Abstract: Objective To explore the relationship among health literacy (HL), self-efficacy, and quality of life (QoL) among disabled elders and their spouse caregivers. Methods Convenience sampling was adopted to selected 1,086 disabled elders and their spouse caregivers in 7 provinces in China from December 2020 to June 2022 to conduct the questionnaire survey. The survey tools included the Katz Activities of Daily Living (ADL) Scale, Health Literacy Scale for Chronic Patients, General Self-Efficacy Scale, and Short Form-36 Health Survey. The relationship among HL, self-efficacy, and QoL of disabled elders and their spouse caregivers were analyzed by the Actor-Partner Interdependence Model（APIM）. Results The median for HL, self-efficacy, and QoL of disabled elders and their spouse caregivers was 79.00, 20.00, 378.33, 85.00, 20.00, and 548.11 respectively. In terms of actor-effect, the HL and self-efficacy of disabled elders and their spouse caregivers had significant effects on their own QoL (β=0.389, β=0.267, β=0.340, β=0.222, all P<0.05). In terms of partner effect, the HL of disabled elders had a significant effect on the QoL of the spouse caregivers (β=0.138, P<0.001), while the HL of the spouse caregivers had no significant effect on QoL of the disabled elders (β=0.050, P=0.078). Self-efficacy of disabled elders and their spouse caregivers had significant effects on QoL (β=0.034, P=0.259; β=0.032, P=0.276). Conclusion The QoL of disabled elders and their spouse caregivers was affected by their own HL and self-efficacy, and the HL of disabled elders had a certain interaction with the QoL of their partners. To improve their QoL, disabled elders and their spouse caregivers should be viewed as a unit, and "bundling" health empowerment strategies to strengthen HL and self-efficacy should be implemented to improve their QoL.

Key words: disabled elder, spouse caregiver, health literacy, self-efficacy, quality of life, actor-partner interdependence model