Abstract
Background: Health literacy is essential to population health, yet few studies have described the geographic variation in health literacy in China. This study aimed to investigate the level of health literacy, its regional heterogeneities, as well as influencing factors of health literacy in 25 provinces or municipalities in China.Methods: The study was conducted among residents aged 15–69 years from 25 provinces or municipalities in China in 2017. Health literacy was measured using the Chinese Health Literacy Scale. MapInfo software was used to map the geographic distribution. Multiple logistic regression was used to adjust for the factors associated with the health literacy level in the overall and regional samples.Results: A total of 3,482 participants were included in the study, comprising 1,792 (51.5%) males and 1,690 (48.5%) females. Notable geographic variation was observed in health literacy levels. The proportion of respondents with adequate health literacy was 22.3% overall, 33.0% in the eastern region, 23.1% in the central region, and 17.6% in the western region. The proportion of adequate health literacy in the different provinces and municipalities ranged from 10.5% (Xinjiang) to 47.0% (Beijing). Being a female [odds ratio (OR) = 1.353; 95% confidence interval (CI): 1.146–1.597], having a high education level [OR ranging from 2.794 (CI: 1.469–5.314) to 9.458 (CI: 5.251–17.036)], having a high economic status [OR ranging from 1.537 (CI: 1.248–1.891) to 1.850 (CI: 1.498–2.284)], having a good self-rated health status [OR ranging from 2.793 (CI: 1.534–5.083) to 3.003 (CI: 1.672–5.395)], and having frequent community health education (OR = 1.588; 95% CI: 1.066–2.365) were independently associated with adequate health literacy.Conclusions: The health literacy level in the 25 provinces or municipalities of China is relatively low compared to the developed countries, and there are heterogeneities among different regions, between urban and rural areas, and among different social groups. Tailored health education and promotion strategies are needed for different subgroups of residents.
Highlights
Health literacy refers to the ability of individuals to acquire and understand basic health information and services and to use them to make informed decisions to maintain and promote their health [1]
Based on the hierarchical administrative system and 2010 Chinese Census data [16], sampling was undertaken across the following five stages: (a) 2–3 counties were randomly selected in each province according to regional and population factors, (b) one street was randomly selected within each county, (c) one community was randomly selected within each street, (d) 40–50 households were randomly selected from each community according to the community’s resident roster, and (e) one eligible respondent was randomly selected from each selected household
A majority (60.6%) of the respondents had not participated in community health education within the past 3 years
Summary
Health literacy refers to the ability of individuals to acquire and understand basic health information and services and to use them to make informed decisions to maintain and promote their health [1]. Many studies with various methodologies have shown that deficiencies in health literacy are related to poor life expectancy and quality of life, poor healthcare utilization and health outcomes (relatively high mortality rates and poor overall health status), and health disparities [4,5,6,7]. People with limited health literacy may not properly understand health information from health practitioners or the media, and cannot effectively utilize healthcare [9]; these deficiencies may be associated with reduced life expectancy and increased health care costs [9]. Governments and national agencies in the USA, China, Australia, and some European countries have developed national strategies and targets to improve health literacy in their populations [11]. This study aimed to investigate the level of health literacy, its regional heterogeneities, as well as influencing factors of health literacy in 25 provinces or municipalities in China
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
