Health literacy model integrating health education, health behaviors, self-rated health, and socioeconomic status in the Chinese population

Health literacy is crucial for influencing health behaviors and outcomes; however, its development in China has been hindered by the lack of effective measurement tools and conceptual models. This study aimed to evaluate health literacy among Chinese residents using the HLS₁₉-Q47 and construct a health literacy model. A cross-sectional survey was conducted in Guangzhou from February to June 2023 involving 4047 participants. Data were collected on demographics, health literacy, education, socioeconomic status, health behaviors, and self-rated health. Descriptive statistics, logistic regression, and structural equation modeling were used to analyze associations and construct an empirical model. Results showed that only 23.7% of participants had sufficient health literacy. Age, education, and socioeconomic status significantly influence health literacy. Higher health literacy and participation in health education were associated with a lower likelihood of smoking, higher levels of physical activity, and more regular health checkups, but were not significantly associated with alcohol consumption. The findings underscore the applicability of HLS₁₉-Q47 in China and the importance of targeted health education and socioeconomic support in improving health literacy and promoting positive health behaviors. The study establishes an empirical model of health literacy, providing a foundation for interventions to enhance public health in China.