Exploring health literacy among Japanese and international university students in Japan: A comparative cross-sectional study

Objective: Health literacy (HL) is the ability to access, understand, evaluate, and apply health information for well-being. However, comparisons between domestic and international students remain limited. This study aims to investigate HL among Japanese and international university students in Japan and explore the factors that influence it. Methods: This cross-sectional study used both the English and Japanese versions of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). Using convenience sampling, a total of 1366 university students across six regions in Japan who provided informed consent participated in this self-administered, online-based survey. Descriptive statistics, t-tests, ANOVA and multiple regression were conducted as appropriate at a 0.05 alpha level using JMP statistical software (version 17.0.0) Results: The results revealed that 60 % and 32 % of participants had inadequate and problematic HL, respectively, indicating that 92 % of all students had limited HL. International students exhibited better HL than Japanese university students (p < 0.0001), a difference that remained after adjusting for sociodemographic and educational factors (β = 3.39, 95 % confidence interval = 2.83 – 3.95, p < 0.0001). The competency of “appraising” within the healthcare domain presented the greatest challenge for international students, whereas “understanding” within the disease prevention domain was most difficult for Japanese students. Furthermore, the results indicated a strong association between HL and sociodemographic factors such as age, level of study, marital status, and religious affiliation. In contrast, health literacy showed an inverse association with economic status, program of study and parental education level. There was an observable trend between improved Japanese language proficiency and improved HL among international students. Conclusion: International students in Japan demonstrated better HL than Japanese university students. Educational institutions must take a more proactive role in fostering HL for all students through general health education and peer-to-peer programs to create a more informed, healthy, and productive student community.