Ali Vafaee-Najar - National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran.
Mahdi Gholian-Aval - Department of Health Education and Health Promotion, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Jamshid Jamali - Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background and Objective: A good picture of the Health literacy (HL) state in rural communities is essential to prevent and reduce the cost of treatment. The aim of this study is to estimate the HL of Iranian rural communities and identify related factors.Materials and Methods: This cross-sectional study was conducted with multi-stage cluster sampling on about ۵۷۰۰ insured people living in rural areas of Iran in ۲۰۲۱. HL for Iranian Adults (HELIA) questionnaire and demographic information checklist were used to collect information. Bivariate and multivariable regression analyses were conducted to examine the factors associated with HL.Results: Out of ۵۶۷۵ participants in the study, ۳۵.۹% were male, ۱۸.۶% had university education levels, and ۲۴.۱% were single. The overall average score of the HL Questionnaire was ۵۹.۶۴ ± ۲۲.۸۵. Age, marital status, education level, number of insurance years, and annual visits were associated with HL (p<۰.۰۵).Conclusion: The level of HL in the rural communities of Iran was inadequate. Education level was the most critical factor related to HL. Due to the low literacy level, the production of simple, understandable, cheap, and available media and educational materials appropriate to the cultural, economic, and social characteristics of Iranian rural communities is recommended.

Health Literacy, Rural, HELIA questionnaire, Iran