Health Literacy, lifestyles, and socio-economic factors in the Italian population: a national survey

Abstract Introduction Health literacy (HL) entails people's knowledge and abilities to find, understand and use health information to make health-related decisions. This study aims to evaluate HL association with lifestyles in the Italian adult population. Methods In 2021, in the framework of the Italian participation in the WHO network Measuring Population and Organizational Health Literacy M-POHL, a survey was conducted on a representative sample of the Italian population aged 18+ years (n = 3,500). A validated 47-item questionnaire was used to collect core HL information, plus 31 items for correlate information, including lifestyles. For each HL-item, a 4-point Likert scale was applied: very easy/easy/difficult/very difficult. The HL index (percentage of very easy/easy), was stratified in Inadequate (0%−50%), Problematic (51%−66%), Sufficient (67%−80%), Excellent (81%−100%). Inadequate/Problematic were merged into “Limiting”, Sufficient/Excellent in “Not limiting”. Multivariate logistic regression analysis was implemented to assess the association between dichotomous HL and obesity (BMI > =30 Kg/m2), physical activity-PA (intense (5-7 days a week)/not intense (0-4 days a week)), fruit and vegetable diet-FVD (daily/not daily), smoking habit (yes/no), adjusted by sex, age, region, education-ED, financial deprivation-FD. Results Prevalence of Limiting HL is 64.6%. In Limiting HL, obesity is significantly higher than in Not limiting HL (14.6% vs 12.0%), similarly not intense PA (82.3% vs 75.7%), not daily FVD (54.0% vs 47.7%), low ED (22.3% vs 18.0%), severe FD (20.8% vs 9.1%); the opposite for smokers (30.2% vs 34.7%). Significant association with Limiting HL was found for not intense PA (Odds Ratio-OR=1.48), not daily FVD (OR = 1.24), low ED (OR = 1.39), severe FD (OR = 3.33). Conclusions Results show that persons with not intense PA and those with not daily FVD need targeted support to improve HL, as well as those with a lower level of education and problematic financial situation. Key messages • This study aims to evaluate Health literacy association with lifestyles and socio-economic factors in the Italian adult population. • Intense physical activity and a regular fruit and vegetable diet lifestyles are associated with ‘Not limiting’ Health Literacy, as well as high educational level and low financial deprivation.