Health Literacy and Chronic Disease Self-Efficacy Among Older Adults with Multimorbidity: Evidence from Low-Resource Context.

Background/Objectives: Multimorbidity among older adults is increasing globally and places significant pressure on primary healthcare systems, particularly in low-resource settings. Health literacy is recognized as an important determinant of chronic disease management; however, evidence regarding its association with chronic disease self-efficacy remains limited. This study examined the association between health literacy and chronic disease self-efficacy among older adults with multimorbidity receiving primary healthcare services in Albania. Methods: A cross-sectional study was conducted among 464 adults aged ≥65 years with at least two chronic conditions attending primary healthcare centres in Vlora Municipality. Stratified random sampling was used. Data were collected using a sociodemographic questionnaire, the European Health Literacy Questionnaire (HLS-EU-Q16), and the Stanford Chronic Disease Self-Efficacy Scale (CDSES-33). Health literacy was classified into three categories: inadequate, problematic, or adequate. Pearson's correlation and hierarchical multiple linear regression analyses were performed after adjustment for relevant sociodemographic and clinical characteristics. Results: Participants were predominantly women (54.3%), with a mean age of 69.9 ± 4.7 years. Hypertension (72.6%) and diabetes mellitus (70.3%) were the most prevalent chronic conditions. Health literacy demonstrated a moderate positive correlation with chronic disease self-efficacy (r = 0.407, p < 0.001). In the fully adjusted regression model, health literacy remained an independent predictor of chronic disease self-efficacy. Higher educational attainment and better self-rated health were also significantly associated with greater chronic disease self-efficacy. Conclusions: Older adults with multimorbidity demonstrated varying levels of health literacy and chronic disease self-efficacy. Higher health literacy was independently associated with greater confidence in managing chronic conditions. These findings support the integration of health-literacy-responsive interventions into primary healthcare to strengthen chronic disease self-management and improve person-centred care among older adults with multimorbidity.