# Status and influencing factors of dual health literacy in modern medicine and traditional Chinese medicine among Chinese residents

## TL;DR

This study examines how Chinese residents understand both modern medicine and traditional Chinese medicine, finding that urban and educated individuals have higher health literacy, while rural and less educated groups need more support.

## Contribution

The study introduces a dual health literacy framework combining modern medicine and TCM, identifying key factors influencing integrated health literacy.

## Key findings

- Only 6.8% of participants achieved standard dual health literacy (DHL), with rural areas performing significantly worse than urban areas.
- Higher education and health insurance coverage were strongly associated with better health literacy in both modern medicine and TCM.
- Health skills and chronic disease prevention were among the lowest areas of health literacy attainment.

## Abstract

Dual Health Literacy (DHL), integrating modern and traditional Chinese medicine (TCM), is crucial for health management in China. However, many struggle with both systems, causing fragmented decisions and poor outcomes. Most studies address only one system, overlooking their interplay. This study bridges the gap by assessing DHL and its key influencing factors to support integrated healthcare.

Based on standardized 2017 questionnaires, this survey assessed health literacy based on modern medicine (HL) and traditional Chinese medicine (TCM-HL) among Chinese residents aged 15 to 69, using sampling via an online Sojump questionnaire. Group differences were assessed using the Mann–Whitney and Kruskal-Wallis test for continuous variables, and the chi-square test for categorical variables. Multivariate logistic regression was employed to identify factors associated with HL, TCM-HL, and DHL.

A total of 605 participants (median age: 23.0 years, IQR: 20–45) were surveyed, with the majority being female (69.4%), rural residents (59.8%), or holding junior college or undergraduate education (68.4%). Standard attainment rates were 27.1% for HL, 10.9% for TCM-HL, and 6.8% for DHL, with a strong correlation between HL and TCM-HL (r = 0.81). The lowest attainment was observed in basic medical literacy (13.2%), health skills (15.0%), chronic disease prevention & control (16%) within HL, and healthy lifestyle (0%) and appropriate methods of public health within TCM-HL (3.5%). DHL was higher in suburban and urban areas than in rural areas (13.3 and 9.4% vs. 4.7%; χ2 = 6.453, p = 0.04). Urban residence (AOR = 1.60, 95% CI: 1.09–2.34, p = 0.016), higher education level (AOR = 1.64, 95% CI: 1.22–2.21, p = 0.001) and health insurance coverage (AOR = 2.74, 95% CI: 1.12–6.68, p = 0.027) were significantly associated with higher HL attainment. Higher education level (AOR = 1.78, 95% CI: 1.33–2.37, p < 0.001) was significantly associated with TCM-HL attainment.

Given the strong correlation between HL and TCM-HL, promoting the integrated concept of DHL is essential. The low DHL level underscores the need for targeted support, particularly for rural, less educated and uninsured residents. Efforts should enhance both modern and TCM health strategies, emphasizing health skills, chronic disease prevention and basic medical literacy in HL and healthy lifestyle and appropriate public health approaches in TCM-HL.