Health literacy by migration region and gender: association with healthcare perception among students

Abstract Background Numerous studies have assessed health literacy (HL) among university students; however, gaps remain in HL comparison across regions of migration among international students. While gender differences in HL are recognized, they are not well understood. This study aims to examine region of migration and gender differences in health literacy among international students and its association with healthcare perception. Methods Leveraging data from the Japan International Migrant Population and Comparative Health Study (J-IMPACT Study), a total of 500 international students who self-identified as male or female and completed the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47) participated. Regions of migration were categorized into nine groups based on participants’ countries of origin. Healthcare perception was self-reported and classified as effective or ineffective. Descriptive statistics, t-tests, ANOVA, and multiple regression analyses were performed using JMP 17.2.0 as appropriate. Results Male international students in Japan had higher HL than female international students (p < 0.0003). After adjusting for potential covariates, this difference remained robust (β = 2.87, SE = 0.72, 95% CI = 1.45 - 4.29, p < 0.0001). Region of migration was associated with HL (p < 0.002), with international students from East Asia displaying the lowest and those from North America the highest HL. After adjusting for potential confounders, students from North America, Southeast Asia, and Europe exhibited a notable increase in HL, with percentage point rises of 5.6, 4.3, and 2.5, respectively, compared to their counterparts from the East Asia region. Furthermore, sufficient HL was associated with effective healthcare perception (odds ratio [95% CI]: 1.68 [1.02-2.77], p = 0.03). Conclusions HL was associated with both gender and region of migration among international university students in Japan. Improved HL was associated with reported healthcare effectiveness. Key messages • HL was associated with both gender and region of migration among international university students in Japan. • Improved HL was associated with reported healthcare effectiveness.