Regional heterogeneities of health literacy in China: a population-based study

Abstract Background: Few studies have described the geographic variation in health literacy in China. This study aimed to investigate the regional heterogeneities of health literacy levels in the Chinese population to formulate targeted health literacy promotion strategies in different economic and cultural contexts.Methods: Multi-stage stratification and cluster sampling were used to select 70 study sites from 25 provinces or municipalities in China in 2017. Health literacy was measured using the National Resident Health Literacy Monitoring Questionnaire. 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]=1.360; 95% confidence interval [CI]: 1.153-1.605), having a high education level (OR=1.860; 95% CI: 1.671-2.070), having a high economic status (OR=1.353; 95% CI: 1.220-1.502), having a good self-rated health status (OR=1.263; 95% CI: 1.081-1.476), and having extensive community health education (OR=1.192; 95% CI: 1.034-1.374) were independently associated with adequate health literacy.Conclusions: The health literacy level of Chinese people is still low, 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.