Socioeconomic Gradients and Mechanisms of Chronic Disease Health Literacy: The Mediating Role of Preventive Healthcare Utilization in Rural China

Purpose: To explore the social determinants and underlying mechanisms of health literacy in managing chronic diseases, and analyze how socioeconomic status (SES) influences it. Method: This study, based on Shandong Province’s 2022 Health Literacy Surveillance Database, selected 2,826 residents from eligible areas using multistage stratified cluster random sampling. It explored the social determinants of chronic disease health literacy using multiple linear regression, multiple logistic regression, interactive analysis and mediation analysis. Results: Higher SES (OR=1.207, 95%CI: 1.018–1.432, P=0.03), marriage (OR=1.309, 95%CI: 1.050–1.632, P=0.017), higher education (OR=1.269, 95%CI: 1.125–1.432, P<0.001) are significantly correlated with chronic disease. It is worth noting that although having chronic disease SES was generally associated with lower chronic disease health literacy (OR=0.546, 95%CI: 0.341–0.874, P=0.012), patients with hypertension, coronary heart disease, or diabetes showed higher health literacy. The preventive healthcare services (95% CI: 0.016-0.041, P<0.001), changes in health behavior (10.0%, 95% CI: 0.002-0.020, P<0.001) and frequency of examinations (8.6%, 95% CI: 0.004-0.015, P<0.001) significantly mediated the relationship between SES and chronic disease health literacy.Subgroup analysis shows that in the low SES group, women (OR=0.60,95% CI: 0.50-0.75, P<0.001) and elders (OR=0.70,95% CI: 0.42-0.91, P=0.001) have significantly lower chronic disease health literacy than men and young participants. Conclusion: This study systematically uncovers the multidimensional mechanisms by which SES impacts chronic disease health literacy and provides a scientific basis for developing targeted interventions.