Chinese Students' Health Literacy Level and Its Associated Factors: A Meta-Analysis

Health Literacy (HL) is an important determinant of health. Many scholars have conducted a large number of studies on the level of Chinese students' HL and its associated factors. However, previous studies on HL level and the factors that influence it have been contradictory. Therefore, this systematic review and meta-analysis was conducted to estimate the level of Chinese students' HL and its three dimensions (knowledge, behavior and skills) and to identify factors associated with HL in Chinese students. Two investigators independently searched literature, selected research and extracted data through comprehensively searching of four international electronic databases and three Chinese electronic database to identify all relevant observational studies on affecting factors for HL in Chinese students published in English and Chinese from database January, 2010 to September, 2020. In total, 61 articles were extracted in the study. The results showed that the level rates of HL and its three dimensions were 26%, 35%, 26%, 51%, respectively. For Chinese students, the significant factors were urban residents, senior class students, well performance at school, the Han nationality, focus on health knowledge, less exposure to video games, highly educated parents, income of one-child families, receiving health education, having medical background. This study provides some inspirations for improving the level of Chinese students' HL and their health. First, the findings may help Chinese policy makers understand the overall HL of Chinese students and their levels across three dimensions (knowledge, behavior and skills). Second, protective factors for Chinese students' HL were found in this research, which will help to improve the level of Chinese students' HL, stimulate students' awareness of prevention, and lay the foundation for a healthy China.