To analyze the structural characteristics and core influencing factors of health literacy among residents in Sichuan Province during the 14th Five-Year Plan period (2021-2025), and provide empirical evidence for formulating health literacy optimization strategies for the 15th Five-Year Plan period.

Based on the health literacy surveillance data of Sichuan residents in 2021, 2023 and 2025, Chi-square test was used to analyze the structural characteristics of literacy on six categories of health issues, multivariate Logistic regression was applied to identify the influencing factors, and stepwise regression method was adopted to test the mediating effect of education level.

During the 14th Five-Year Plan period, the overall health literacy rate of Sichuan residents increased from 24.10% to 33.80%, with a cumulative increase of 9.70 percentage points, and the level in 2025 was slightly higher than the national average. The literacy on six categories of health issues presented the characteristics of prominent strengths, obvious weaknesses, and peaking then declining in some dimensions: scientific health concept and safety & first aid were dominant fields, while chronic disease prevention and control, infectious disease prevention and control were core weaknesses. Education level of college degree or above (OR=5.467，95%CI=5.453-5.481) and occupation as medical staff (OR=1.796，95%CI=1.790-1.802) were strong promoting factors, while rural household registration, people aged 65-69 years and farmers were main risk factors. The mediating effect of education level accounted for 35.2% and 42.6% of the association between urban-rural status, farmer occupation and health literacy, respectively.

The health literacy of Sichuan residents has achieved significant improvement, but prominent problems such as structural imbalance, regional and population disparities still exist. Education level is the core mediating variable. Targeted optimization strategies should be implemented to promote the transformation of health literacy to qualitative optimization.