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.

我国居民疾病谱正在发生变化，医疗卫生服务正面临巨大压力，了解患者健康素养水平现状及其影响因素，有助于提高医患沟通水平，促进患者自身健康，缓解医疗服务压力。目前，针对患者健康素养水平的调查研究较少，且既往研究多聚焦于特定疾病患者。

了解门诊患者健康素养现状及其影响因素，旨在为改善患者健康状况、提高其疾病自我管理能力提供科学依据，为医务人员开展健康教育与指导、治疗管理与持续改进工作提供参考。

采用系统抽样法选取我国东、中、西部8省份14家二级或三级综合医院作为调查地点，随机抽取2021年1—5月至14家医院门诊就诊且年龄≥15岁的患者为调查对象，采用"患者健康素养测评量表"调查门诊患者的健康素养水平，以<41分为不具备健康素养，以41~54分为具备中等健康素养，以≥55分为具备良好健康素养。比较不同特征门诊患者的健康素养水平，采用有序多分类Logistic回归分析门诊患者健康素养水平的影响因素。

共回收有效问卷2 808份。2 808例门诊患者健康素养平均得分为（43.38±6.25）分，健康素养总体具备率为68.38%（1 920/2 808），其中133例（6.93%）具备良好的健康素养。不同年龄、文化程度、职业、家人从事医疗卫生行业情况、家庭人均月收入，以及不同医疗信息获取途径（医疗卫生人员、家人/朋友/同事、工作单位/社区组织的活动、广播/电视/报纸/书籍、互联网及其他）门诊患者的健康素养水平比较，差异有统计学意义（P<0.001）。有序多分类Logistic回归分析结果显示：文化程度和家庭人均月收入越高的患者健康素养水平越高（P<0.001）；与其他职业人群相比，学生、工矿企业工人、商业零售或服务人员健康素养水平较高（P<0.05）；平时从医疗卫生人员处、互联网中获取医疗信息的门诊患者具备较高的健康素养（P<0.05）。

14所医院门诊患者健康素养处于中等水平。应发挥医疗卫生人员在提高门诊患者健康素养水平中的重要作用，加大对文化程度和收入较低患者的关注力度，进一步拓宽患者获取医疗信息的渠道，加强对其的教育和指导，进而提升患者的健康素养。