 -.044, .017 Health Literacy à Internal Motivation à Weighted Physical Activity .015 -.007, .042 Accessible Services à External Motivation à Weighted Physical Activity .006 -.017, .031 .068~, .024 Accessible Services à Internal Motivation à Weighted Physical Activity .018 -.009, .056 Health Literacy à External Motivation à Healthy Food .005 -.003, .030 .023, .023 Health Literacy à Internal Motivation à Healthy Food .018 -.006, .052 Accessible Services à External Motivation à Healthy Food .015 -.008, .044 .168**, .037~ Accessible Services à Internal Motivation à Healthy Food .022 -.007, .063 Health Literacy à External Motivation à Positive Feeling -.005 -.035, 002 .225***, .023 Health Literacy à Internal Motivation à Positive Feeling .028* .002,.065 Accessible Services à External Motivation à Positive Feeling -.016 -.048, .003 .071, .019 Accessible Services à Internal Motivation à Positive Feeling .035* .005, .073 Female Health Literacy à External Motivation à Weighted Physical Activity .008 -.002, .031 .135~, .053** Health Literacy à Internal Motivation à Weighted Physical Activity .046** .021, .070 Accessible Services à External Motivation à Weighted Physical Activity .007 -.005, .028 .016, .008 Accessible Services à Internal Motivation à Weighted Physical Activity .001 -.019, .023 Health Literacy à External Motivation à Healthy Food .009 -.002, .037 .100, .070** Health Literacy à Internal Motivation à Healthy Food .061** .024, .102 Accessible Services à External Motivation à Healthy Food .008 -.004, .034 .046, .009 Accessible Services à Internal Motivation à Healthy Food .001 -.027, .030 Health Literacy à External Motivation à Positive Feeling -.014 -.045, .002 .027, .042~ Health Literacy à Internal Motivation à Positive Feeling .055* .019, .103 Accessible Services à External Motivation à Positive Feeling -.013 -.040, .008 -.022, -.012 Accessible Services à Internal Motivation à Positive Feeling .001 -.031, .032 *** p<.001, ** p<.01, * p<.05, ~ p<.10. Discussion We aimed to examine the relationship between health literacy, motivation, and preventive health behaviors within the ultra-Orthodox Jewish community in Israel. Specifically, we examined the mediating role of motivation in translating health literacy and access to health care into health-promoting behaviors, with a particular focus on gender differences. The results provide important insights into how different motivational factors influence health-related decisions and the utilization of preventive health services. Our results supported the first hypothesis (H1) and show that higher health literacy and access to health care were positively associated with higher motivation for a healthy lifestyle. This finding is consistent with previous research showing that individuals with higher health literacy are more likely to engage in health-promoting behaviors (McAnally & Hagger, 2023). However, our study extends this knowledge by emphasizing the mediating role of motivation. While knowledge alone is an essential component of behavior change, it must be coupled with intrinsic or extrinsic motivation to translate into meaningful action (Shiralian et al., 2025). Consistent with our second hypothesis (H2), motivation for a healthy lifestyle was significantly associated with health-promoting activities. However, an important finding of our study was the significant gender differences in motivational factors. Females exhibited significantly higher levels of intrinsic motivation, which had a strong impact on adherence to preventive health measures, healthy eating habits, and moderate physical activity. In contrast, males relied more on extrinsic motivators, such as social pressure, to engage in health-conscious behavior. This is consistent with self-determination theory (Deci & Ryan, 1985), which states that intrinsic motivation leads to more sustainable behavior change compared to extrinsic motivation (Schulze & Janssen, 2024; Teixeira et al., 2012). A striking gender difference was observed in smoking behavior, with males reporting a much higher prevalence of smoking (22.0%) than females (3.6%). This supports previous research suggesting that males are more likely to engage in risky health behaviors and may require stronger social and environmental incentives to change their behavior (Courtenay, 2000). In contrast, females' intrinsic motivation was a more consistent predictor of health-related behavior, highlighting the importance of tailoring interventions that use different motivational strategies for males and females. Our results also confirm hypothesis three (H3) and show that motivation was positively associated with subjective well-being. However, the pathways through which motivation influences well-being differed by gender. For females, self-motivation significantly predicted both healthy behaviors and higher positive affect, whereas for males, social pressure played a greater role in shaping their behaviors and well-being. The collectivist nature of the ultra-Orthodox Jewish community underscores the importance of religious and social influences in shaping health behaviors (Gendler, Ofri & Videl, 2025). Our findings suggest that males were more responsive to health-related messages framed in a religious or community-based context. This supports the findings of Epstein (2018) that health interventions in ultra-Orthodox populations are most effective when endorsed by religious leaders (Jacobson et al., 2023; Zalcberg et al., 2023). In contrast, females showed greater autonomy in their health decisions, suggesting that public health campaigns targeting this population should take a dual approach: utilizing religious leadership for males' engagement and emphasizing personal empowerment strategies for females (Orr & Zalcman, 2024; Pinchas-Mizrachi et al., 2024). Our study empirically supports this model by showing that males were more likely to engage in healthy behaviors when prompted by external triggers, such as religiously supported health campaigns. Female, on the other hand, acted independently of their knowledge and motivation and needed fewer external triggers to adopt health-promoting behaviors. This difference suggests that gender-specific intervention strategies are needed to optimize health behavior change in this population (Cherniak et al.,2021; Orr et al., 2024). Hypotheses four (H4) and five (H5) were also supported, as health literacy and accessibility to health care indirectly influenced preventive health behaviors via motivation. For males, self-motivation acted as a mediator in translating health literacy into positive well-being outcomes. Interestingly, self-motivation played a broader role among females by mediating the relationship between health literacy and all three outcome variables: well-being, healthy food consumption, and physical activity. These findings have important implications for public health interventions. Because motivation is a critical link between knowledge and action, health literacy programs should include strategies that increase both intrinsic and extrinsic motivation. For males, interventions should emphasize social responsibility and religious advocacy, while for females, promoting self-efficacy and autonomous decision making may lead to better outcomes. Although this study provides valuable insights, several limitations should be noted. First, the cross-sectional design precludes our ability to infer causal relationships between health literacy, motivation, and behavior. Future research should consider longitudinal studies to track changes in health behaviors over time. Second, self-reported measures of health behavior may lead to social desirability bias, particularly in a religious community where adherence to health norms may be socially expected. Future studies should incorporate objective health measures to validate the self-reported data. Finally, while this study focuses on the ultra-Orthodox Jewish population in Israel, there are also differences between various subgroups (e.g., Hasidic vs. Lithuanian Haredim). Examining how these differences between subgroups affect health behaviors could lead to further refinement of culturally tailored interventions. Conclusions This study highlights the complex interplay between health literacy, motivation, and preventive health behaviors within the ultra-Orthodox Jewish community in Israel. Gender differences emerged as a critical factor in understanding health behaviors, with females demonstrating higher intrinsic motivation and males relying more on extrinsic motivators. These findings underscore the need for culturally sensitive, gen-der-specific public health interventions that capitalize on the unique social and religious structures of this community. Future research should focus on developing and testing interventions that integrate these prin-ciples to improve engagement in health care and overall well-being in this population. Declarations Ethics approval and consent to participate Participants gave informed consent prior to their participation, and all data were anonymized to maintain confidentiality. No financial incentives were offered to participants. Ethical approval was obtained from the Ariel University Ethics Committee prior to data collection. Consent for publication All authors gave consent for publication. Data availability The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy restrictions. Competing interests The authors declare that they have no competing interests. Funding The authors declare that they have not received any funding. Author Contributions Conceptualization: R.T., D.F., N.S., R.N.G.; Methodology: R.T., M.Z., A.Z., M.S.; Analysis: R.T., A.Z., S.L.; Writing: R.T., D.F., N.S.; Supervision: R.T., R.N.G.; Project administration: R.T., N.S., R.N.G. References Bayram T, Donchin M. Determinants of health behavior inequalities: A cross-sectional study from Israel. Health Promot Int. 2019;34(5):941–52. 10.1093/heapro/day054 . Cherniak AD, Pirutinsky S, Rosmarin DH. 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Defining, assessing, and implementing organizational health literacy: barriers, facilitators, and tools–a systematic review. BMC Health Serv Res. 2025;25(1):599. 10.1186/s12913-025-12775-w . Pinchas-Mizrachi R, Orr Z, Zalcman BG, Romem A. Barriers to the healthcare system faced by ultra-orthodox religious disaffiliates. Rev Religious Res. 2024;66(1):56–80. 10.1177/0034673X231220386 . Schulze M, Janssen M. Self-determined or non-self-determined? Exploring consumer motivation for sustainable food choices. Sustainable Prod Consum. 2024;45:57–66. 10.1016/j.spc.2023.12.028 . Shiralian S, Talebi K, Ghodratizadeh F, Chitsaz E. The role of design thinking in promoting innovative behavior: An exploration of team cohesion and motivation. J Gen Manage. 2025. 10.1177/03063070251322856 . Simhi M, Yoselis A, Sarid O, Cwikel J. Hidden figures: Are ultra-orthodox Jewish women really so different when it comes to health care? J Relig Health. 2020;59(3):1398–420. 10.1007/s10943-019-00862-2 . Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, HLS-EU) Consortium Health Literacy Project European. Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ). BMC Public Health. 2012;12:1. 10.1186/1471-2458-12-1 . Teixeira PJ, Carraça EV, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self-determination theory: A systematic review. Int J Behav Nutr Phys Act. 2012;9:78. 10.1186/1479-5868-9-78 . Zalcberg Block S, Zalcberg S. Religious minorities’ perceptions of official COVID-19 health guidelines: The case of Ultra-Orthodox society in Israel. J Relig Health. 2023;62(1):408–27. 10.1007/s10943-022-01662-x . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8637002","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585323158,"identity":"02d61c8a-0b2a-4f7a-aa95-6dd91d3a1789","order_by":0,"name":"Riki Tesler","email":"","orcid":"","institution":"Ariel University","correspondingAuthor":false,"prefix":"","firstName":"Riki","middleName":"","lastName":"Tesler","suffix":""},{"id":585323161,"identity":"d9e4363a-8a0c-4e07-8cf7-0f8b53c9fed0","order_by":1,"name":"Moti Zwilling","email":"","orcid":"","institution":"Ariel 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Education","correspondingAuthor":false,"prefix":"","firstName":"Miri","middleName":"","lastName":"Shachaf","suffix":""},{"id":585323176,"identity":"f909a4c0-8833-4067-b52c-840bcedd8b76","order_by":8,"name":"Rachel Nissanholtz-Gannot","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIie2PLwvCQBjGnzFYElZvTPArvCK4ottXcQxmMRiNM60Iq/sYgmC+ccGi3WDQcsmwaDB4/qu7RcH7pZfj+d3zvoDB8Js4wBxw1cSfA2AtuV4hwMueCr2UrJ1Crxi9nxqVIBfyXNMp3OwOF14Tem5mN7d092nQL0km2/2UqpLQL7lmMYaZ43dIJEOeQnQI1lp3C3Ovjn9XyqCQEHdCpFeYagGJkJhqUefHLRQ59FYkJuwoUa2IJaXQLpZIdluIyC1Su74tRuMizy/nJuVLnH2+AOw2eUXUMmcwGAz/yAOXf0pe1yCmAQAAAABJRU5ErkJggg==","orcid":"","institution":"Ariel University","correspondingAuthor":true,"prefix":"","firstName":"Rachel","middleName":"","lastName":"Nissanholtz-Gannot","suffix":""}],"badges":[],"createdAt":"2026-01-19 08:42:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8637002/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8637002/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101869326,"identity":"b00d18be-386b-4517-a2e8-d67f8c16e7ce","added_by":"auto","created_at":"2026-02-04 13:00:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":115092,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8637002/v1/42cce8738b8bef59943c89d6.png"},{"id":101869334,"identity":"3ec4afb0-fcc6-4c31-981a-beff83cc7613","added_by":"auto","created_at":"2026-02-04 13:00:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1220692,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8637002/v1/2dea1c77-880b-4279-826c-f0fbe8f9a59e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health Literacy, Motivation, and Preventive Health Behaviors Among the Ultra-Orthodox Jewish Community in Israel: A Path Analysis Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe ultra-Orthodox Jewish community represents a unique sociocultural and religious minority in Israel, characterized by distinct lifestyle patterns, communal structures, and adherence to religious principles that influence health behaviors. This population group is growing rapidly and accounts for approximately 13% of the Israeli population, with projections that it will reach 16% by 2030 (Malach \u0026amp; Cahaner, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The demographic composition, socioeconomic challenges, and religious values of this community contribute to health behaviors, including disparities in health care utilization and participation in health-promoting activities (Bayram \u0026amp; Donchin, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Simhi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Despite the growing importance placed on preventive healthcare in Israel, research suggests that there are still disparities in health literacy, motivation, and access to healthcare services among the ultra-Orthodox compared to the general Jewish population (Neter et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eHealth Literacy and Preventive Health Behavior\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eHealth literacy, defined as the ability to access, understand, and apply health information, plays a fundamental role in the utilization of health services and adherence to preventive measures (Nutbeam, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Pelizzari et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Studies have indicated that people with higher health literacy have more confidence when it comes to making informed health decisions and show higher motivation to engage in health-promoting behaviors (Paasche \u0026amp; Wolf, 2010). However, in the ultra-Orthodox Jewish community, cultural and religious considerations may influence the impact of health literacy on health care utilization. Research suggests that traditional health knowledge, reliance on rabbinic authority, and limited access to secular education contribute to unique patterns of health literacy within this community (Levin, 2013; Simhi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMotivation as a Mediator of Health Literacy and Behavior\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eMotivation is one of the most important determinants for the adoption and maintenance of health behavior. Self-determination theory (Deci \u0026amp; Ryan, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1985\u003c/span\u003e) distinguishes between intrinsic motivation (determined by personal values and enjoyment) and extrinsic motivation (influenced by external pressures, such as social expectations or religious norms). Empirical evidence suggests that intrinsic motivation promotes long-term maintenance of health behaviors, while extrinsic motivation can serve as a short-term catalyst for behavior change (Teixeira et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Within the ultra-Orthodox Jewish community, men and women may experience different motivational influences: men are often under social and religious pressure to maintain their health, while women are more intrinsically motivated (Benyamini et al., 2014; Neter et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Understanding these gender-specific motivational pathways is essential for the development of culturally sensitive health interventions.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eGender Differences in Health Behaviors and Preventive Care\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eGender differences in health behavior are well documented, particularly in relation to physical activity, smoking, and dietary habits. Females tend to engage in healthier behaviors and show greater motivation for preventive health care than males, who tend to engage in riskier health behaviors (Connell, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Courtenay, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Within the ultra-Orthodox Jewish community, these patterns are further influenced by religious norms that dictate gender roles and access to health-related information (Gendler et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). For example, females\u0026rsquo; engagement in health-promoting behaviors, such as balanced diets and health screenings, may be shaped by their role as caregivers, while males are less proactive in seeking preventive care unless motivated by religious or community expectations (Levin, 2013; Simhi et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the growing body of research on health literacy and motivation, few studies have specifically examined how these factors interact in the unique sociocultural context of the ultra-Orthodox Jewish community. The present study aims to fill this gap by examining the relationships among health literacy, motivation (intrinsic and extrinsic), and preventive health behaviors among ultra-Orthodox individuals in Israel. Using a path analytic approach, this study examined: 1) the relationship between health literacy and motivation to maintain a healthy lifestyle; 2) the role of intrinsic and extrinsic motivation in shaping preventive health behaviors; 3) gender differences in the associations among health literacy, motivation, and health behaviors; and 4) the mediating effects of motivation on the relationship between health literacy and preventive health care utilization. we aimed to provide a nuanced understanding of health behaviors in the ultra-Orthodox Jewish community in Israel.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSample and Sampling Procedure\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe data for this study were obtained from a survey of 641 Ultra-Orthodox Jews in Israel (mean age: 35.6 years; standard deviation [SD]: 12.9 years; age range 18\u0026ndash;86 years), of whom 304 (47.4%) were male. The majority (n\u0026thinsp;=\u0026thinsp;309; 48.2%) were from Jerusalem and the surrounding area; 172 (26.8%) were from Tel Aviv and the surrounding area, and the rest (n\u0026thinsp;=\u0026thinsp;160; 25%) were from the north, south, or coastal regions of Israel. All respondents ticked the \"ultra-Orthodox\" option when asked about their religious affiliation, ensuring that all respondents belonged to the target population. For overall physical activity, we developed a weighted scale that combined all three levels of physical activity (W: Low=.25, Moderate=.5, High\u0026thinsp;=\u0026thinsp;1; M\u0026thinsp;=\u0026thinsp;141.58, SD\u0026thinsp;=\u0026thinsp;194.94) multiplied by their weekly frequency. The combined exercise minutes measured the weekly minutes devoted to physical activity at different intensity levels presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVarious background characteristics compared between men and women\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;5.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOtherwise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e(1)\u0026thinsp;=\u0026thinsp;50.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et=-0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Children\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.936\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Mass Index (BMI)\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall Health State (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.883\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical Activity (Minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow Intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et=-1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate Intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et=-2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh Intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.642\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeighted Practice\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e203.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e187.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et=-1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthy Lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFruit and Vegetable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSweet Products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e1\u003c/sup\u003e Only positive number of children was compared (number\u0026thinsp;\u0026lt;\u0026thinsp;14); \u003csup\u003e2\u003c/sup\u003e weighed total practicing minutes, low=.25, moderate=.5, high\u0026thinsp;=\u0026thinsp;1; \u003csup\u003e3\u003c/sup\u003e Missing or wrongfully written values were excluded, especially the height (25% were missing or incorrect values).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Design and Participants\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn this study, a cross-sectional survey was conducted to examine the relationships between health literacy, motivation, and preventive health behaviors among ultra-Orthodox Jewish adults in Israel. The study was conducted between [2023\u0026ndash;2024], using structured self-report questionnaires distributed in different ultra-Orthodox communities. Participants were recruited through ultra-Orthodox educational institutions, community centers, and religious networks to ensure a representative sample of the population. The inclusion criteria included identification as an ultra-Orthodox Jew, 18 years or older, and residence in Israel at the time of data collection. We excluded individuals who did not self-identify as ultra-Orthodox Jews, were under the age of 18, or did not reside in Israel during the data collection period.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHealth Literacy\u003c/span\u003e: Health literacy was assessed using a modified version of the Health Literacy Questionnaire (S\u0026oslash;rensen et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), which was adapted for the ultra-Orthodox Jewish population. The scale measures the ability to access and understand health information (e.g., \u0026ldquo;I can find reliable health information that concerns me\u0026rdquo;) and confidence in navigating the healthcare system (e.g., \u0026ldquo;I know how to make an appointment with a doctor if I need to\u0026rdquo;). Responses were recorded on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree), with higher scores indicating higher health literacy.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMotivation for Health Behavior\u003c/span\u003e: Motivation for healthy behavior was assessed based on self-determination theory (Deci \u0026amp; Ryan, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1985\u003c/span\u003e), distinguishing between intrinsic motivation (e.g., \u0026ldquo;I exercise because I enjoy it\u0026rdquo;) and extrinsic motivation (e.g., \u0026ldquo;I eat healthily because my family expects me to\u0026rdquo;). The items were rated on a 5-point Likert scale, with higher scores indicating greater motivation.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePreventive Health Behaviors\u003c/span\u003e: Participants reported their engagement in four key preventive health behaviors: physical activity \u0026ndash; frequency and duration of weekly moderate and vigorous exercise; diet \u0026ndash; consumption of fruits, vegetables, and processed foods; smoking \u0026ndash; current and past smoking habits; and health care utilization \u0026ndash; frequency of medical checkups, vaccinations, and screenings. Each behavior was categorized based on standard public health recommendations (e.g., World Health Organization physical activity guidelines).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDemographic and Socioeconomic Variables\u003c/span\u003e: Demographic information included age, gender, marital status, number of children, level of education, and geographical location. Socioeconomic status was determined based on household income and employment status.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Procedure\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eParticipants were given written informed consent and were assured anonymity and confidentiality. Paper questionnaires were distributed at community centers, and online surveys were distributed via ultra-Orthodox digital platforms (filtered internet networks). The questionnaires took approximately 15\u0026ndash;20 minutes to complete, and participation was voluntary. Data collection was conducted between February 2023 to May 2023.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eData were analyzed using SPSS (version 28) for structural equation modeling. Analytical procedures included descriptive statistics to summarize sample characteristics and exploratory factor analysis (EFA) to validate the scale constructs. We conducted Pearson correlations to examine bivariate relationships and path analysis (structural equation modeling) to examine direct and indirect effects between health literacy, motivation, and preventive health behavior. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, with Bonferroni corrections applied for multiple comparisons.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eParticipants gave informed consent prior to their participation, and all data were anonymized to maintain confidentiality. No financial incentives were offered to participants. Ethical approval was obtained from the Ariel University Ethics Committee prior to data collection.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this investigation, we wanted to assess awareness of health. We begin with a brief reminder of the research hypotheses: (H1) Health literacy and the availability of health services are positively related to motivation to maintain a healthy lifestyle; (H2) Motivation for a healthy lifestyle, whether internal (self-motivated) or external (socially motivated), is positively related to activities associated with a healthy lifestyle; (H3) Motivation will be positively associated with positive feelings; (H4) Availability and knowledge of health will be indirectly associated through motivation with actual activity to maintain a healthy lifestyle; (H5) Similar to H4, motivation will play a role in how the availability of health and knowledge of health affects activity and positive feelings. To test these hypotheses, we developed a two-stage analysis plan in which the first stage involved an EFA (extraction method: principal axis factoring, PAF; rotation: Promax (Hefetz \u0026amp; Liberman, 2017) to detect items that loaded poorly on the factor; and in the second stage, we applied a path analysis model to test theoretical hypotheses. Path analysis is a special case of structural equation modeling, but does not use latent factors, only observed or calculated indicators. One advantage of the path analysis modeling approach is the assessment of the indirect effect, i.e., the impact of independent indicators on outcomes through a mediating indicator. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExploratory Factor Analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA first approach for the creation of scales is exploratory factor analysis, especially when the validation of survey instruments is unclear. Several indicators were constructed based on the EFA results. Table 2 provides a description and reliability measures of the outcome indicators. In contrast to the general gender similarities in personal characteristics, the research indicators showed significant differences; female had higher health awareness, although their access to health services was lower than they self-reported. Males felt more social pressure to lead a healthy life, while females were more confident in their motivation to lead a healthy life. Females were more inclined to consume healthy foods (fruit and vegetables) than males. Regardless of their lower levels of healthy behaviors, such as lower levels of physical activity, males, on average, reported higher monthly positive affect compared to the feelings reported by females. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Potential research indicators, descriptive statistics, reliability, and comparisons by gender\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e# Items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eAlpha\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003ep\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHealth awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eAccessibility of health services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eSocial pressure to retain a healthy life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eSelf-pressure to retain a healthy life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e5.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.755\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e6.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003ePositive Affect (during the last month)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eHealthy Food Consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e3.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 1\u003c/sup\u003e p for a two-tailed significance level based on the two-independent sample t-test.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Abbreviation: SD, standard deviation.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; The correlation coefficients provide an initial indication of possible model results (Table 3). The correlation coefficients were found to be reasonable, but not high. We found that health status was positively associated with positive feelings (i.e., subjective and relatively objective states were correlated). These correlation coefficients were calculated for the entire sample.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3:\u0026nbsp;Pearson\u0026rsquo;s correlation coefficients across research indicators\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003ePearson\u0026rsquo;s r\u003c/p\u003e\n \u003cp\u003ep-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e(10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eAge (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.738\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eHealth State (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003ePhysical Activity (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.993\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eHealth awareness (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eEase of search (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.061\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eService Accessibility (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSense of belonging (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.327\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSocial pressure (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e-.039\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.326\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSelf-pressure (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003ePositive Feeling (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;In Figure 1, we show this structure of direct and indirect paths, with solid lines representing direct effects and dashed lines representing indirect effects. An indirect effect can be complete if no significant direct effect was found, and a complementary one, i.e., partial, if it provides a complementary path from the independent indicator to the outcome indicator. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1. A conceptual path analysis model\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModeling Results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 shows the results of the path analysis models. The overall goodness of fit is shown, which means that the path analysis was performed for both subgroups. Although the overall quality of the model fit was high with respect to the usual fit thresholds, the breakdown of the \u0026chi;2 by gender shows a better fit for females compared to males (the smaller the \u0026chi;2, the better). Both subjective and objective health literacy and health awareness were positively associated with self-motivation for healthy living for males (\u0026beta;=.21, p\u0026lt;.001; \u0026beta;=.26, p\u0026lt;.001; respectively), while accessibility was positively associated with social pressure to maintain a healthy life (\u0026beta;=.20, p\u0026lt;.001). This was not as clear for females, where only health literacy was positively associated with self-motivation (\u0026beta;=.28, p\u0026lt;.001). male\u0026rsquo;s health literacy was also positively associated with positive feelings (\u0026beta;=.23, p\u0026lt;.001), while accessibility to health services was positively associated with healthy food consumption (\u0026beta;=.17, p\u0026lt;.01). Among female, we found that self-motivation was positively associated with all three outcomes (feeling positive: \u0026beta;=.20, p\u0026lt;.001; healthy food consumption: \u0026beta;=.22, p\u0026lt;.001; physical activity: \u0026beta;=.16, p\u0026lt;.001). In other words, females not only had a stronger self-motivation to lead a healthy life compared to males, but this motivation was highly associated with actual better health behaviors and feelings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Path analysis results, gender comparison, and standardized estimates \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eExternal Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eInternal Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePositive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eHealthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePhysical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eAccessible Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.07 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.21*** (.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.23*** (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.02 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-.04 (.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eHealth Literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.20*** (.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.26*** (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.07 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.17** (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.06~ (.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eExternal Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-.08 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.07 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.03 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eInternal Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.20*** (.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.14* (.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.09 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.07 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePositive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eHealthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.12**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.06~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.09**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eAccessible Services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.09 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.28*** (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.03 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.10 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.14~ (.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eHealth Literacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.08 (.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.01 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-.02 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.05 (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.02 (.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eExternal Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-.15** (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.10~ (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.08(.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eInternal Motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.16** (.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.20** (.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.22*** (.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.16*** (.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePositive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.06 (.041)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eHealthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.070 (.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.08*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.06~\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.09**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e.07*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eModel goodness of fit: \u0026chi;\u003csup\u003e2\u003c/sup\u003e=4.10, df=4, p=.392; CFI=.999, TLI=.995, RMSEA=.000, 95%CI[.000,.086]; SRMR=.014; Male\u0026rsquo;s \u0026chi;\u003csup\u003e2\u003c/sup\u003e: 4.04, Female\u0026rsquo;s \u0026chi;\u003csup\u003e2\u003c/sup\u003e: 0.07; *** p\u0026lt;.001, ** p\u0026lt;.01, * p\u0026lt;.05, ~ p\u0026lt;.10.\u003c/p\u003e\n\u003cp\u003eShaded cells for correlations; standard errors in parentheses.\u003c/p\u003e\n\u003cp\u003eAn additional analysis of the path model related to the indirect role of motivation (social and self) in mediating the effect of literacy and accessibility on behavioral outcomes. We show all possible indirect effects in Table 5. However, for males, there were only two indirect pathways leading from literacy and accessibility to positive feelings. In the first, i.e., Health Literacy, Internal Motivation, Positive Feeling, this complemented the direct effect, while in the second, Accessible Services, Internal Motivation, Positive Feeling, this was a replacement as the direct effect was not significant. This means that self-motivation, which had no direct effect on outcomes, acted as a mediator to express the effects of literacy and accessibility on outcomes. Indirect effects were also found for the female. Self-motivation was found to mediate the effect of health literacy on outcomes beyond the direct effect described above (See Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Indirect effects of health literacy and health service accessibility on subjective and objective outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003ePathways\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eIndirect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e95% Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eTotal Effect:\u003c/p\u003e\n \u003cp\u003eDirect, Indirect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy \u0026agrave; External Motivation \u0026agrave; \u0026nbsp; Weighted Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.004, .021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.044, .017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Weighted Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.007, .042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; External Motivation \u0026agrave; \u0026nbsp;Weighted Physical Activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.017, .031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.068~, .024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Weighted Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.009, .056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy \u0026agrave; External Motivation \u0026agrave; \u0026nbsp; Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.003, .030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.023, .023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.006, .052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; External Motivation \u0026agrave; \u0026nbsp;Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.008, .044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.168**, .037~\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; Internal Motivation \u0026agrave; \u0026nbsp; \u0026nbsp;Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.007, .063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy \u0026agrave; External Motivation \u0026agrave; \u0026nbsp;Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.035, 002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.225***, .023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.028*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e.002,.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; External Motivation \u0026agrave; \u0026nbsp; Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.048, .003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.071, .019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; Internal Motivation \u0026agrave; \u0026nbsp; Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.035*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e.005, .073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy \u0026agrave; External Motivation \u0026agrave; \u0026nbsp; Weighted Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.002, .031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.135~, .053**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Weighted Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.046**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e.021, .070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; External Motivation \u0026agrave; \u0026nbsp;Weighted Physical Activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.005, .028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.016, .008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Weighted Physical Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.019, .023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy \u0026agrave; External Motivation \u0026agrave; \u0026nbsp; Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.002, .037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.100, .070**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.061**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e.024, .102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; External Motivation \u0026agrave; \u0026nbsp;Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.004, .034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.046, .009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; Internal Motivation \u0026agrave; \u0026nbsp; \u0026nbsp;Healthy Food\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.027, .030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy \u0026agrave; External Motivation \u0026agrave; \u0026nbsp;Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.045, .002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e.027, .042~\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eHealth Literacy\u0026nbsp;\u0026agrave;\u0026nbsp;Internal Motivation\u0026nbsp;\u0026agrave;\u0026nbsp;Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.055*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e.019, .103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; External Motivation \u0026agrave; \u0026nbsp; Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.040, .008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e-.022, -.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 276px;\"\u003e\n \u003cp\u003eAccessible Services \u0026agrave; Internal Motivation \u0026agrave; \u0026nbsp; Positive Feeling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e-.031, .032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*** p\u0026lt;.001, ** p\u0026lt;.01, * p\u0026lt;.05, ~ p\u0026lt;.10.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe aimed to examine the relationship between health literacy, motivation, and preventive health behaviors within the ultra-Orthodox Jewish community in Israel. Specifically, we examined the mediating role of motivation in translating health literacy and access to health care into health-promoting behaviors, with a particular focus on gender differences. The results provide important insights into how different motivational factors influence health-related decisions and the utilization of preventive health services.\u003c/p\u003e\n\u003cp\u003eOur results supported the first hypothesis (H1) and show that higher health literacy and access to health care were positively associated with higher motivation for a healthy lifestyle. This finding is consistent with previous research showing that individuals with higher health literacy are more likely to engage in health-promoting behaviors (McAnally \u0026amp; Hagger, 2023). However, our study extends this knowledge by emphasizing the mediating role of motivation. While knowledge alone is an essential component of behavior change, it must be coupled with intrinsic or extrinsic motivation to translate into meaningful action (Shiralian et al., 2025).\u003c/p\u003e\n\u003cp\u003eConsistent with our second hypothesis (H2), motivation for a healthy lifestyle was significantly associated with health-promoting activities. However, an important finding of our study was the significant gender differences in motivational factors. Females exhibited significantly higher levels of intrinsic motivation, which had a strong impact on adherence to preventive health measures, healthy eating habits, and moderate physical activity. In contrast, males relied more on extrinsic motivators, such as social pressure, to engage in health-conscious behavior. This is consistent with self-determination theory (Deci \u0026amp; Ryan, 1985), which states that intrinsic motivation leads to more sustainable behavior change compared to extrinsic motivation (Schulze \u0026amp; Janssen, 2024; Teixeira et al., 2012). A striking gender difference was observed in smoking behavior, with males reporting a much higher prevalence of smoking (22.0%) than females (3.6%). This supports previous research suggesting that males are more likely to engage in risky health behaviors and may require stronger social and environmental incentives to change their behavior (Courtenay, 2000). In contrast, females\u0026apos; intrinsic motivation was a more consistent predictor of health-related behavior, highlighting the importance of tailoring interventions that use different motivational strategies for males and females.\u003c/p\u003e\n\u003cp\u003eOur results also confirm hypothesis three (H3) and show that motivation was positively associated with subjective well-being. However, the pathways through which motivation influences well-being differed by gender. For females, self-motivation significantly predicted both healthy behaviors and higher positive affect, whereas for males, social pressure played a greater role in shaping their behaviors and well-being.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe collectivist nature of the ultra-Orthodox Jewish community underscores the importance of religious and social influences in shaping health behaviors (Gendler, Ofri \u0026amp; Videl, 2025). Our findings suggest that males were more responsive to health-related messages framed in a religious or community-based context. This supports the findings of Epstein (2018) that health interventions in ultra-Orthodox populations are most effective when endorsed by religious leaders (Jacobson et al., 2023; Zalcberg et al., 2023). In contrast, females showed greater autonomy in their health decisions, suggesting that public health campaigns targeting this population should take a dual approach: utilizing religious leadership for males\u0026apos; engagement and emphasizing personal empowerment strategies for females (Orr \u0026amp; Zalcman, 2024; Pinchas-Mizrachi et al., 2024).\u003c/p\u003e\n\u003cp\u003eOur study empirically supports this model by showing that males were more likely to engage in healthy behaviors when prompted by external triggers, such as religiously supported health campaigns. Female, on the other hand, acted independently of their knowledge and motivation and needed fewer external triggers to adopt health-promoting behaviors. This difference suggests that gender-specific intervention strategies are needed to optimize health behavior change in this population (Cherniak et al.,2021; Orr et al., 2024).\u003c/p\u003e\n\u003cp\u003eHypotheses four (H4) and five (H5) were also supported, as health literacy and accessibility to health care indirectly influenced preventive health behaviors via motivation. For males, self-motivation acted as a mediator in translating health literacy into positive well-being outcomes. Interestingly, self-motivation played a broader role among females by mediating the relationship between health literacy and all three outcome variables: well-being, healthy food consumption, and physical activity.\u003c/p\u003e\n\u003cp\u003eThese findings have important implications for public health interventions. Because motivation is a critical link between knowledge and action, health literacy programs should include strategies that increase both intrinsic and extrinsic motivation. For males, interventions should emphasize social responsibility and religious advocacy, while for females, promoting self-efficacy and autonomous decision making may lead to better outcomes.\u003c/p\u003e\n\u003cp\u003eAlthough this study provides valuable insights, several limitations should be noted. First, the cross-sectional design precludes our ability to infer causal relationships between health literacy, motivation, and behavior. Future research should consider longitudinal studies to track changes in health behaviors over time. Second, self-reported measures of health behavior may lead to social desirability bias, particularly in a religious community where adherence to health norms may be socially expected. Future studies should incorporate objective health measures to validate the self-reported data. Finally, while this study focuses on the ultra-Orthodox Jewish population in Israel, there are also differences between various subgroups (e.g., Hasidic vs. Lithuanian Haredim). Examining how these differences between subgroups affect health behaviors could lead to further refinement of culturally tailored interventions.\u003c/p\u003e"},{"header":"Conclusions","content":"This study highlights the complex interplay between health literacy, motivation, and preventive health behaviors within the ultra-Orthodox Jewish community in Israel. Gender differences emerged as a critical factor in understanding health behaviors, with females demonstrating higher intrinsic motivation and males relying more on extrinsic motivators. These findings underscore the need for culturally sensitive, gen-der-specific public health interventions that capitalize on the unique social and religious structures of this community. Future research should focus on developing and testing interventions that integrate these prin-ciples to improve engagement in health care and overall well-being in this population."},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eParticipants gave informed consent prior to their participation, and all data were anonymized to maintain confidentiality. No financial incentives were offered to participants. Ethical approval was obtained from the Ariel University Ethics Committee prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors gave consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have not received any funding.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor Contributions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eConceptualization: R.T., D.F., N.S., R.N.G.; Methodology: R.T., M.Z., A.Z., M.S.; Analysis: R.T., A.Z., S.L.; Writing: R.T., D.F., N.S.; Supervision: R.T., R.N.G.; Project administration: R.T., N.S., R.N.G.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBayram T, Donchin M. Determinants of health behavior inequalities: A cross-sectional study from Israel. 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J Relig Health. 2023;62(1):408\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10943-022-01662-x\u003c/span\u003e\u003cspan address=\"10.1007/s10943-022-01662-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"israel-journal-of-health-policy-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jhpr","sideBox":"Learn more about [Israel Journal of Health Policy Research](http://ijhpr.biomedcentral.com/)","snPcode":"13584","submissionUrl":"https://www.editorialmanager.com/jhpr/default2.aspx","title":"Israel Journal of Health Policy Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Health literacy, motivation, preventive healthcare, Ultra-Orthodox Jewish community, gender differences, health behaviors","lastPublishedDoi":"10.21203/rs.3.rs-8637002/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8637002/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 641 ultra-Orthodox Jewish individuals in Israel (mean age\u0026thinsp;=\u0026thinsp;35.6, SD\u0026thinsp;=\u0026thinsp;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHealth 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%).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eCulturally tailored interventions, particularly those supported by religious authorities, may improve health care utilization and long-term health behavior change in this population.\u003c/p\u003e","manuscriptTitle":"Health Literacy, Motivation, and Preventive Health Behaviors Among the Ultra-Orthodox Jewish Community in Israel: A Path Analysis Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 13:00:27","doi":"10.21203/rs.3.rs-8637002/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-03T12:29:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T23:24:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63779095434851888632617645580742474924","date":"2026-02-03T22:03:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-02T20:56:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-28T07:01:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-28T07:01:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Israel Journal of Health Policy Research","date":"2026-01-19T08:20:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"israel-journal-of-health-policy-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jhpr","sideBox":"Learn more about [Israel Journal of Health Policy Research](http://ijhpr.biomedcentral.com/)","snPcode":"13584","submissionUrl":"https://www.editorialmanager.com/jhpr/default2.aspx","title":"Israel Journal of Health Policy Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b9bf59f5-30a1-403a-8f37-6bae387e08a2","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T13:53:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 13:00:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8637002","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8637002","identity":"rs-8637002","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}