Health Literacy and the Influencing Factors: A Study in Five Provinces of Iran


Ali-Akbar Haghdoost 1 , Mohammed Amir Amirkhani 1 , Arash Tehrani 1 , * , Seyed-Moayed Alavian 1 , Homa Asgharifard 1 , Saeid Parsinia 1 , Mozhgan Barghamdi 1 , Hamid Baradaran 1 , Sahar Fathi Ranjbar 1


1 Iran


Strides in Development of Medical Education: 4 (1); e58326
Published Online: July 28, 2007
Article Type: Research Article
Received: July 19, 2017
Accepted: February 13, 2007




Background & Objective: Health literacy is defined as the degree to which individuals have the
capacity to obtain, process, and understand basic health information and services required for
making appropriate health decisions. The aim of this study was to estimate the level of health
literacy and to determine the factors influencing it using valid instrument.
Methods: In a Population-based household survey in 5 cities and 5 villages of Boushehr,
Mazandaran, Kermanshah, Ghazvin and Tehran provinces, 1086 adults aged 18 and older were
enrolled into the study. Health literacy was measured by the questionnaire designed for test of
Functional Health Literacy in Adults (TOFHLA) after validation. Regression analysis was used to
determine the association of demographic factors and level of health literacy.
Results: The average response rate was 70.8% in the studied clusters. From all participants, 61.4%
were female and the rest were male. Mean age of participants was 38.1 years. Seventeen percent of
the study population was illiterate and 36% had diploma or higher education. The level of health
literacy was adequate in 28.1%, borderline in 15.3% and inadequate in 56.5% of the subjects.
Mean score of health literacy was 45.3 in males and 41.1 in females (P=0.057). However, after
adjustment for educational level in the regression model, health literacy was found to be higher in
females (P=0.14). Limited health literacy was also associated with lower economic status
Conclusion: This study indicates that the level of health literacy is low in Iran. Educational level
was the most important determinant of health literacy and the most increase was seen in subjects
with more than 8 years education. Lower health literacy in women, older people and rural
inhabitants was mainly due to lower educational levels in these groups.


Health literacy survey influencing factors

© 2008, Strides in Development of Medical Education. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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