Health literacy and health promotion practices among clinical medicine students in Sichuan, China: a cross-sectional study

Background Translating health literacy (HL) into personal health promotion practices (HPP) is a skill needed in future physicians, but even in clinical medicine students there is still a knowledge-behavioral gap. This gap is not investigated in regions with a high socio-demographic diversity under the initiative Healthy China 2030. Objective In this study we assessed the level of HL and HPP, study their association, and study the moderating role of socio-demographic factors and perceived challenges among clinical medicine undergraduates from Sichuan. Methods In this study we recruited 1,421students from 5 public universities by stratified random sampling. We used validated scales to measure HL (Cronbach’s α=0.86), HPP (HPLP-II, Cronbach’s α=0.94) and perceived challenges. We used descriptive statistics, non-parametric tests and Pearson correlation. Results Participants exhibited uniformly high HL (composite mean=4.58/5). HPP scores were also generally elevated but uneven across domains, life appreciation ranked highest (mean=4.91), whereas structured vigorous exercise was notably lower (mean=3.84). Very positive correlation between HL and HPP ( r =0.894, p <0.001), and negatively related to perceived challenges. Gender, year of study and family income moderated some HPP domains. The most interesting result was that rural students reported significantly lower HL challenges ( p =0.007) and better health responsibility and exercise practices than urban students. Conclusion Clinical medicine students possess high health literacy, but translation in practice is inequitable and moderated by socio-demographic factors. Contrary to common deficits, rural students showed resilience, better health practices, and less likely to face challenges. These results call for equity-based medical education reforms that bridge knowledge-behaviour gap and create physician role models in line with the “Healthy China 2030” goal.