Health literacy in five districts in Sri Lanka: a baseline assessment of health literacy levels among 18-49-year-olds and associated factors

Abstract

Background: Despite Sri Lanka’s high general literacy rate, disparities persist in health literacy (HL), which is a critical determinant of healthcare outcomes. This study assessed HL levels among adults aged 18–49 years in five districts and identified the associated sociodemographic and behavioral factors. Methods: A cross-sectional study was conducted (October 2022 - March 2023) via multistage cluster sampling across five districts (Colombo, Hambantota, Kurunegala, Monaragala, and Mullaitivu). Participants (n = 532) were recruited. The validated HLS-EU-Q16 (European Health Literacy Survey- 16-item version) tool was used, and HL was categorized as “limited” (0–12) or “sufficient” (13–16). Multivariable logistic regression was used to analyze the predictors of limited HL. The analysis was conducted via SPSS software (version 23.0). Results: Overall, 84.6% of the participants demonstrated sufficient HL, whereas 15.4% had limited HL. Regular interaction with public health midwives, the use of television or the internet for health information, and the absence of language barriers significantly reduced the odds of limited HL. Socioeconomic disparities were evident, with 27% lacking access to health information and 17% reporting language-related comprehension challenges. Conclusion: While Sri Lanka’s primary healthcare infrastructure supports relatively high HL, systemic gaps persist, particularly among linguistically diverse and socioeconomically disadvantaged groups in Sri Lanka. Prioritizing multilingual health communication, digital platforms, and community-based education through frontline health workers can help bridge these gaps. Integrating critical HL competencies into national education and health policies is vital to address the disconnect between general literacy and health empowerment.