Abstract: Objective To evaluate individual and environmental charateristics,health service and some other social factors influencing health literacy among rural residents in Jiangsu,Shanxi and Henan province of China,and to provide evidence for developing intervention strategies of health literacy.Methods Multistage stratified random sampling was applied to investigate the rural permanent residents aged 15-65 years in three provinces and questionnaire survey and interview were adopted to collect data.Results A total of 1 281 qualified questionnaires were collected with a respondent rate of 82.74%.The proportion of adequate health literacy(AHL) of the residents was 8.37%(7.45% for male,9.17% for female).The residents of 25-34 years old(16.89%),with junior college education(21.74%),and with college education (21.43%) had higher health literacy.The residents engaged in farming physical labor had very limited health literacy level.Two-week morbidity(χ²=9.42,P<0.01),getting comphrehensive knowledge about illness and health from health worker when visiting a doctor(χ²=10.29,P<0.01),and with good health education(χ²=42.90,P<0.01) related to health literacy.Social and environmental factors,including residential place(χ²=81.66,P<0.01),with safe drinking water(χ²=20.74,P<0.01),with sanitary latrine usage(χ²=68.29,P<0.01),and with concentrated gabage treatment(χ²=36.82,P<0.01) also related to health literacy.Logistic regression analyses showed that education(odds ratioOR=1.518),concentrated gabage treatment(OR=2.065),and with health education and communication with medical professionals(OR=2.020)were protective factors of health literacy among the residents,while residential place(central China:OR=0.405,west China:OR=0.069 compared to east China)and age(OR=0.975) were risk factors.Conclusion The health literacy of rural residents was influenced by health service,individual,social and environmental factors.Individual,government and social organization should collaborate to build supporting environment for health literacy.