Health literacy among university students and their families in the Republic of San Marino: association with socioeconomic and health status determinants

Over the last decade Health Literacy (HL) has become a vibrant area of research. Low HL has been associated with poorer health status, greater inequalities and higher health system costs. This study examined functional, interactive and critical HL among university students and their families within the context of the Republic of San Marino. This study aimed to: (1) adapt the HL-EU-Q47 instrument; (2) estimate the prevalence of inadequate or problematic HL and analyze its associations with socioeconomic and health status variables; and (3) identify HL-related risk factors using a logistic regression model and odds ratios. HL was measured through a questionnaire with 47 items that fall into four information management dimensions, namely: obtain information, understand, evaluate, and apply it. It was also linked to each of the three health domains, namely: health care, disease prevention and health promotion. The items of the survey measuring HL skills were formulated as direct questions, using a Likert scale. The instrument was administered by the Paper Assisted Personal Interview (PAPI) method. The first results considered the percentages of inadequate or problematic HL, according to different categories of sociodemographic and health status variables. Significant differences were also found in the means of Standardized Literacy Index (SLI). These results confirmed the presence of a social gradient influencing HL levels, highlighting how sociodemographic and health status variables shape HL outcomes. Inadequate or problematic HL was significantly associated with factors including advanced age, low income, limited educational attainment, poor self-perceived health, and limitations in activities of daily living. These findings are consistent with previous literature, confirming a significant relationship between limited HL and factors such as older age, low education, lower income, low perceived health status and activity limitations, among others. These results are also consistent with those of HLS-EU Survey.