To reveal the complex associations among six domains of health literacy among residents in Chengdu using network analysis, and to identify differences and key nodes in health literacy networks between urban and rural residents.

Participants were recruited using a multi-stage sampling design with probability proportional to size (PPS). A total of 6 450 participants aged 15-69 years were enrolled. Health literacy and sociodemographic characteristics were assessed using the National Residents’ Health Literacy Surveillance Questionnaire (Health Statistics Form No. 115). R 4.4.1 was used to conduct statistical analysis.

Among six domains of health literacy, the possession rates of Scientific Health Perspectives, Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, Safety and First Aid, Basic Healthcare, and Health Information were 61.49%, 36.39%, 38.96%, 63.45%, 39.68%, 50.32% among urban residents, and 52.73%, 35.93%, 36.00%, 52.36%, 39.07%, 38.85% among rural residents. Network comparison showed differences in network structure and global strength between urban and rural residents. The strongest correlations in both urban and rural networks were between Scientific Health Perspectives and Safety and First Aid (urban: 1.489, rural: 1.386). Additionally, the associations between Scientific Health Perspectives and Chronic Disease Prevention and Management (urban: 1.047, rural:0.752), as well as between Infectious Disease Prevention and Control and Basic Healthcare (urban: 0.997, rural: 0.495), were stronger in urban areas than in rural areas. In contrast, the correlations between Scientific Health Perspectives and Infectious Disease Prevention and Control (rural: 0.917, urban: 0.675), Scientific Health Perspectives and Basic Healthcare (rural: 1.310, urban: 0.863), Chronic Disease Prevention and Management and Basic Healthcare (rural: 1.225, urban: 0.870), and Chronic Disease Prevention and Management and Health Information (rural: 1.257, urban: 1.009) were stronger in rural areas than in urban areas. The centrality strength values for Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, and Basic Healthcare differed between urban and rural networks (P<0.05).

Health literacy levels among rural residents still require comprehensive improvement, while persistent gaps remain in urban areas regarding literacy in Infectious Disease Prevention and Control, Chronic Disease Prevention and Management, and Basic Healthcare. To enhance the overall health literacy level, tailored strategies are needed for different settings.