Health literacy among undergraduate students in Tianjin, China: A cross-sectional study

Abstract

This study aimed to assess the health literacy levels of undergraduate students, analyze its component structure, and compare gender differences among students in Tianjin, China. A cross-sectional survey was conducted with 405 students from Tianjin universities, using stratified multistage sampling. Health literacy was measured through a validated multidimensional instrument covering five domains: reading, access to information, understanding, appraisal, and decision-making/behavioral intention. Data analysis involved descriptive statistics, Pearson correlations, confirmatory factor analysis, and an independent-samples t-test. Results indicated that Tianjin undergraduates had a moderate overall health literacy level. Among the domains, understanding and appraisal were relatively stronger, while reading was weaker; all domains showed positive intercorrelations. Confirmatory factor analysis demonstrated a good model fit with significant factor loadings, supporting a coherent five-domain structure. No statistically significant gender differences were observed in overall health literacy. These findings suggest that higher education should emphasize strengthening support for functional reading and information navigation, integrating comprehension-to-decision activities into health education, and ensuring students can access reliable digital and offline health information through coordinated campus initiatives.