The changing disease spectrum of Chinese residents poses great challenges to the healthcare delivery. Understanding patients' health literacy and influencing factors is helpful to improve doctor-patient communication, promote patients' health and alleviate the pressure of healthcare delivery. However, the number of studies on patients' health literacy is insufficient, and most of them focus on those with a special illness.

To understand the status of health literacy and its influencing factors among Chinese outpatients, providing a scientific basis for improving patients' health status and self-management ability, and for medical workers to perform patient education and instruction, disease management and relevant improvement.

A systematic sampling method was used to select 14 secondary or tertiary general hospitals in eight regions in eastern, central and western China as survey settings, and outpatients (≥15 years old) of them during January to May 2021 were randomly selected and surveyed using the Patient Health Literacy Scale (PHLS) 〔those with scores <41 were deemed unlikely to have health literacy; those with scores ≥55 were judged as having high level of health literacy; those with scores between 41 and 54 were regarded as having moderate level of health literacy〕. The health literacy level of outpatients was compared by various personal factors. Ordinal and multinomial Logistic regression analyses were used to analyze the influencing factors of health literacy.

Altogether, 2 808 cases who handed in responsive questionnaires were included for final analysis. The average score of PHLS in the respondents was (43.38±6.25) . The prevalence of health literacy, and high level of health literacy was 68.38% (1 920/2 808) , and 6.93% (133/2 808) , respectively. The level of health literacy varied obviously by age, education level, occupation, average household monthly income per person, prevalence of a family member working as a healthcare worker, and prevalence of using the way of acquiring health information (from medical workers, family members, friends or coworkers, activities conducted by the work unit or the community, listening to the radio, watching television, reading a newspaper/book, searching the Internet, or other approaches) (P<0.001) . Higher educational level and average household monthly income per person were associated with higher level of health literacy (P<0.001) . Being a student, worker of an industrial/mining enterprise, retailer or server was associated with higher level of health literacy (P<0.05) . Acquiring heath information from healthcare workers and searching the Internet were associated with higher level of health literacy (P<0.05) .

On the whole, the health literacy was moderate in outpatients of the 14 general hospitals. To improve the health literacy level in this population, it is suggested to improve the levels of health education and guidance for them by strengthening the key role of healthcare workers in health information delivery, giving more concerns to the low educated or low-income earners, and increasing the ways of acquiring health information.