Abstract: Objective To examine the level and influence factors of health literacy and to explore the mediating effect of health knowledge and attitude on healthy lifestyle and behaviors among residents,and to provide theoretical bases for improving health literacy of residents.Methods With probability sampling,a questionnaire survey was carried out among 3 475 residents aged 15-64 years selected from 72 villages or cummunities in 12 counties or districits of Hunan province during October to December 2012.The diffenrence in health literacy was ananlyzed using Chi-square test; influencing factors of health literary were explored with logistic regression and mediating effect of health literacy on health life style and behaviors was evaluated with bootstrap test.Results Of all the participants,459 (13.2%)reported having basic health literacy; 18.6%,15.0%,and 14.2% reported havig basic health knowledge and concept,healthy lifestyle and behavior,and health skills, respectively.Logistic regression analyses showed that the health literacy level was mainly influenced by nationality,education,occupation,and income (P<0.05 for all).Health literacy level presented an upward trend with the increase of education (odds ratio OR=1.447,95% confidence interval 95%CI=1.259-1.664).Among the participants,medical personnel exhibited a significantly higher health lieracy than farmers (OR=8.556,95%CI=4.676-15.658).Basic health knowledge and concepts showed strong correlation with health skill (r=0.821) and with healthy lifestyle and behavior (r=0.821) (both P<0.01); health skill was significantly correlated with healthy lifestyle and behavior (r=0.836) (P<0.01).The mediating effect of health skills on the correlation between health literacy and behaivor was 0.136 (95%CI:0.119,0.154).The total effect of the basic health knowledge and concept on healthy lifestyle and behavior was 0.497,with a mediating effect proportion of 27.44%.Conclusion The health literacy level among residents in Hunan province is higher than the national average,but still needs to be improved.The mediating effect of health skill shoud be concerned in health education programs for the promotion of health literacy among the residents,especially among the famers in the province.