To explore the health literacy about infection disease prevention and treatment in residents of Taizhou, Zhejiang during 2017—2020, and to analyze the trend of changes as well as influencing factors, providing scientific evidence for the precise implementation of actions for achieving "Healthy Taizhou 2030".

This study was implemented from 2017 to 2020 with Taizhou permanent residents aged between 15 and 69 selected using multistage random sampling, for investigating their demographics, socioeconomic features and health literacy about infection disease prevention and treatment using the National Residents' Health Literacy Monitoring Questionnaire developed by us. In January 2021, the data of health literacy about infection disease prevention and treatment of residents in Taizhou City in four years was analyzed. The health literacy data during 2017—2020 were comparatively analyzed after being processed with weight standardization, and the trend of changes during the period was analyzed using a Chi-squared test for linear trend. Binary logistic regression was used for identifying factors associated with relevant health literacy of these residents in 2020.

The number of respondents for the survey conducted in four consecutive years from 2017 to 2020, was 3 595, 5 389, 5 929, and 5 847, respectively. The samples in the four yearly surveys showed basically similar demographics, with those aged 45-54 (27.42%-30.46%) , education level was junior high school (27.78%-29.93%) , occupation was farmer (44.52%-58.03%) accounting for the largest proportion. The urban to rural population ratio for the sample of four consecutive yearly surveys was 0.50∶1, 0.55∶1, 0.54∶1 and 0.52∶1, respectively. And the male to female ratio was 1∶1, 0.95∶1, 0.99∶1 and 0.94∶1, respectively. The prevalence of having health literacy about infection disease prevention and treatment for 2017—2020 was 7.86% (642/3 595) , 19.00% (1 024/5 389) , 19.51% (1 157/5 929) , and 27.14% (1 587/5 847) , respectively. After the data were processed with weight standardization, the prevalence of health literacy regarding infectious disease prevention and treatment in 15-69-year-old residents in 2017—2020 was 22.25%, 24.72%, 25.34% and 33.14%, respectively. The health literary level regarding infectious disease prevention and treatment in the residents showed a successive linear increment during the study period regardless of living in rural or urban areas, sex, age (except for 65-69 year olds) , and education level (except for illiteracy/lower illiteracy) , and occupation (P<0.05) . Multivariate Logistic regression analysis showed that gender, age, education level, out-of-pocket health care costs in the past year, and annual household income were associated with health literacy regarding infectious disease prevention and treatment (P<0.05) .

Our analysis indicates that some advances in prevention and control as well as health education regarding infectious diseases have been achieved in Taizhou, but there is still much room for improvement. In the "golden window" period for normalized prevention and control of COVID-19, it is suggested that Taizhou should strengthen health education regarding infectious disease prevention and treatment for key groups, such as those who are middle-aged and elderly, lower educated, or engage in a career as a farmer or worker, to further improve relevant heath literacy of Taizhou residents.