Objective  To examine changes in health literacy after the implementation of singing service of village doctors and to explore the impact of the singing service on health literacy among rural residents.

  Methods  We conducted a questionnaire survey among 2 240 permanent residents in rural regions covered by signing service of village doctors in Jiangsu province in March 2015 using health literacy questionnaire. T test and nonparametric test were adopted to analyze differences in overall and dimensional score of health literacy among the participants from various populations.

  Results  The average overall health literacy score of the residents receiving signing service of village doctors was higher than that of residents not receiving the service (72.33 ± 10.10 vs. 71.41 ± 10.67). The residents with village doctors’ signing service showed higher scores for health knowledge and concept (42.27 ± 6.56 vs. 41.64 ± 7.08) and health behavior (13.80 ± 2.93 vs. 13.38 ± 2.87), but a lower score for health skill (16.25 ± 3.84 vs. 16.39 ± 3.96) compared to the residents without the service. Among the residents receiving village doctors’ signing service, those with the education of high school and lower and with the monthly income of less than 2 000 RMB yuan had lower overall health literacy score (72.45 ± 2.95 and 71.03 ± 5.46); among the residents not receiving village doctors’ signing service, those divorced had a higher overall health literacy score (74.67 ± 2.88).

  Conclusion  Rural doctors’ signing service is helpful to enhance health literacy level among rural residents, suggesting the utilization of village doctors’ signing service should be promoted among rural populations.