Health literacy in Saudi Arabia: Implications for public health and healthcare access.

This study aims to describe the distribution of low health literacy (HL) in the population in the Kingdom of Saudi Arabia (KSA), and to analyze factors associated with low HL in KSA. A cross-sectional national survey using quota sampling, population-based of residents of KSA conducted via phone interviews supplemented by in-person interviews. The survey included an overall evidence-based measurement of HL. Both descriptive statistics of the sample and a multivariable logistic regression model predicting low HL were developed. A total of 3557 surveys were available for analysis, and 46% of the respondents were classified as having low HL. In regression modelling, low HL was associated with older age groups (age 47-56 odds ratio [OR] 1.60, 95% confidence interval [CI] 1.30-1.97; age 57-66 OR 1.38, 95% CI 0.98-1.94), the regions of Ha'il (OR 0.65, 95% CI 0.5-0.85) and Najran (OR 1.27, 95% CI 0.99-1.64), having been formerly married, lower levels of education (less than elementary OR 3.20, 95% CI 2.10-4.88; and elementary, OR 1.62, 95% CI 1.14-2.30), lower levels of income, and having sought healthcare exactly three times in the last year. Approximately half of KSA has low HL, and risk factors for low HL were older ages, lower income and education, having been formerly married, and a moderate pattern of health use. Future studies are needed to better characterize the distribution and determinants of low HL across KSA.