Health literacy and healthy lifestyle score by occupational status in the Italian adult population

Background

Health literacy (HL) refers to person ability to find, understand, judge, use health information to take health-related decisions. The study aims to assess the association between HL and healthy lifestyle score (HLS), stratified by occupational status (OS)

Methods

In 2021, the National Institute of Health, within the WHO M-POHL network, conducted a national survey on a representative sample of the Italian resident population aged≥18 years. A validated 47-item questionnaire was used to assess HL alongside 31 items on correlates, including lifestyles. A 4-point Likert scale was used to classify HL in inadequate, problematic, sufficient, excellent according to the very easy/easy responses prevalence and dichotomised into limiting HL-LHL (inadequate/problematic), not limiting HL-NLHL (sufficient/excellent). An HLS (range 0–5) was derived by assigning 0 to smoking, not intense physical activity, not daily fruit/vegetable intake, alcohol consumption, pre-obesity/obesity, 1 to the other categories and grouped in 0–1, 2–3, 4–5. Multivariate logistic regression analyses, stratified by OS (employed-E, not employed-NE), were performed, adjusting by sex, age, geographical area, education, financial deprivation-FD

Results

Prevalence of LHL was similar in NE and E (65.2% vs 65.7%). HLS category (0–1) was more frequent in LHL than in NLHL in both NE (15.5% vs 10.5%) and, with higher prevalence, in E (28.4% vs 24.4%). In stratified models (HLS 0–1 as ref.) HLS 4–5 was significantly associated with lower odds of LHL in both groups (OR = 0.62 in NE; 0.60 in E), HLS 2–3 was significant only in NE (OR = 0.67). Severe FD remained strongly associated with LHL in both groups (OR = 3.69 and 3.04, respectively)

Conclusions

Healthy lifestyles appeared to be more protective against LHL in NE participants, while FD remained strongly associated with LHL in both OS groups. These findings suggest different vulnerability profiles by occupational status, supporting targeted HL strategies.

Key messages

• A higher healthy lifestyle score was associated with lower odds of limiting health literacy, while financial deprivation remained strongly associated.

• A higher healthy lifestyle score resulted in a stronger protective association with limiting health literacy in not employed than in employed subjects.