Health Literacy of High School Students in Indonesia: Prevalence and Gender Differences in Predictors

Background: Health literacy refers to the ability to find, understand, and apply health information to make informed health decisions. In Indonesia, students generally have low levels of health literacy. Research on student health literacy and its predictors is rarely conducted in Indonesia. This study aimed to investigate gender differences in the factors associated with the health literacy levels among high school students in Central Java, Indonesia. Methods: A school-based cross-sectional survey was conducted from January 2023 to May 2023. A total of 1285 tenth- and eleventh-grade students were randomly chosen from five state high schools located in the Central Java region, Indonesia. Data on health literacy were collected using the Short-Form Health Literacy Scale (HLS-SF12). A gender-stratified multivariable analysis was conducted to investigate gender differences in factors determining health literacy levels. Results: The majority of the respondents (44.75%) had problematic health literacy, while only 2.96% exhibited excellent health literacy. Factors associated with health literacy levels in students differed by gender. Health literacy levels in female students were determined by grades, family affluence scale, and academic score (OR=2.05, 95% CI:1.44-2.94). In male students, academic score was the only factor significantly associated with health literacy (OR=2.04, 95% CI: 1.29-3.23). Conclusion: Students’ academic ability plays a central role in determining health literacy levels in male and female students. Therefore, integrated efforts need to be undertaken in schools to increase the health literacy of high school students, especially targeting vulnerable groups such as adolescents with low academic performance, grades, and family affluence scale.