Health literacy and associated factors among selected ethnic minority communities in Yunnan, China: a cross-sectional study

Selected ethnic minority communities with cross-stage development in Yunnan, China, represent a unique population that transitioned from historically isolated traditional social structures to modern society. However, limited data exist regarding their health literacy (HL) status amidst rapid epidemiological transitions. This study aimed to assess the prevalence of HL and identify its sociodemographic associated factors within these transitional communities. A cross-sectional survey employing a multi-stage stratified cluster and probability proportional to size (PPS) sampling design was conducted from July to August 2022 among 1,375 residents across 15 counties in five border prefectures of Yunnan Province using the standardized Chinese Adult Health Literacy Questionnaire (CAHLQ). Health literacy adequacy was defined as achieving ≥ 80% of the total score (≥ 53/66 points). Statistical analyses included Fisher's exact Chi-square tests, Cramér's V, One-way ANOVA with Tukey's HSD post-hoc tests ( η 2 ), multivariate logistic regression, and multiple linear regression to explore factors associated with HL levels. The overall unweighted prevalence of adequate health literacy was 4.2% (58/1,375; 95% CI: 3.2%–5.4%). Across the three primary categories, the prevalence rates were 14.0% for "Healthy Lifestyles and Behaviors," 12.5% for "Health-related Skills," and 10.7% for "Basic Knowledge and Beliefs," reflecting a comprehensive application deficit when integrating these components. Multivariate logistic regression identified education level as the primary independent factor associated with adequate HL (OR = 3.71, 95% CI: 2.49–5.52, P < 0.001). Multiple linear regression ( R 2 = 0.206, Adjusted R 2 = 0.202) confirmed a strong positive "education gradient" ( β = 0.384, P < 0.001), and an inverse age association ( β = − 0.146, P < 0.001). Significant unadjusted subgroup score disparities were observed across occupational strata (ANOVA F = 27.571, P < 0.001, η 2 = 0.139; traditional farmers scoring lowest at 28.65 ± 0.36), chronic disease status (30.23 ± 10.91 vs. 32.28 ± 10.36, P = 0.008), and self-rated health ( F = 23.463, P < 0.001, η 2 = 0.064). Experiencing an injury was not significantly associated with safety literacy (28.8% vs. 29.4%, P = 0.869), providing no evidence to support the experiential learning hypothesis in this cross-sectional context. Transitional ethnic minority communities in Southwest China face a substantial health literacy deficit, strongly associated with lower educational attainment, traditional agricultural occupations, and older age. The observed disparities among individuals with chronic conditions and poor self-rated health highlight important vulnerabilities in health communication. Future policies should prioritize culturally adapted, visual, bilingual, and peer-led educational approaches to enhance health literacy in these marginalized populations.