Abstract
Health literacy is crucial for effectively navigating health systems and promoting equitable health outcomes. Multilingual and culturally dual regions present unique challenges for health communication; however, disparities in health literacy within such contexts remain insufficiently explored. This study constitutes the first population-based assessment of health literacy in Alto Adige/South Tyrol, a bilingual province in northern Italy, utilizing the validated HLS-EU-Q16 instrument. A stratified random sample of 2090 residents aged 18 and older was surveyed in 2024. Weighted analyses ensured population representativeness, and scores were analyzed overall, by domain (health care, disease prevention, health promotion), and by language group (German, Italian, multilingual). Regression models incorporating sociodemographic and health-related covariates were employed to identify predictors of health literacy. Half of the population (50.0%) exhibited problematic or inadequate health literacy, with significant differences observed across language groups. Italian speakers demonstrated the highest scores, whereas German speakers scored lowest overall. These differences remained significant after adjustment for age, education, chronic illness, and professional background. Domain-specific analyses revealed distinct patterns: German-speaking respondents scored particularly low in the health promotion domain, while multilingual individuals achieved the highest scores in the prevention and promotion domains. Education level and language background emerged as the strongest predictors of health literacy, while most other covariates exhibited limited explanatory power. The findings underscore the necessity for language-sensitive and domain-specific interventions, highlighting health literacy as both a personal skill and a structural responsibility.