Association between occupational health literacy and occupational stress among workers in metal mining, metallurgy and non-metallic manufacturing in Gansu, China

Abstract

Background: Occupational stress has become a significant public health concern, and health literacy (HL) is increasingly recognized as a potential influencing factor. However, most existing studies focus on knowledge-intensive occupational groups such as healthcare and education, while research on the relationship between occupational health literacy (OHL) and occupational stress in traditional industrial settings, such as factories and mines, remains limited. Methods: The study sample comprised 3,772 employees from the metal mining, metallurgy, and non-metallic mineral products industries located in Gansu Province. OHL was evaluated using the Individual Questionnaire of the National Key Population Occupational Health Literacy Monitoring Survey (IQ-NKPOHLMS), while occupational stress was measured via the Core Occupational Stress Scale (COSS). The analytical methods employed encompassed logistic regression modeling, restricted cubic spline (RCS) analyses, and subgroup analyses. These approaches were utilized to evaluate the association between occupational health literacy (OHL) and occupational stress, investigate potential dose-response relationships, and assess interaction effects. Results: Among participants, 55.6% exhibited adequate levels of occupational health literacy. Logistic regression analyses indicated that each one-point increment in OHL (continuous variable) was associated with a 2% reduction in the odds of experiencing occupational stress (OR = 0.981, 95% CI: 0.976–0.985). Furthermore, workers classified as having adequate OHL demonstrated a 31.6% lower likelihood of occupational stress compared to those with inadequate OHL (OR = 0.684, 95% CI: 0.589–0.793). The RCS analysis substantiated a significant linear dose-response relationship between OHL and occupational stress (p for nonlinearity = 0.2715). Subgroup analyses revealed that weekly working hours significantly moderated this association, with the protective effect of OHL being more pronounced among workers with shorter working hours; this interaction was statistically significant (p for interaction < 0.001). Conclusion: Adequate occupational health literacy is strongly linked to a lower risk of occupational stress, especially among employees who work fewer hours. This indicates that improving occupational health literacy should be a key part of workplace health initiatives, particularly for those involved in prolonged, demanding jobs. Additionally, strategies such as encouraging reasonable work hours, minimizing excessive overtime, and implementing focused occupational health literacy programs are advised to comprehensively enhance workers’ mental well-being.