Lee et al. BMC Public Health 2010, 10:614 http://www.biomedcentral.com/1471-2458/10/614 R E S E A R C H A R T I C L E Open Access Health literacy, health status, and healthcare utilization of taiwanese adults: results from a national survey Shoou-Yih D Lee1, Tzu-I Tsai2*, Yi-Wen Tsai3, Ken N Kuo4 Abstract Background: Low health literacy is considered a worldwide health threat. The purpose of this study is to assess the prevalence and socio-demographic covariates of low health literacy in Taiwanese adults and to investigate the relationships between health literacy and health status and health care utilization. Methods: A national survey of 1493 adults was conducted in 2008. Health literacy was measured using the Mandarin Health Literacy Scale. Health status was measured based on self-rated physical and mental health. Health care utilization was measured based on self-reported outpatient clinic visits, emergency room visits, and hospitalizations. Results: Approximately thirty percent of adults were found to have low (inadequate or marginal) health literacy. They tended to be older, have fewer years of schooling, lower household income, and reside in less populated areas. Inadequate health literacy was associated with poorer mental health (OR, 0.57; 95% CI, 0.35-0.91). No association was found between health literacy and health care utilization even after adjusting for other covariates. Conclusions: Low (inadequate and marginal) health literacy is prevalent in Taiwan. High prevalence of low health literacy is not necessarily indicative of the need for interventions. Systematic efforts to evaluate the impact of low health literacy on health outcomes in other countries would help to illuminate features of health care delivery and financing systems that may mitigate the adverse health effects of low health literacy. Background Low health literacy, defined as an individual’s limited ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions [1], has been suggested as a worldwide problem and a global challenge for the 21st century [2]. In its recent report, the WHO Commission on the Social Determinants of Health (CSDH) declares health literacy as a major determinant for health and advises countries to create a multi-stakeholder Council on Health Literacy to monitor and coordinate strategic activities to enhance health literacy [3]. The declaration of health literacy as a global challenge and the CSDH’s recommendation of health literacy initiatives as important elements in the strategies to * Correspondence: titsai@ym.edu.tw 2School of Nursing, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan Full list of author information is available at the end of the article reduce health inequity are largely based on studies in the United States and a few other English-speaking countries. Those studies indicated a high prevalence of low health literacy in adults and found that low health literacy was linked to limited understanding of health information and medical instructions [4-7], inadequate self-management of diseases [6], underuse of preventive services and routine physician visits [8-13], increased hospitalizations and medical costs [14,15], and high mortality rates [16]. So far, little research on health lit- eracy has been conducted in non-English-speaking countries. It is unclear if low health literacy is a world- wide problem and whether low health literacy also has adverse health effects in countries that have more equi- table access to health care. In this paper, we report the results of a national assessment of health literacy in Taiwanese adults. The purpose is twofold: (1) to assess the prevalence and dis- tribution of low health literacy in Taiwanese adults, and © 2010 Lee et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.