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

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/m(2)), 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.