Abstract:

Introduction:
Health literacy includes various skills, namely reading, numeracy, critical thinking, and communication, all of which are essential for making informed choices. In higher education settings, students face novel roles as they are entering adulthood were critically thinking regarding health will impact their future. The aim of this study was to assess health literacy levels in higher education students and its determinants.

Methods:
A quantitative, observational, and cross-sectional study was conducted using an online questionnaire available between December 2020 and April 2021, dissemination was conducted by the Portuguese Academic Health Literacy Network in 5 higher education institutions of the North of Portugal. The short version of European Health Literacy Survey (HLS-EU-PT16) was used, the questionnaire is divided into 3 domains healthcare, disease prevention, and health promotion. The literacy is classified into four levels: insufficient, problematic, sufficient, and excellent. In addition, data on gender, age, scientific area of the enrolled course and reported health status was obtained. Pearson’s Chi-square tests were applied to assess the association between literacy levels and students’ characteristics.

Results:
A sample of 1,173 students were assessed, of those 892 (76%) were female, the mean age was 24.3 with a standard deviation of 8.4 years. Regarding the gender and global level of literacy no association was founded (p-value 0.336) with more than 40% with insufficient or problematic literacy levels in both genders. Similar results were founded in the three domains with no association with gender identified in healthcare, disease prevention and health promotion (p-values 0.262, 0.895 and 0.611, respectively). A little more than half of the students, 602 (51.3%) were enrolled in courses related to health, regarding this characteristic a statistically significant association was identified with the global literacy level (p-value <0.001) with about 60% of students enrolled in health courses presenting a sufficient or excellent level versus about 55% in students enrolled in other courses. About 23% (249) of the students reported a reasonable health status, and 76.5% (897) of the students reported a good or very good health status, a statistically significant association with the global level of health literacy was observed (p-value <0.001) with the students that report a better health status presenting higher levels of health literacy (around 40%, 52%, 57% and 68% of sufficient or excellent levels of literacy reported in the bad, reasonable, good and very good reported health status groups).

Discussion:
No association was identified between global health literacy and gender different from the association identified with reported health status. Students enrolled in courses related to health presented higher levels of literacy as expected. However, about half of this students still presented an insufficient or problematic health literacy level. It is crucial that both education and health agents take immediate measures to improve these results. As higher education students transition into active professional lives and assume roles as future leaders and healthcare professionals, their health literacy will help them advocate and shape a healthier society.

Keywords:

Health literacy, higher education students.