Objective: The purpose of this study was to evaluate the relationship between health literacy, self-care agency, social support and health status among elderly Chinese nursing home residents in Xinjiang. Design: Participants were selected using a stratified cluster random sampling design. Setting: The study was conducted from September 2011 to June 2012 in 44 nursing homes in four cities of Xinjiang, China. Methods: A total of 1,452 participants aged between 60 and 99 years met the study inclusion criteria. Data were collected using the Chinese Citizen Health Literacy Questionnaire, the Exercise of Self-Care Agency Scale, the Social Support Rating Scale, the Short Form 36 Health Survey Questionnaire and the Activities of Daily Living Scale. Subsequently, 1,452 questionnaires were distributed with a response rate of 96.14% (1,396 of 1,452). Results: Path analysis with structural equation modelling was used to test a hypothesised model linking health literacy to self-care agency, social support and health status. The optimal fitted model indicated that pathways linking health literacy to health status consisted of one direct path (path coefficient = 0.074) and three indirect paths (path coefficient = 0.194), with a total path coefficient of health literacy to health status being 0.268. Conclusion: Improving health literacy may enable older adults to more appropriately use self-care agency and social support as part of health promotion. The outcomes of this study suggest that to enhance the effects of health promotion interventions, health professionals should aim at raising the health literacy levels of elderly people in China.