Introduction

In South Korea, all adult male citizens are obligated to serve in the military for national defense for a specific period. Unlike civilian society, the military has environmentally special characteristics, and soldiers live in isolation from civilian society for a certain period of time, which may cause stress among soldiers [1,2]. In addition, since military personnel must constantly maintain a state of alertness during peacetime due to the intense and strenuous physical activities required for various types of training, operations, and combat capability evaluation, they may have difficulty managing and maintaining their physical and mental health [3]. According to the 2024 Military Health Survey, among military personnel, the smoking rate and monthly drinking rate were 48% and 65%, respectively, which are higher than those of the general population, and the obesity rate also increased to 46% compared to the previous year [4]. These data suggest that unhealthy health behaviors such as smoking and drinking not only hinder the performance of national defense duties [5], but can also be directly linked to a decline in individuals’ quality of life. Health promotion is a multidimensional concept that focuses on maintaining and improving health, and it is aimed at minimizing preventable health risk factors, such as smoking, drinking, unhealthy dietary habits, and lack of physical activity, and achieving optimal health [6]. In particular, Pender emphasized that health-promoting behaviors should be performed in a direction that they can maintain or increase individual’s well-being and life satisfaction and contribute to self-realization in order to promote healthy lifestyles [7]. Nevertheless, the level of health-promoting behaviors among military personnel was found to be lower than that of the general public [8]. Soldiers are, on average, in the early adulthood in terms of the stages of human development, and health habits formed during this period can have a lifelong impact, significantly affecting individuals’ overall aspects of life, including preventing various diseases and influencing their families [1,9]. On the other hand, soldiers’ active engagement in health promotion behaviors has been shown to improve their adaptation to military life and mental health [10]. Furthermore, such active performance of health promotion behaviors among soldiers can not only reduce healthcare costs but also have a positive effect on improving soldiers’ health and extending their lifespan [11]. Thus, to improve quality of life in military personnel and ensure health equity, it is an essential task to understand health promotion behaviors among military personnel and identify factors that can improve them.

Health literacy includes the knowledge, motivation, and ability needed to access, understand, evaluate, and use health information, and it enables individuals to make informed, appropriate decisions regarding medical care, disease prevention, and health promotion in their daily lives, thereby contributing to maintaining or improving quality of life [12]. Health literacy directly influences various health management behaviors, including health behaviors, healthcare service utilization, and medication adherence [13,14], and the World Health Organization (WHO) has presented strategies for improving health literacy at the individual and organizational levels [15]. Although strategies for promoting health literacy through linkage to local communities are being applied overseas, such efforts have not been insufficiently made in Korea [16]. Considering that health literacy is an important means to improve the healthcare quality and health equity of the population, it is a very important task to promote health literacy in the fields of domestic health education and health promotion [17]. Previous studies have shown that health literacy is a major influencing factor for health promotion behaviors. However, these studies have primarily focused on vulnerable groups with limited access to health information, such as older adults in rural areas [18] and foreign workers [19]. In Korea, there have been few studies on health literacy among military personnel. Due to the discipline-centered living environment of the military, military personnel have limited access to health information, and medical decision-making is frequently centered on the organization rather than the individual, so it is essential to accurately understand the role of health literacy.

Meanwhile, psychological well-being is theoretically defined as the sum of psychological factors that comprise an individual’s quality of life, unlike subjective well-being, which is an individual’s overall and subjective evaluation of his or her life [20]. According to previous studies, psychological well-being is closely related to health issues such as cardiovascular diseases and cognitive decline [21,22], and acts as a key predictor of physical health status. Furthermore, previous studies [23,24] have shown that psychological well-being is closely related to health promotion behaviors. Psychological well-being is one of the key factors affecting health literacy. A higher level of psychological well-being leads to improved health literacy, which in turn has a positive impact on the individual’s motivation, self-esteem, and self-management skills [25]. These effects of psychological well-being and health literacy also have important implications for adaptation to military life and quality of life in military personnel [26]. However, the military is a controlled, hierarchical society and it is a more closed and coercive organization than other organizations. These characteristics of the military cause a high level of stress among soldiers, which not only leads to a decline in psychological well-being but also negatively affects health promotion behaviors [2,27,28]. Nevertheless, there is still a lack of research to investigate the impact of psychological well-being on health promotion behaviors in military personnel.

Against the above backdrop, this study aimed to analyze the impact of health literacy and psychological well-being on health promotion behaviors among military personnel in order to provide fundamental data for improving their quality of life. The results of this study are expected to serve as an important basis for understanding soldiers as a unique occupational group from a community perspective and developing person-centered health management strategies.

Methods

Study design

This study is a descriptive survey study to investigate the impacts of health literacy and psychological well-being on health promotion behaviors among military personnel.

Participants

The participants of this study were active-duty military personnel, and they were selected by the convenience sampling method from the frontline and rear-area divisions located in G Province and G City. The sample size for multiple regression analysis was calculated using G*Power 3.1, and the minimum sample size was calculated to be 127 people by applying an effect size of .15, a significance level of .05, a power of .80, and 12 predictor variables. Then, considering a dropout rate of approximately 10%, the final sample size was determined as 142. In this study, questionnaires were distributed to a total of 142 people, and all of the 142 copies of questionnaires were collected without any insincere responses or missing data, so they were all included in the final analysis. The number of samples secured in this way exceeds the minimum sample size calculated through the prior power analysis performed before participant recruitment, so the sample size of this study indicates having secured sufficient statistical power for the multiple regression analysis used in this study. In addition, considering 16 observed variables, the sample size of this study included approximately 8.9 cases per variable, so the sample size requirement for multivariate analysis was satisfied.

Measures

Health literacy

The level of health literacy was measured using the health literacy scale from the Korea National Health and Nutrition Examination Survey (KNHANES). This scale was developed by Jeong et al. [29]. This tool consists of a total of 10 items across four subfactors: disease prevention (3 items), health management (4 items), health promotion (1 item), and resource utilization (2 items). Each item is rated on a 4-point Likert scale ranging from 1 point (= Not at all) to 4 points (= Very much). Total scores range from 10 to 40 points, and a higher score indicates a higher level of health literacy. Regarding the reliability of the instrument, the value of Cronbach’s α was reported as .87 by the developer of the tool [29], and it was calculated as .92 in this study.

Psychological well-being

The level of psychological well-being was assessed using a Korean version of the Scale of Psychological Wellbeing developed by Ryff [30]. The Korean version used was developed through translation and adaptation of the original scale by Kim [20]. This scale consists of 46 items across 6 subfactors: self-acceptance (8 items), positive relation (7 items), autonomy (8 items), environmental mastery (8 items), purpose in life (7 items), and personal growth (8 items). Each item is rated on a 5-point Likert scale ranging from 1 point (= Not at all) to 5 points (= Very much). Total scores range from 46 to 230 points, and higher scores indicate higher levels of psychological well-being. The value of Cronbach’s α was reported as .66∼.76 in the study by Kim [20], and it was calculated as .91 in this study.

Health promotion behavior

The level of health promotion behavior was assessed using a Korean adapted version of the FANTASTIC Lifestyle Questionnaire developed by Wilson & Ciliska [31]. The Korean version used in this study was developed by Jung & Chun [32]. This tool consists of a total of 25 items across 9 subfactors: family & friend (3 items), exercise∙leisure activity (2 items), nutrition (4 items), smoking∙caffeine intake (3 items), drinking (2 items), sleep∙seat belt∙stress (3 items), personal characteristics (3 items), emotional (3 items), and social life (2 items). Each item is rated on a 3-point scale ranging from 0 to 2 points, with a total score of 0 to 50 points. A higher score indicates a higher level of health promotion behavior. To assess body weight among the items on nutrition, BMI values were calculated using the height and weight of each participant. Based on the criteria presented by the World Health Organization Asia-Pacific region and the Korean Society for the Study of Obesity, 2 points were assigned to normal weight (BMI: 18.5~22.9), 1 point to underweight (BMI: <18.5) and overweight (BMI: 23.0~24.9), and 0 points to obesity (BMI: ≥25.0). The value of Cronbach’s α was reported as .70 in the study by Jung & Chun [20], and it was calculated as .71 in this study.

General characteristics

In this study, the general characteristics of the participants were examined using a total of 10 items on gender, age, education level, state, rank, total military service period, branch of service, marital status, subjective health status, and presence of religion.

Data collection

This study received approval from the Institutional Review Board (IRB) of the affiliated institution of the researcher. Then, after a security review, data collection was carried out from May 13 to May 23, 2025. Prior to data collection, the researchers personally visited the relevant military units in advance to request and receive cooperation and permission from the commanding officers of the units, and posted the research participant recruitment notice along with the research description. To collect data, an online survey was conducted among those who voluntarily expressed intention to participate in the study after fully understanding the purpose and procedures of the study. The survey took approximately 15 to 20 minutes for each participant to complete.

Data analysis

The collected data were analyzed using SPSS/WIN 27.0. The general characteristics of the participants were analyzed by calculating means, standard deviations, frequencies, and percentages. The levels of health literacy, psychological well-being, and health promotion behaviors among the participants were analyzed using means and standard deviations. Also, to examine differences in the level of health promotion behaviors according to the general characteristics of the participants, the independent t-test and one-way ANOVA were performed, and post-hoc analysis was performed using the Scheffé test. The correlations between subjective health, health literacy, psychological well-being, and health promotion behaviors among the participants were analyzed using Pearson’s correlation coefficient. In addition, to identify the influencing factors for health promotion behavior among the participants, multiple linear regression analysis was performed by entering all independent variables simultaneously.

Ethical considerations

This study was conducted after receiving approval from the Institutional Review Board of the affiliated institution of the researcher (IRB NO.: AFMC 2025-04-010) to ensure ethical protection of the participants. Before conducting the online survey, the participants were informed of the purpose and methods of the study, voluntary participation, guarantee of anonymity, and the right to withdraw from the study at any time without any disadvantages by presenting these explanations on the first page of the questionnaire of the online survey. The survey was conducted after obtaining informed consent from the participants, and the collected data was stored in encrypted electronic files to ensure that only the researcher would have access to the research data. The data will be retained for three years after completion of the research, and thereafter, it will be completely deleted and destroyed. Each participation of this study was given a small gift as a token of appreciation.

Results

General characteristics of the participants

The general characteristics of the participants are shown in Table 1. Among the participants, males accounted for 59.9% (85 people). In age, those under 30 years of age accounted for the majority (100 people, 70.4%), and the average age was 29.84 years. Regarding education level, ‘university’ accounted for the majority (106 people, 74.7%). In terms of state, the proportion of commissioned officers (102 people, 71.8%) was larger than that of non-commissioned officers. As for total military service period, 109 people (76.8%) had served for less than 10 years. In terms of branch of service, 90 people (63.4%) served in the combat branch. In marital status, 85 people (59.9%) were unmarried, and regarding subjective health, people with good subjective health accounted for the largest proportion (70 people, 49.3%). Regarding the presence of religion, 84 people (59.2%) answered ‘yes.’

Levels of health literacy, psychological well-being, and health promotion behavior among the participants

The levels of health literacy, psychological well-being, and health promotion behavior among the participants are shown in Table 2. Regarding the level of health literacy, the average score was 3.28±0.46 out of 4 points, and among the subdomains of health literacy, ‘health management’ had the highest score at 3.45±0.46 points, while ‘resource utilization’ had the lowest score at 3.08±0.54 points. As for psychological well-being, the average score was 3.74±0.38 out of 5 points, and regarding the levels of the subdomains, the score of ‘positive interpersonal relation’ was highest at 4.04±0.58 points, and the score of ‘autonomy’ was lowest at 3.14±0.46 points. With respect to health promotion behavior, the average score for health promotion behavior was 1.44±0.20 out of 2 points, and in the case of the levels of the subdomains, the score of ‘family & friend’ was highest at 1.74±0.40 points, and the score of ‘nutrition’ was lowest at 1.10±0.37 points.

Differences in health promotion behavior, health literacy, and psychological well-being according to general characteristics

Differences in the level of health promotion behavior, health literacy, and psychological well-being according to general characteristics are shown in Table 3. Analysis results showed that there were significant differences in health promotion behavior according to gender (t=-2.50, p=.014) and marital status (t=-2.03, p=.043). More specifically, the level of health promotion behavior was higher among women than men, and married people showed a higher level of health promotion behavior than unmarried people. With respect to health literacy, there were significant differences in the level of health literacy according to gender (t=-3.33, p=.001), age (F=5.58, p=.007), total military service period (F=7.25, p=.003), branch (F=6.59, p=.002), and religion (t=2.48, p=.014). The level of health literacy was higher among women than men, and it was higher in those under 30 years of age than those aged 40 or old. Also, those serving in the special branch showed a higher level of health literacy than those serving in the combat branch. Additionally, the group without religion showed a higher level of health literacy than the group with religion. As for psychological well-being, there was a significant difference in the level of psychological well-being according to gender (t=2.04, p=.043). Male soldiers showed a higher level of psychological well-being than female soldiers.

Correlations between subjective health, health literacy, and psychological well-being, and health promotion behavior

The analysis results of correlations between subjective health status, health literacy, psychological well-being, and health promotion behavior among the participants are shown in Table 4. Health promotion behavior showed a significant positive correlation with subjective health (r=.42, p<.001), health literacy (r=.32, p<.001), and psychological well-being (r=.40, p<.001)

Factors affecting health promotion behaviors

The significant influencing factors for health promotion behavior are shown in Table 5. In regression analysis, the variables that had a significant impact on health promotion behavior in univariate analysis prior to regression analysis were entered, and other general characteristics were also included in the analysis. Additionally, the three variables that showed significant correlations with health promotion behavior were also included in the regression analysis. As a result of testing the basic assumptions of regression analysis, the Durbin-Watson statistic was 2.09, indicating that there was no autocorrelation problem. The tolerance values were all greater than 0.1, ranging from 0.16 to 0.81, and the variance inflation factor (VIF) values ranged from 1.22 to 6.05, indicating that there was no multicollinearity problem. Gender, age, education level, state, total military service period, branch, marital status, and religion were treated as dummy variables. The results of regression analysis revealed that total military service period of 20 years or more (β=0.39, p=.019) had the most significant impact on health promotion behavior, followed by subjective health (β=0.32, p<.001), psychological well-being (β=0.26, p=.003), gender (β=0.23, p=.014), and university in education level (β=0.21, p=.024). This regression model had an explanatory power of 31.5%, and the model was statistically significant (F=5.32, p<.001).

Discussion

This study attempted to investigate the impacts of health literacy and psychological well-being on health promotion behavior among military personnel. The main findings of this study are discussed below.

In this study, the average score for health literacy among the participants was 3.28±0.46 out of 4 points. Although it is difficult to directly compare these results with those of other studies due to the lack of prior studies using the same tool, the level of health literacy in this study was higher, compared to 3.01±0.44 points in a study of Spanish soldiers [33] and 3.11±0.41 points in a study of nursing students [34]. This relatively higher level of health literacy among the participants of this study may be attributed to military personnel’s relatively high accessibility to health information due to the structured health management system in the military organization, including regular health checkups, physical training, and health education. Regarding the subdomains of health literacy, the score of ‘health management’ was highest, and the score of ‘resource utilization’ was lowest. These results about the subdomains of health literacy are thought to be related to the following factors. Since the participants were mostly young people under 30 years of age, and a high proportion of them had an education level of university or higher, most of the participants did not have much difficulty understanding basic health information [35], but because most of them belonged to the combat branch and had a relatively short period of military service, they may not have had sufficient experience in searching for, evaluating, and utilizing information.

In this study, the average score for psychological well-being among the participants was 3.74±0.38 out of 5 points, which is higher than 3.58±0.33 points in a previous study on soldiers using the same tool [26] and 3.45±0.34 points in a study on clinical nurses [24]. This relatively higher level of psychological well-being in this study compared to the results of other studies may be attributed to the differences in the working environment and job characteristics of the participants. Among the subfactors of psychological well-being, ‘positive relation’ had the highest score, while ‘autonomy’ had the lowest score, and these results are consistent with a prior research [24]. These analysis results regarding the subfactors of psychological well-being are thought to reflect the ambivalent characteristics of the military in that while the hierarchical structure and collective nature of the military organization limit individuals’ autonomy, the communal living environment shared by peer soldiers can contribute to the formation of positive interpersonal relationships.

In this study, the average score for health promotion behavior was 1.44±0.20 out of 2 points, which corresponds to 36.21±5.06 out of 50 points when it was converted into a score on a 50-point scale. This score is relatively higher compared to 32.82±6.13 points in a study of middle-aged women using the same tool [32], and it is also higher than 32.82±6.13 points in a study of adults [36]. The relatively high level of health promotion behavior among military personnel is thought to be due to the influence of the structural environment of the military organization, such as regular daily rhythm, mandatory physical training, and periodic health management. However, these results may reflect an organization-centered lifestyle rather than individuals’ voluntary choices. Thus, when interpreting these results, it should be noted that they may not represent the actual level of self-directed health behaviors of individuals. Among the subfactors, ‘family∙friend’ had the highest score, and this finding suggests that social support is an important protective factor for soldiers’ performance of health behaviors. On the other hand, among the subfactors of health promotion behavior, ‘nutrition’ was found to have the lowest score, and these results may be attributed to the influence of structural constraints such as limited choices of meals as well as the military food service environment where it is difficult to reflect individual needs. These results are consistent with a previous study on soldiers in the Navy [37].

Regarding differences in the level of health promotion behaviors according to general characteristics, there were significant differences in health promotion behavior according to gender and marital status. Additionally, in this study, the level of health promotion behavior was higher among women than men, and these results are consistent with prior studies [38,39] showing that women are more active in practicing disease prevention and self-care. In particular, in the light of previous research [40] reporting that female soldiers showed a higher level of physical health and a higher level of physical activity, compared to general women, there is a need to develop customized programs that can enhance female soldiers’ self-care ability. However, some previous studies [41,42] reported that the level of health promotion behavior was higher among men than women, so further research is needed to more clearly elucidate gender differences. Furthermore, in this study, the married group showed a higher level of health promotion behavior than the unmarried group, and this finding is consistent with prior research [43] reporting that economic stability and family emotional support promote health behaviors. However, some research [44] reported conflicting results showing that the level of health promotion behavior was lower among married people than unmarried people. Therefore, to clearly understand the impact of marital status on health behaviors, further research should be conducted by considering various sociopsychological factors.

In this study, psychological well-being was identified as an influencing factor for health promotion behavior. In other words, psychological well-being showed a significant positive correlation with health promotion behavior, and it was found to have a significant influence on health promotion behavior. These results are consistent with a prior study [23]. Psychological well-being is related to positive psychological resources, such as life satisfaction, purpose in life, and optimism, and can promote healthy lifestyle habits and inhibit unhealthy behaviors such as smoking [45]. These findings suggest that not only health promotion education but also psychosocial interventions that can improve individuals’ psychological well-being should be implemented. If appropriate health management and support systems for soldiers are put in place, military service can provide positive experiences that can strengthen individuals’ physical and mental health. On the other hand, in this study, health literacy was found to have no significant effect on health promotion behavior, and this finding is in conflict with previous studies that reported health literacy as a major predictor for health promotion behavior [46,47]. Although health literacy showed a significant positive correlation with health promotion behavior, it did not have a significant impact on health promotion behavior. Regarding these results, it is presumed that as health literacy was entered together with other variables in regression analysis, its effects overlapped with those of others factors such as subjective health and psychological well-being, leading to the decrease of the independent effect of health literacy. In addition, the results about health literacy may be related to the military environment. To be more specific, since the participants were members of military organizations, and their environmental characteristics involve the situation where health behaviors are somewhat restricted by rules and systems, there is a possibility that behavioral changes may not have been easily induced through individuals’ health literacy alone. In other words, the lack of statistical significance of health literacy in this study does not necessarily mean that health literacy can be dismissed as an unimportant factor, and there is a possibility that its independent effect was not revealed in this study due to the influence of other factors or environmental constraints of the military. Therefore, in the military environment, to effectively promote health promotion behaviors, providing institutional and environmental support is also required in addition to improving health literacy. Accordingly, in future studies, to build a more realistic health behavior prediction model, interactions between specific subdomains of health literacy and military environmental factors should also be considered.

In summary, psychological well-being was found to be a major factor promoting health promotion behavior among military personnel, and the results of this study suggest that both individual psychological resources and organizational environments should be considered to understand soldiers’ health. The major significance of this study lies in the fact that it analyzed the relationships of health promotion behavior with various factors such as health literacy and psychological well-being among military personnel. However, this study has limitations in generalizing the results because the data were collected from the participants who were selected by the convenience sampling method from the frontline and rear-area divisions. Nevertheless, as this research comprehensively analyzed health problems and individual health resources that are found in the special working environment of military personnel, the results of this study have significance as basic data for the development of future health promotion programs and policy formulation for soldiers.

Conclusions

This study attempted to investigate the relationships between health literacy, psychological well-being, and health promotion behavior among military personnel, and to identify factors influencing health promotion behavior in order to provide basic data for health promotion in the military organization. The study results revealed that total military service period, subjective health, psychological well-being, gender, and education level were factors influencing health promotion behavior. Based on these findings, the following suggestions are made. First, this study analyzed the relationships between variables by constructing a hypothetical model based on previous studies rather than conducting analysis based on a specific theoretical model. As a result, this study has limitations in fully reflecting and interpreting the causal relationships presented by theories on health promotion and health literacy. Therefore, it is suggested that follow-up studies should construct a research model that reflects the characteristics of military personnel based on a theoretical framework, and more meticulously verify the causal relationships between variables. Second, because the study was conducted with a limited number of military personnel serving in frontline and rear-area divisions, there are limitations in generalizing the results to the entire population of military personnel. Therefore, in future research, it is required to use a larger sample size and conduct a replication study. Third, follow-up research is needed to develop a customized program for improving health promotion behavior among military personnel and verify the effectiveness of the program.

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