Drivers of Enrolment Intention towards Social Health Insurance among Informal Sector Workers in Tanzania: Moderating Role of Health Literacy

Abstract

The focus of the study is to examine the moderating role of health literacy on the determinants of enrolment intention towards social health insurance among informal sector workers in Tanzania. The study employed a positivist research philosophy, a deductive approach, and an explanatory research design. Using stratified and systematic random sampling techniques, a sample of 350 vendors from local markets across Dar es Salaam, Tanzania, was selected. Data were collected through a structured questionnaire and analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). The findings reveal that attitude, subjective norms, and perceived behavioural control significantly, and positively affect enrolment intention in social health insurance. Nonetheless, health literacy significantly moderates only the relationship between perceived behavioural control and enrolment intention. This study contributes to the literature by integrating the Theory of Planned Behaviour (TPB) with health literacy to assess enrolment intention in the context of social health insurance among informal sector workers in Tanzania. It is among the first studies in the region to explore the moderating role of health literacy in the effects of attitude, subjective norms, and perceived behavioural control on enrolment intention. The findings offer theoretical insights and practical implications for designing health insurance policies and literacy interventions targeted at underserved populations.