Social determinants of health literacy among adults in Gonabad, Iran: a cross-sectional study

Abstract Background Health literacy (HL) is an important factor associated with health outcomes and health equity. The relationship between social determinants and HL remains underexplored in Gonabad County, Iran. Therefore, this study aimed to describe HL levels and examine associated social determinants among adults registered at three participating urban–rural Comprehensive Health Service Centers in Gonabad County, Iran. Methods We conducted a cross-sectional study among 496 individuals aged 18 years or older who were registered at three urban–rural Comprehensive Health Service Centers in Gonabad County, Iran, in 2022–2023. Participants were selected using stratified random sampling and completed the Health Literacy Instrument for Adults (HELIA) and a sociodemographic questionnaire. Linear regression was used to examine associations between sociodemographic and socioeconomic factors and HL. Results The mean age of participants was 35.48 years (SD = 12.60), and 58.9% were women. The mean HL score was 70.87 (SD = 16.89), and 35.3% of participants had limited HL. Female gender and higher educational level were independently associated with higher HL scores, whereas low current socioeconomic status (SES), older age, and homemaker status were independently associated with lower HL scores. Conclusions Limited HL was common and varied across sociodemographic and socioeconomic groups in the registered study population. Primary healthcare services should prioritize clear and accessible communication tailored to older, less-educated, and socioeconomically disadvantaged adults. Future studies should examine additional digital and healthcare-system factors and evaluate whether targeted interventions improve HL and reduce inequities.