Research on influencing factors and improvement paths of rational medication literacy among college students: a cross-sectional survey in Zhejiang province

Introduction: Rational medication use is a critical component of public health and healthcare quality. However, college students, as a key transitional population in health behavior development, exhibit varying levels of medication literacy that remain underexplored. This study aims to investigate the level of rational medication literacy and health education acceptance among college students in Zhejiang Province, analyze the influencing factors and associative paths of medication literacy, and formulate targeted strategies to enhance rational medication literacy. Methods: A stratified convenience sampling method was used to select six representative universities in Zhejiang Province. A total of 1,500 students were surveyed, and 1,436 valid questionnaires were collected (95.73%). Non-parametric tests were employed for descriptive statistics. Univariate analysis and binary logistic regression identified influencing factors. Structural equation modeling was applied to explore the pathways between these factors and medication literacy. Results: The mean medication literacy score of the surveyed college students was 11.32 ± 4.75, with 796 participants (55.43%) achieving high-level literacy (score ≥ 13). Among the four dimensions of medication literacy, the non-prescription drug dimension received the highest mean score (3.65 ± 1.73); the drug advertisement dimension had the lowest (1.63 ± 1.04). The total effect sizes of variables on medication literacy were ranked by absolute value from largest to smallest as follows: long-term medication use (0.162), gender (0.160), social support (0.158), mother's educational level (-0.104), university attended (0.100), course selection (-0.095), academic workload (0.081), part-time work experience (0.073), monthly living expenses (0.026), major type (0.012). All six surveyed universities offered rational medication courses, but overall enrollment rates remained low. College students primarily obtained medical knowledge through internet media platforms (56.69%), followed by medical staff at campus clinics (48.96%). Discussion: The level of rational medication literacy among college students in Zhejiang Province requires further improvement. A multi-level health education network for rational medication use should be established, integrating self-directed learning, institutional promotion, and government guidance, with the goal of institutionalizing the cultivation of safe and rational medication awareness and enhancing students' health literacy, particularly in the domain of medication literacy.