Health literacy among residents in communities implementing healthy community initiatives: a cross-sectional study

To examine the association between healthy community construction and residents' health literacy and to provide evidence for optimizing health promotion strategies.

A cross-sectional study was conducted using a multi-stage random sampling method. A total of 263 residents from two health-promoting communities in Xiaoshan District, Hangzhou, were surveyed, and the data were statistically analyzed.

The overall health literacy rate among residents was 65.78%, which was significantly higher than the reported local level in 2024 (53.18%) (p < 0.05). Higher literacy levels were observed in several dimensions, including healthy lifestyles and behaviors, basic health skills, health information, communicable disease prevention, and chronic disease prevention, compared with district-level reference data (p < 0.05). However, no significant improvement was found in basic knowledge and concepts (p > 0.05), and a decline was noted in literacy related to safety and first aid, scientific health concepts, and basic medical care. Logistic regression analysis indicated that being married (OR = 9.327), having chronic diseases (OR = 7.368), and preferring a meat-based diet (OR = 3.009) were positively associated with higher health literacy, whereas older age (OR = 0.321) and poorer self-rated health status (OR = 0.213) were negatively associated (p < 0.05).

Residents from communities implementing Healthy Community initiatives showed relatively high levels of health literacy compared with district-level reference data. However, development across different dimensions remains uneven. Health education in areas such as scientific health concepts, safety and first aid, and basic medical care should be further strengthened. In addition, targeted interventions for older adults and other key populations are needed to promote sustained improvements in overall health literacy.