Abstract
BACKGROUND: Health literacy (HL) in Thailand remains a significant issue, with a large portion of the population demonstrating limited HL, and limited research exists on specific determinants among Thai university students. Some culture shapes health decision-making and HL disparities within this group, highlighting the need to evaluate HL comprehensively. This study aims to assess and compare HL levels among health science and non-health science students, and identify key predictors associated with HL. METHODS: A cross-sectional study was conducted among 1,647 Thai university students, comprising 676 health science and 971 non-health science students, recruited through multi-stage stratified random sampling. Data were collected using validated questionnaires that measured sociodemographic characteristics, academic background, lifestyle behaviors, and HL levels across three sub-domains, including healthcare, disease prevention, and health promotion. Statistical analyses included univariable and multivariable regression models, with significance set at p-value < 0.05. RESULTS: Health sciences students demonstrated significantly higher HL scores across all sub-domains compared to non-health sciences students. Limited HL was found in 12.6% for health science students, and 28.4% for non-health science students. Key predictors of overall HL included gender, income, faculty of study, and lifestyle-related health behaviors. Female students showed higher total HL (β = 1.41; 95% CI: 0.62, 2.21), as did those with higher income (β = 1.28; 95% CI: 0.76, 1.80). Students enrolled in health sciences programs had higher HL scores (β = 2.86; 95% CI: 2.07, 3.64). Lifestyle behaviors also correlated with HL, with non-smoking (β = -0.58; 95% CI: -1.03, -0.13), no alcohol consumption (β = -0.45, 95%CI: -0.89, -0.01), and regular physical activity (β = 0.35; 95% CI: 0.04, 0.66). Consumption of sweet foods/drinks was inversely related to HL scores (β = -0.87; 95% CI: -1.49, -0.26). CONCLUSIONS: HL among Thai university students varies significantly by sociodemographic factors, academic background, and lifestyle behaviors. Health sciences students exhibited stronger HL skills, underscoring the importance of integrating health education into non-health sciences curricula. Targeted HL interventions are recommended for non-health sciences students, males, and individuals from lower-income backgrounds to enhance health decision-making and reduce HL disparities. These findings have implications for policy and practice, emphasizing the integration of HL modules into university curricula, health promotion campaigns, and the provision of accessible health services to foster an inclusive and health-literate student population.