The Comparison of the Relationship between Health Literacy and Preventive Lifestyle for Non-Communicable Diseases among Medical Students at Tehran University of Medical Sciences

The Comparison of the Relationship between Health Literacy and Preventive Lifestyle for Non-Communicable Diseases among Medical Students at Tehran University of Medical Sciences | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Comparison of the Relationship between Health Literacy and Preventive Lifestyle for Non-Communicable Diseases among Medical Students at Tehran University of Medical Sciences Rasa Zafari, Elham Shakibazadeh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7875707/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Non-communicable diseases (NCDs) impose a substantial burden on the healthcare system worldwide, being related to unhealthy lifestyles. Health literacy can help people promote their lifestyle, reducing the incidence of NCDs. This study aimed to observe the adequacy of health literacy and health-promoting lifestyles among medical students at Tehran University of Medical Sciences (TUMS). Methods This cross-sectional study was conducted among medical students in preclinical and clinical stages. Three questionnaires were used: a demographic questionnaire, the Health Literacy Instrument for Adults (HELIA), and the validated Persian Lifestyle questionnaire (LSQ) format. We used a linear regression model adjusted for age, sex, academic term, and marital status to assess the association between health literacy and health-promoting lifestyle. Results A total of 160 medical students were included in this study. The mean health literacy score was 67.84 ± 10.73 for preclinical students and 73.88 ± 12.56 for clinical students. The mean LSQ score was 318.69 ± 41.19 for preclinical students and 313.90 ± 36.72 for clinical medical students. Although our assessment revealed no significant differences between groups for LSQ score, unlike for health literacy, we observed a significant association between health literacy and LSQ scores among all medical students [Standardized в = 0.492, P value < 0.001]. Conclusion The health literacy and health-promoting lifestyle are not significantly different between medical students of TUMS in preclinical and clinical levels. Nevertheless, health literacy and health-promoting lifestyle are significantly associated among participants, suggesting the importance of health literacy in the enhancement of health among medical students. Non-communicable diseases Health literacy Lifestyle Health promotion Medical students Figures Figure 1 Background Non-communicable diseases (NCDs) are recognized as the leading cause of mortality worldwide, being responsible for over 74% of the total disease burden( 1 ). Recent studies have constantly suggested that the enhancement of poor lifestyles can decrease the incidence of NCDs ( 2 , 3 ). Moreover, it is evident that lifestyle is closely associated with overall health status ( 4 ). The health-promoting lifestyle refers to activities that help people have greater control over their health status ( 5 , 6 ). Evidence has suggested that most of the prevalent mortality factors, including tobacco use, diabetes, lack of physical activity, hypertension, and obesity can be mitigated through the adoption of healthier lifestyle practices ( 7 ). In addition, some studies have suggested that enhancing health literacy can play a more effective role in improving unhealthy lifestyles among individuals ( 8 ). Health literacy refers to the ability of people to have appropriate access, understanding, and appraising health matters in order to enhance and maintain their health status ( 9 ). The World Health Organization (WHO) also defines health literacy as a set of cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use health information in ways that promote and maintain good health ( 10 ). It is indicated that adequate health literacy is associated with informed health-related decision-making, better health-related lifestyles, and lower incidence of NCDs ( 11 , 12 , 13 ). Studies have reported that enhanced health literacy is an essential factor in the prevention of diseases and clinical treatment, which can significantly contribute to the prevention of NCDs ( 14 , 15 ). However, there is still limited and inconclusive evidence on the association of health literacy and health-related lifestyles ( 16 ). Medical students are among the most influential professional groups of the future, who can lead countries to growth and development. Moreover, as healthcare personnel, they can play a pivotal role in encouraging and motivating people to follow healthy lifestyles ( 17 , 18 ). Meanwhile, some assessments have revealed that healthcare practitioners may fail to follow healthy lifestyles ( 19 , 20 ). Recent studies have used the Health Literacy Instrument for Adults (HELIA) to evaluate the health literacy among participants ( 21 ). This assessment instrument was designed to capture both basic and advanced aspects of health literacy through five core dimensions, including access to health information, reading, understanding, appraisal, and decision-making/behavioral intention ( 22 ). In addition, to observe the compliance of participants with healthy lifestyles, some studies have utilized a validated Persian format of the Lifestyle questionnaire (LSQ) ( 23 ). By assessing the level of health literacy and the compliance of medical students with healthy lifestyle practices, as well as examining the potential association between these variables, we can gain deeper insight into their health-related behaviors and influencing factors In this study, we aimed to observe the level of health literacy among medical students at Tehran University of Medical Sciences and assess their adherence to healthy lifestyles to compare the health literacy and lifestyle between preclinical and clinical medical students and to evaluate whether there is a significant association between health literacy and lifestyle among participants. Methods Study design This was a cross-sectional assessment of health literacy and lifestyle for medical students at Tehran University of Medical Sciences, in both preclinical and clinical stages. The participants completed a survey on demographic data, health literacy, and lifestyle through the HELIA assessment tool and LSQ. This study was approved by Research Ethics Committee of the Tehran University of Medical Sciences under the code IR.TUMS.SPH.REC.1404.179. Study participants Study participants consisted of preclinical and clinical medical students at Tehran University of Medical Sciences. Preclinical medical students consisted of students at both basic science and physiopathology stages, whereas clinical medical students consisted of clerkships and internship students. Students who were unwilling to participate were excluded from the study. Variables and measurements The collected variables in this study consisted of demographic data, health literacy, and health-related lifestyle. To assess health literacy, we used the previously validated Persian form of HELIA, an assessment tool provided by Montazeri et al. 2020 for health literacy evaluating access to information, reading, comprehension, appraisal, and decision-making ( 21 ). The instrument consists of 33 items rated on a Likert scale, with scores standardized on a 0-100 scale to facilitate interpretation ( 21 ). Also, to evaluate health-related lifestyles, we used the Persian form of LSQ, which was previously developed and validated as a comprehensive tool for assessing healthy lifestyles among Iranian populations ( 23 ). This assessment tool contained 70 items, which were designed based on theoretical frameworks of health-promoting lifestyle behaviors ( 23 ). Analysis Data analysis was performed using SPSS version 26. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were applied to summarize health-related lifestyle scores and health literacy across demographic variables. Pearson’s correlation coefficient was used to assess the associations between health literacy and health-related lifestyle. Group comparisons were conducted using independent t-tests and analysis. In addition, linear regression models were applied to explore the relationship between health literacy and health-related lifestyle, along with its dimensions, while controlling for selected demographic variables. Results A total of 160 medical students, consisting of 80 preclinical medical students and 80 clinical medical students from Tehran University of Medical Sciences, were enrolled in this study. Among these participants, 35% were female and more than 90% were single. Also, more than 90% of participants were from urban areas. The overall mean age of participants was 22.22 (SD: 1.93). The characteristics of participants are provided in more detail in Table 1. Table 1. Demographic characteristics. Preclinical medical students (n=80) Clinical medical students (n=80) P value Age 20.71 ± 1.31 23.74 ± 1.06 0.026 Gender (F/M) 35/45 21/59 <0.001 Academic stage Basic Science (N%) Clerkship (N%) Physiopathology (N%) Internship (N%) 40 (25%) 40 (25%) - - - - 34 (42.5%) 46 (57.5%) HELIA Score Access to health Information Reading Understanding Appraisal Decision-making intention 67.84 ± 10.73 72.60 ± 13.93 62.03 ± 17.21 75.13 ± 13.32 67.73 ± 14.04 61.72 ± 13.96 73.88 ± 12.56 80.42 ± 13.58 68.44 ± 22.43 83.17 ± 15.11 71.95 ± 18.11 65.44 ± 14.05 <0.05 <0.001 0.044 <0.001 0.102 0.095 LSQ Score 318.69 ± 41.19 313.90 ± 36.72 0.439 Values are showed as mean(±SD) or raw numbers of patients Results of independent T-test analysis between groups noted as p value. HELIA: Health Literacy Instrument for Adults, LSQ: Lifestyle questionnaire. The overall health literacy among medical students at preclinical stages was 67.84 (SD: 10.73), whereas clinical students represented an overall health literacy of 73.88 (SD: 12.56), categorizing them as “Adequate health literacy” (Figure 1a). Among the different questions of the HELIA questionnaire, those related to “Understanding” recorded the highest scores with a mean of 75.13 (SD: 13.32) and 83.17 (SD: 15.11), among preclinical and clinical students, respectively. In addition, “Decision-making and behavior” recorded the lowest scores with a mean of 61.72 (SD: 13.96) among medical students at preclinical levels as well as a mean of 65.44 (SD: 14.05) among clinical students. Moreover, we observed significant differences for the overall score of health literacy between medical students at preclinical levels and clinical stages [t (158) = 3.27, P value < 0.05]. Also, significant differences were found for “Reading” [t (158) = 2.026, P value= 0.044], “Access” [t (158) = 3.592, P value< 0.001], “Understanding” domains of health literacy between medical students at these levels [t (158) = 3.568, P value< 0.001]. Moreover, LSQ scores were calculated for both groups to evaluate the preventive lifestyle. Surprisingly, our analysis showed a higher LSQ score for preclinical students than that for clinical students (318.69 (SD: 41.19) in preclinical medical students, compared to 313.90 (SD: 36.72) in clinical medical students) (Figure 1b). Meanwhile, reported differences for LSQ scores were not significant between the two groups [t (158) = 0.776, P value= 0.439]. In the next phase, we conducted a linear regression analysis to examine whether there is a significant association between health literacy and the academic semester of medical students in these groups. Our analysis revealed that, unlike preclinical medical students [Standardized в = - 0.122, P value = 0.481], there was a significant association between health literacy and semester among clinical medical students [Standardized в = 0.332, P value = 0.020]. Furthermore, when all medical students were considered collectively, a significant association was identified between HELIA score and educational semester of participants [Standardized в = 0.384, P value = 0.020]. Moreover, unlike other demographic features, we found a significant association between age and LSQ score across all participants [Standardized в = 1.529, P value = 0.013]. Additionally, we conducted a linear regression analysis, adjusted for age, sex, academic term, and marital status to further assess the association of health literacy and the adherence level of medical students at Tehran University of Medical Sciences to preventive lifestyles. Our results suggested a significant association between health literacy and LSQ scores among all medical students [Standardized в = 0.492, P value < 0.001]. Same results on the significant association between HELIA score and LSQ assessment were reported in both preclinical medical students [Standardized в = 0.503, P value < 0.001], and clinical medical students [Standardized в = 0.493, P value < 0.001] (Table 2). Table 2. Results of linear regression analyses of LSQ score and health literacy. Preclinical students Clinical students Sex 0.006 -0.172 Age 0.078 0.088 Academic term -0.320 -0.086 Marital status 0.080 0.183 HELIA score 0.485* 0.512* * p<0.05 Each cell shows the p-value from the linear regression analysis between LSQ score and HELIA score, adjusted for age, sex, academic term, and marital status. HELIA: Health Literacy Instrument for Adults, LSQ: Lifestyle questionnaire. Discussion In this study, we attempted to evaluate health literacy and compliance with a health-promoting lifestyle, as well as observing their potential association, among medical students from both preclinical and clinical stages at Tehran University of Medical Sciences. We utilized a linear regression model, adjusting for age, sex, marital status, and the educational semester of participants. Our results revealed adequate levels of health literacy in both groups. Nevertheless, unlike health literacy, no significant differences in lifestyle practices were observed in medical students at preclinical and clinical levels. Despite this, we revealed a significant association between health literacy and health-promoting lifestyles among participants. Our findings are consistent with previous studies, reporting generally adequate health literacy among medical students and health-related trainees. Lane et al. evaluated health literacy among medical students in Australia, using a multi-dimensional Health Literacy Questionnaire ( 24 ). The results of this study indicated that male participants reflect higher health literacy, considering information access and appraisal. However, their health literacy reflected notable weaknesses in engaging with health care providers and navigating the health system ( 24 ). Another study in China attempted to observe health literacy among medical students, using the Health Literacy Questionnaire ( 25 ). The junior students revealed the highest score in terms of health literacy, while the freshman students reflected the lowest score. Also, students living in urban areas exhibited better health literacy, compared to those living in rural areas ( 25 ). In addition, Mullan et al. applied the Health Literacy Questionnaire to assess health literacy among health professional university students, the results of which showed that medical students recorded the highest score for health literacy, while nursing students recorded the lowest score ( 26 ). Our study also demonstrated an adequate level of health literacy among medical students at Tehran University of Medical Sciences in both preclinical and clinical levels. Nowadays, there is growing evidence on the association of health literacy and health-promoting lifestyle ( 27 ). It is shown that the level of health literacy is significantly associated with hospitalization, overall health status, and mortality ( 28 ). Moreover, inadequate health literacy is shown to be correlated with increased hospitalization rate and mortality ( 29 , 30 , 31 , 32 ). It is shown that factors, such as age, income, education level, and access to the internet can affect the level of health literacy, and as a consequence, the level of health-related lifestyle ( 33 ). Jayasinghe et al. indicated that lower health literacy is associated with higher rates of smoking, reduced physical activity, and obesity ( 34 ). Conversely, it is also suggested that improving health literacy can significantly enhance health-promoting behaviors, especially among individuals with higher educational backgrounds ( 34 ). These findings are in line with the results of a recent meta-analysis that reflected a significant yet weak association between health literacy and healthy lifestyle ( 35 ). This study also suggested that females may reflect higher levels of health literacy than males ( 35 ). In addition, a study done by Yokokawa et al. identified a stronger link between the decision-making domain of health literacy and healthy lifestyle ( 36 ). It is also shown that a negative association between health literacy and the incidence of metabolic disorders ( 36 ). Consistent with these findings, the results of our study also suggested a significant association between health literacy and health-promoting behaviors in both pre-clinical and clinical medical students at Tehran University. We used the HELIA tool as a validated and Persian instrument in the assessment of health literacy among participants. This tool measures health literacy in five main domains, including access to health information, reading, understanding, appraisal, and decision-making intention ( 22 ). Other available instruments to assess health literacy include the Rapid Estimate of Adult Literacy in Medicine (REALM) ( 37 ), the Newest Vital Sign (NVS) ( 38 ), and the Test of Functional Health Literacy in Adults (TOFHLA) ( 39 ), all of which are increasingly considered less suitable in the measurement of health literacy, as they fail to evaluate all aspects of healthy literacy and their weaker associations with healthy lifestyle ( 40 ). Additionally, Tavousi et al. reported an acceptable validity for HELIA in the assessment of health literacy, compared to other evaluation tools ( 22 ). Another comprehensive instrument in the evaluation of health literacy is the European Health Literacy Survey, which also assesses health literacy outcomes ( 41 ). This survey is based on the fact that health literacy is not a fixed measure and can evolve over time ( 41 ). In this study, we used a valid and Persian format of HELIA developed by Montazeri et al., which revealed a significant difference in health literacy between medical students of Tehran University in preclinical and clinical stages. Moreover, to assess the lifestyle of participants, we employed the Persian version of the LSQ, developed by Lali et al ( 23 ). This questionnaire evaluates 10 aspects of lifestyle, including physical health, sports and fitness, weight control and nutrition, disease prevention, psychological health, spiritual health, social health, drug and alcohol avoidance, accident prevention, and environmental health ( 23 ). Previous studies suggested that the performance of medical staff in LSQ can differ due to academic major, education level, financial status, and age ( 42 ). Age can increase the score of the health responsibility domain, while decreasing the score of the stress management domain ( 43 ). Our study align with these findings by revealing a significant association between age and LSQ score across all participants. Our study has some limitations that should be acknowledged. First, this study was conducted on medical students of one university in the country, which cannot provide an overall assessment of health literacy and its correlation with health-promoting lifestyles among all medical students. Moreover, this study was a self-report assessment which can affect the validity and accuracy of reported results due to reporting bias. Also, participants were not matched based on their sex and marriage status to reduce the potential confounding effect on the provided evidence. Finally, there were no longitudinal assessments to evaluate the alterations of variables over time. Conclusion In conclusion, our study identified significant differences between preclinical and clinical medical students in case of the health literacy, whereas no significant differences were observed in health-promoting lifestyles. Nevertheless, we observed a significant association between health literacy and healthy lifestyle among both groups, which suggests the critical role of health literacy in the enhancement of health status among medical students. Further studies with longer evaluation and diverse participants can shed more light on our information about the impact of health literacy on the prevention of NCDs and the improvement of health status among healthcare professionals. Abbreviations HELIA Health Literacy for Iranian Adults LSQ Lifestyle Questionnaire NCD Non-Communicable Diseases WHO World Health Organization Declarations Ethical approval and consent to participate. The study received ethical approval from the Ethics Committee of Tehran University of Medical Sciences under the code IR.TUMS.SPH.REC.1404.179. Written informed consent was obtained from all participants prior to completing the questionnaire, and this consent procedure was also approved by the Institutional Review Board (Ethics Committee of Tehran University of Medical Sciences). Participants’ privacy and confidentiality were strictly protected, with all data accessible only to the principal investigators. Anonymized data were used for statistical analyses. Participants were free to skip any questions or withdraw from the study at any time. The research was carried out in accordance with the Declaration of Helsinki, as well as relevant national regulations and ethical guidelines. Consent for publication. This manuscript has been approved for publication by all authors. Availability of data and materials. The datasets analyzed during the current study are available upon request with no restriction. Competing interests. The authors declare no competing interests. Funding. We do not have any financial support for this study Authors’ contributions. RZ and ES Designed the study; RZ collected data and interrupted data, and analyzed the data; RZ wrote the draft version of the manuscript; RZ created Figures, and Tables; ES supervised the paper. The manuscript was revised and approved by all authors. Acknowledgements. Not applicable. Clinical trial number. Not applicable. Declaration of Generative AI and AI-assisted technologies in the writing process. We have used Grammarly to check for potential grammatical mistakes in the final version of the manuscript. References Boerma T, Mathers CD. The World Health Organization and global health estimates: improving collaboration and capacity. BMC medicine. 2015;13(1):50. Organization WH. 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16:30:16","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":106429,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7875707/v1/3206024758e180480728badf.html"},{"id":99220596,"identity":"2df981ca-d8f6-4c35-8917-09cafe68e11e","added_by":"auto","created_at":"2025-12-30 09:36:17","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":353438,"visible":true,"origin":"","legend":"\u003cp\u003eThe level of health literacy and health-promoting lifestyles among participants. (a) HELIA score (b) LSQ score. HELIA: Health Literacy Instrument for Adults, LSQ: Lifestyle questionnaire.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7875707/v1/c353904f4445885df4ca517d.png"},{"id":100420334,"identity":"a4c0bae3-c9ff-4902-a49a-802fa33ef4f7","added_by":"auto","created_at":"2026-01-16 13:28:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":860453,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7875707/v1/8ead6ef5-ca8c-46f7-884a-5285c13d17d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Comparison of the Relationship between Health Literacy and Preventive Lifestyle for Non-Communicable Diseases among Medical Students at Tehran University of Medical Sciences","fulltext":[{"header":"Background","content":"\u003cp\u003eNon-communicable diseases (NCDs) are recognized as the leading cause of mortality worldwide, being responsible for over 74% of the total disease burden(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Recent studies have constantly suggested that the enhancement of poor lifestyles can decrease the incidence of NCDs (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Moreover, it is evident that lifestyle is closely associated with overall health status (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The health-promoting lifestyle refers to activities that help people have greater control over their health status (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Evidence has suggested that most of the prevalent mortality factors, including tobacco use, diabetes, lack of physical activity, hypertension, and obesity can be mitigated through the adoption of healthier lifestyle practices (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In addition, some studies have suggested that enhancing health literacy can play a more effective role in improving unhealthy lifestyles among individuals (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHealth literacy refers to the ability of people to have appropriate access, understanding, and appraising health matters in order to enhance and maintain their health status (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The World Health Organization (WHO) also defines health literacy as a set of cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use health information in ways that promote and maintain good health (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It is indicated that adequate health literacy is associated with informed health-related decision-making, better health-related lifestyles, and lower incidence of NCDs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Studies have reported that enhanced health literacy is an essential factor in the prevention of diseases and clinical treatment, which can significantly contribute to the prevention of NCDs (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, there is still limited and inconclusive evidence on the association of health literacy and health-related lifestyles (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMedical students are among the most influential professional groups of the future, who can lead countries to growth and development. Moreover, as healthcare personnel, they can play a pivotal role in encouraging and motivating people to follow healthy lifestyles (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Meanwhile, some assessments have revealed that healthcare practitioners may fail to follow healthy lifestyles (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Recent studies have used the Health Literacy Instrument for Adults (HELIA) to evaluate the health literacy among participants (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This assessment instrument was designed to capture both basic and advanced aspects of health literacy through five core dimensions, including access to health information, reading, understanding, appraisal, and decision-making/behavioral intention (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In addition, to observe the compliance of participants with healthy lifestyles, some studies have utilized a validated Persian format of the Lifestyle questionnaire (LSQ) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). By assessing the level of health literacy and the compliance of medical students with healthy lifestyle practices, as well as examining the potential association between these variables, we can gain deeper insight into their health-related behaviors and influencing factors\u003c/p\u003e \u003cp\u003e In this study, we aimed to observe the level of health literacy among medical students at Tehran University of Medical Sciences and assess their adherence to healthy lifestyles to compare the health literacy and lifestyle between preclinical and clinical medical students and to evaluate whether there is a significant association between health literacy and lifestyle among participants.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional assessment of health literacy and lifestyle for medical students at Tehran University of Medical Sciences, in both preclinical and clinical stages. The participants completed a survey on demographic data, health literacy, and lifestyle through the HELIA assessment tool and LSQ. This study was approved by Research Ethics Committee of the Tehran University of Medical Sciences under the code IR.TUMS.SPH.REC.1404.179.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy participants\u003c/h3\u003e\n\u003cp\u003e Study participants consisted of preclinical and clinical medical students at Tehran University of Medical Sciences. Preclinical medical students consisted of students at both basic science and physiopathology stages, whereas clinical medical students consisted of clerkships and internship students. Students who were unwilling to participate were excluded from the study.\u003c/p\u003e\n\u003ch3\u003eVariables and measurements\u003c/h3\u003e\n\u003cp\u003eThe collected variables in this study consisted of demographic data, health literacy, and health-related lifestyle. To assess health literacy, we used the previously validated Persian form of HELIA, an assessment tool provided by Montazeri et al. 2020 for health literacy evaluating access to information, reading, comprehension, appraisal, and decision-making (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The instrument consists of 33 items rated on a Likert scale, with scores standardized on a 0-100 scale to facilitate interpretation (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Also, to evaluate health-related lifestyles, we used the Persian form of LSQ, which was previously developed and validated as a comprehensive tool for assessing healthy lifestyles among Iranian populations (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This assessment tool contained 70 items, which were designed based on theoretical frameworks of health-promoting lifestyle behaviors (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eData analysis was performed using SPSS version 26. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were applied to summarize health-related lifestyle scores and health literacy across demographic variables. Pearson\u0026rsquo;s correlation coefficient was used to assess the associations between health literacy and health-related lifestyle. Group comparisons were conducted using independent t-tests and analysis. In addition, linear regression models were applied to explore the relationship between health literacy and health-related lifestyle, along with its dimensions, while controlling for selected demographic variables.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 160 medical students, consisting of 80 preclinical medical students and 80 clinical medical students from Tehran University of Medical Sciences, were enrolled in this study. Among these participants, 35% were female and more than 90% were single. Also, more than 90% of participants were from urban areas. The overall mean age of participants was 22.22 (SD: 1.93). The characteristics of participants are provided in more detail in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Demographic characteristics.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003ePreclinical medical students (n=80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003eClinical medical students (n=80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e20.71 \u0026plusmn; 1.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e23.74 \u0026plusmn; 1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eGender (F/M)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e35/45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e21/59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eAcademic stage\u003c/p\u003e\n \u003cp\u003eBasic Science (N%)\u003c/p\u003e\n \u003cp\u003eClerkship (N%)\u003c/p\u003e\n \u003cp\u003ePhysiopathology (N%)\u003c/p\u003e\n \u003cp\u003eInternship (N%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (25%)\u003c/p\u003e\n \u003cp\u003e40 (25%)\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e34 (42.5%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46 (57.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eHELIA Score\u003c/p\u003e\n \u003cp\u003eAccess to health\u003c/p\u003e\n \u003cp\u003eInformation\u003c/p\u003e\n \u003cp\u003eReading\u003c/p\u003e\n \u003cp\u003eUnderstanding\u003c/p\u003e\n \u003cp\u003eAppraisal\u003c/p\u003e\n \u003cp\u003eDecision-making intention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e67.84 \u0026plusmn; 10.73\u003c/p\u003e\n \u003cp\u003e72.60 \u0026plusmn; 13.93\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e62.03 \u0026plusmn; 17.21\u003c/p\u003e\n \u003cp\u003e75.13 \u0026plusmn; 13.32\u003c/p\u003e\n \u003cp\u003e67.73 \u0026plusmn; 14.04\u003c/p\u003e\n \u003cp\u003e61.72 \u0026plusmn; 13.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e73.88 \u0026plusmn; 12.56\u003c/p\u003e\n \u003cp\u003e80.42 \u0026plusmn; 13.58\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e68.44 \u0026plusmn; 22.43\u003c/p\u003e\n \u003cp\u003e83.17 \u0026plusmn; 15.11\u003c/p\u003e\n \u003cp\u003e71.95 \u0026plusmn; 18.11\u003c/p\u003e\n \u003cp\u003e65.44 \u0026plusmn; 14.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003cp\u003e0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eLSQ Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e318.69 \u0026plusmn; 41.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 153px;\"\u003e\n \u003cp\u003e313.90 \u0026plusmn; 36.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eValues are showed as mean(\u0026plusmn;SD) or raw numbers of patients\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults of independent T-test analysis between groups noted as p value.\u003c/p\u003e\n\u003cp\u003eHELIA: Health Literacy Instrument for Adults, LSQ: Lifestyle questionnaire.\u003c/p\u003e\n\u003cp\u003eThe overall health literacy among medical students at preclinical stages was 67.84 (SD: 10.73), whereas clinical students represented an overall health literacy of 73.88 (SD: 12.56), categorizing them as \u0026ldquo;Adequate health literacy\u0026rdquo; (Figure 1a). Among the different questions of the HELIA questionnaire, those related to \u0026ldquo;Understanding\u0026rdquo; recorded the highest scores with a mean of 75.13 (SD: 13.32) and 83.17 (SD: 15.11), among preclinical and clinical students, respectively. In addition, \u0026ldquo;Decision-making and behavior\u0026rdquo; recorded the lowest scores with a mean of 61.72 (SD: 13.96) among medical students at preclinical levels as well as a mean of 65.44 (SD: 14.05) among clinical students. Moreover, we observed significant differences for the overall score of health literacy between medical students at preclinical levels and clinical stages [t (158) = 3.27, P value \u0026lt; 0.05]. Also, significant differences were found for \u0026ldquo;Reading\u0026rdquo; [t (158) = 2.026, P value= 0.044], \u0026ldquo;Access\u0026rdquo; [t (158) = 3.592, P value\u0026lt; 0.001], \u0026ldquo;Understanding\u0026rdquo; domains of health literacy between medical students at these levels [t (158) = 3.568, P value\u0026lt; 0.001].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMoreover, LSQ scores were calculated for both groups to evaluate the preventive lifestyle. Surprisingly, our analysis showed a higher LSQ score for preclinical students than that for clinical students (318.69 (SD: 41.19) in preclinical medical students, compared to 313.90 (SD: 36.72) in clinical medical students) (Figure 1b). Meanwhile, reported differences for LSQ scores were not significant between the two groups [t (158) = 0.776, P value= 0.439].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the next phase, we conducted a linear regression analysis to examine whether there is a significant association between health literacy and the academic semester of medical students in these groups. Our analysis revealed that, unlike preclinical medical students [Standardized в = - 0.122, P value = 0.481], there was a significant association between health literacy and semester among clinical medical students [Standardized в = 0.332, P value = 0.020]. Furthermore, when all medical students were considered collectively, a significant association was identified between HELIA score and educational semester of participants [Standardized в = 0.384, P value = 0.020]. Moreover, unlike other demographic features, we found a significant association between age and LSQ score across all participants [Standardized в = 1.529, P value = 0.013].\u003c/p\u003e\n\u003cp\u003eAdditionally, we conducted a linear regression analysis, adjusted for age, sex, academic term, and marital status to further assess the association of health literacy and the adherence level of medical students at Tehran University of Medical Sciences to preventive lifestyles. Our results suggested a significant association between health literacy and LSQ scores among all medical students [Standardized в = 0.492, P value \u0026lt; 0.001]. Same results on the significant association between HELIA score and LSQ assessment were reported in both preclinical medical students [Standardized в = 0.503, P value \u0026lt; 0.001], and clinical medical students [Standardized в = 0.493, P value \u0026lt; 0.001] (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Results of linear regression analyses of LSQ score and health literacy.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePreclinical students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eClinical students\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eAcademic term\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e-0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eHELIA score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.485*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e0.512*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* p\u0026lt;0.05\u003c/p\u003e\n\u003cp\u003eEach cell shows the p-value from the linear regression analysis between LSQ score and HELIA score, adjusted for age, sex, academic term, and marital status.\u003c/p\u003e\n\u003cp\u003eHELIA: Health Literacy Instrument for Adults, LSQ: Lifestyle questionnaire.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e In this study, we attempted to evaluate health literacy and compliance with a health-promoting lifestyle, as well as observing their potential association, among medical students from both preclinical and clinical stages at Tehran University of Medical Sciences. We utilized a linear regression model, adjusting for age, sex, marital status, and the educational semester of participants. Our results revealed adequate levels of health literacy in both groups. Nevertheless, unlike health literacy, no significant differences in lifestyle practices were observed in medical students at preclinical and clinical levels. Despite this, we revealed a significant association between health literacy and health-promoting lifestyles among participants.\u003c/p\u003e \u003cp\u003eOur findings are consistent with previous studies, reporting generally adequate health literacy among medical students and health-related trainees. Lane et al. evaluated health literacy among medical students in Australia, using a multi-dimensional Health Literacy Questionnaire (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The results of this study indicated that male participants reflect higher health literacy, considering information access and appraisal. However, their health literacy reflected notable weaknesses in engaging with health care providers and navigating the health system (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Another study in China attempted to observe health literacy among medical students, using the Health Literacy Questionnaire (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The junior students revealed the highest score in terms of health literacy, while the freshman students reflected the lowest score. Also, students living in urban areas exhibited better health literacy, compared to those living in rural areas (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In addition, Mullan et al. applied the Health Literacy Questionnaire to assess health literacy among health professional university students, the results of which showed that medical students recorded the highest score for health literacy, while nursing students recorded the lowest score (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Our study also demonstrated an adequate level of health literacy among medical students at Tehran University of Medical Sciences in both preclinical and clinical levels.\u003c/p\u003e \u003cp\u003eNowadays, there is growing evidence on the association of health literacy and health-promoting lifestyle (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). It is shown that the level of health literacy is significantly associated with hospitalization, overall health status, and mortality (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Moreover, inadequate health literacy is shown to be correlated with increased hospitalization rate and mortality (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). It is shown that factors, such as age, income, education level, and access to the internet can affect the level of health literacy, and as a consequence, the level of health-related lifestyle (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Jayasinghe et al. indicated that lower health literacy is associated with higher rates of smoking, reduced physical activity, and obesity (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Conversely, it is also suggested that improving health literacy can significantly enhance health-promoting behaviors, especially among individuals with higher educational backgrounds (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). These findings are in line with the results of a recent meta-analysis that reflected a significant yet weak association between health literacy and healthy lifestyle (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). This study also suggested that females may reflect higher levels of health literacy than males (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). In addition, a study done by Yokokawa et al. identified a stronger link between the decision-making domain of health literacy and healthy lifestyle (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). It is also shown that a negative association between health literacy and the incidence of metabolic disorders (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Consistent with these findings, the results of our study also suggested a significant association between health literacy and health-promoting behaviors in both pre-clinical and clinical medical students at Tehran University.\u003c/p\u003e \u003cp\u003eWe used the HELIA tool as a validated and Persian instrument in the assessment of health literacy among participants. This tool measures health literacy in five main domains, including access to health information, reading, understanding, appraisal, and decision-making intention (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Other available instruments to assess health literacy include the Rapid Estimate of Adult Literacy in Medicine (REALM) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), the Newest Vital Sign (NVS) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), and the Test of Functional Health Literacy in Adults (TOFHLA) (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), all of which are increasingly considered less suitable in the measurement of health literacy, as they fail to evaluate all aspects of healthy literacy and their weaker associations with healthy lifestyle (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Additionally, Tavousi et al. reported an acceptable validity for HELIA in the assessment of health literacy, compared to other evaluation tools (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Another comprehensive instrument in the evaluation of health literacy is the European Health Literacy Survey, which also assesses health literacy outcomes (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). This survey is based on the fact that health literacy is not a fixed measure and can evolve over time (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In this study, we used a valid and Persian format of HELIA developed by Montazeri et al., which revealed a significant difference in health literacy between medical students of Tehran University in preclinical and clinical stages.\u003c/p\u003e \u003cp\u003eMoreover, to assess the lifestyle of participants, we employed the Persian version of the LSQ, developed by Lali et al (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This questionnaire evaluates 10 aspects of lifestyle, including physical health, sports and fitness, weight control and nutrition, disease prevention, psychological health, spiritual health, social health, drug and alcohol avoidance, accident prevention, and environmental health (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Previous studies suggested that the performance of medical staff in LSQ can differ due to academic major, education level, financial status, and age (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Age can increase the score of the health responsibility domain, while decreasing the score of the stress management domain (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Our study align with these findings by revealing a significant association between age and LSQ score across all participants.\u003c/p\u003e \u003cp\u003eOur study has some limitations that should be acknowledged. First, this study was conducted on medical students of one university in the country, which cannot provide an overall assessment of health literacy and its correlation with health-promoting lifestyles among all medical students. Moreover, this study was a self-report assessment which can affect the validity and accuracy of reported results due to reporting bias. Also, participants were not matched based on their sex and marriage status to reduce the potential confounding effect on the provided evidence. Finally, there were no longitudinal assessments to evaluate the alterations of variables over time.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study identified significant differences between preclinical and clinical medical students in case of the health literacy, whereas no significant differences were observed in health-promoting lifestyles. Nevertheless, we observed a significant association between health literacy and healthy lifestyle among both groups, which suggests the critical role of health literacy in the enhancement of health status among medical students. Further studies with longer evaluation and diverse participants can shed more light on our information about the impact of health literacy on the prevention of NCDs and the improvement of health status among healthcare professionals.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHELIA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Literacy for Iranian Adults\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLSQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLifestyle Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNCD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNon-Communicable Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate.\u003c/strong\u003e The study received ethical approval from the Ethics Committee of Tehran University of Medical Sciences under the code IR.TUMS.SPH.REC.1404.179. Written informed consent was obtained from all participants prior to completing the questionnaire, and this consent procedure was also approved by the Institutional Review Board (Ethics Committee of Tehran University of Medical Sciences). Participants’ privacy and confidentiality were strictly protected, with all data accessible only to the principal investigators. Anonymized data were used for statistical analyses. Participants were free to skip any questions or withdraw from the study at any time. The research was carried out in accordance with the Declaration of Helsinki, as well as relevant national regulations and ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u0026nbsp;\u003c/strong\u003eThis manuscript has been approved for publication by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials.\u0026nbsp;\u003c/strong\u003eThe datasets analyzed during the current study are available upon request with no restriction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests.\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e We do not have any financial support for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions.\u003c/strong\u003e RZ and ES Designed the study; RZ collected data and interrupted data, and analyzed the data; RZ wrote the draft version of the manuscript; RZ created Figures, and Tables; ES supervised the paper. The manuscript was revised and approved by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements.\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number.\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Generative AI and AI-assisted technologies in the writing process.\u003c/strong\u003e We have used Grammarly to check for potential grammatical mistakes in the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBoerma T, Mathers CD. The World Health Organization and global health estimates: improving collaboration and capacity. BMC medicine. 2015;13(1):50.\u003c/li\u003e\n\u003cli\u003eOrganization WH. 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Global journal of health science. 2014;7(2):264.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Non-communicable diseases, Health literacy, Lifestyle, Health promotion, Medical students","lastPublishedDoi":"10.21203/rs.3.rs-7875707/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7875707/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eNon-communicable diseases (NCDs) impose a substantial burden on the healthcare system worldwide, being related to unhealthy lifestyles. Health literacy can help people promote their lifestyle, reducing the incidence of NCDs. This study aimed to observe the adequacy of health literacy and health-promoting lifestyles among medical students at Tehran University of Medical Sciences (TUMS).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted among medical students in preclinical and clinical stages. Three questionnaires were used: a demographic questionnaire, the Health Literacy Instrument for Adults (HELIA), and the validated Persian Lifestyle questionnaire (LSQ) format. We used a linear regression model adjusted for age, sex, academic term, and marital status to assess the association between health literacy and health-promoting lifestyle.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 160 medical students were included in this study. The mean health literacy score was 67.84\u0026thinsp;\u0026plusmn;\u0026thinsp;10.73 for preclinical students and 73.88\u0026thinsp;\u0026plusmn;\u0026thinsp;12.56 for clinical students. The mean LSQ score was 318.69\u0026thinsp;\u0026plusmn;\u0026thinsp;41.19 for preclinical students and 313.90\u0026thinsp;\u0026plusmn;\u0026thinsp;36.72 for clinical medical students. Although our assessment revealed no significant differences between groups for LSQ score, unlike for health literacy, we observed a significant association between health literacy and LSQ scores among all medical students [Standardized в = 0.492, P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001].\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe health literacy and health-promoting lifestyle are not significantly different between medical students of TUMS in preclinical and clinical levels. Nevertheless, health literacy and health-promoting lifestyle are significantly associated among participants, suggesting the importance of health literacy in the enhancement of health among medical students.\u003c/p\u003e","manuscriptTitle":"The Comparison of the Relationship between Health Literacy and Preventive Lifestyle for Non-Communicable Diseases among Medical Students at Tehran University of Medical Sciences","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 09:36:07","doi":"10.21203/rs.3.rs-7875707/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3928433d-ed4b-4695-9861-a8553f1a39ee","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-16T13:15:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 09:36:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7875707","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7875707","identity":"rs-7875707","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}