Abstract
BACKGROUND: Parenting health literacy is essential for effective caregiving, yet its impact on nurturing care ability remains insufficiently studied. This study aimed to investigate the association between parenting health literacy and nurturing care ability, with a focus on the mediating role of parenting stress. METHODS: A cross-sectional survey was conducted among 3623 caregivers of children aged 0-6 years in Yiwu, Zhejiang Province, China. Standardised instruments were used to assess parenting health literacy, parenting stress and nurturing care ability. Mediation analysis quantified the contribution of parenting stress to the association between health literacy and nurturing care ability, and domain-specific mediation effects were examined. RESULTS: Higher parenting health literacy was significantly associated with lower parenting stress (β=-0.12, p<0.001) and greater nurturing care ability (β=0.10, p<0.001). Parenting stress mediated 33.68% of the association between parenting health literacy and nurturing care ability. Domain-specific analyses revealed stronger mediation for parenting style (42.31%), play experience ability (37.81%) and responsive care (37.26%) compared with other domains. CONCLUSIONS: Parenting health literacy improves nurturing care ability both directly and indirectly by reducing parenting stress, with particularly pronounced effects in emotionally demanding domains. Interventions to enhance parenting outcomes should integrate health literacy promotion with stress management strategies.