Objective To understand the health literacy level and change characteristics of residents in Xiaoxian county of Anhui province in 2017 and 2019,and to provide scientific basis for formulating health education strategies and measures. Methods Using multi-stage,probability proportionate to size sampling (PPS sampling) and KISH table methods,the permanent resident population aged 15~69 years old in Xiaoxian county were investigated with questionnaire about health literacy. Results In 2017 and 2019,the health literacy levels of residents in Xiaoxian county were 18.31% and 20.08%,respectively.The results of the two years' survey showed that the health literacy level of residents in different age groups,education levels and occupations had statistical significance (P＜ 0.05).Among the three literacy aspects,the basic knowledge and concept literacy level was the highest and the growth was the highest,which was 37.02% in 2019 and 3.79 percentage points higher than that in 2017.The level of basic skills literacy in 2019 was 20.08%,down 2.69 percentage points from 2017.Among the six categories of health problems,the highest was safety and first aid literacy.The literacy level of science and health as seen the largest increase,increasing by 11.43 percentage points from 2019 to 2017.The literacy level of prevention and treatment of infectious diseases in 2019 was 17.26%,a slight decrease from 17.77% in 2017. Conclusion The health literacy level of residents in Xiaoxian County showed an upward trend,but the level was low and the growth was small.Mostly,the basic skill literacy showed a downward trend,and the quality of infectious disease prevention and control was at a low level.In the future,we should continue to carry out health literacy promotion actions to accelerate the improvement of residents' health literacy level.