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 in health literacy levels in the Chinese population, in order to formulate targeted health literacy promotion strategies in different economic and cultural contexts.Methods: Multi-stage stratification, clustering, and random sampling methods 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. 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 total and regional samples.Results: A total of 3,482 participants were included in the study, including 1,792 (51.5%) males and 1,690 (48.5%) females. Notable geographic variation was observed in the health literacy level. 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 or 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 higher education level (OR=1.860, 95% CI: 1.671-2.070), having a better economic status (OR=1.353, 95% CI: 1.220-1.502), having a better self-rated health status (OR=1.263, 95% CI: 1.081-1.476), and having more 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. The methods used to improve the health literacy levels of people in different regions should be adapted to local conditions. In the central and eastern regions, low-income people are the focus of health literacy improvement efforts. Special emphasis should be placed on the degree of health knowledge publicity and the accessibility of health knowledge and skills in the central and western regions.