Objective: To understand the status of health literacy and its associated factors among primary school students in Shandong Province. Methods: By using stratified cluster sampling method, 9 063 children in grade 1 to 3 from 5 cities in Shandong Province were investigated with self-designed questionnaire. Chi square and multivariate logistic regression were used to analyze associated factors for health literacy. Results: Rate of proficient health literacy among grade 1-3 primary school students was 62.8%(5 689/9 063), with 75.6%(6 850/9 063), 56.3%(5 106/9 063) and 80.1%(7 261/9 063) in dimension of safety emergency, health care and disease prevention and control. Proficient health literacy was 47.7%(4 327/9 063), 88.3%(8 003/9 063) and 73.6%(6 672/9 063) in domain of health knowledge and concept, health behavior and health skills. Univariate analysis showed that the health literacy varied by gender, only-child in the family, grade, living area, cities, self-perceived academic performance, father educational attainment, mother educational attainment, father occupation and mother occupation(χ2=39.66, 161.09, 193.05, 89.23, 1 107.75, 196.35, 99.43, 74.39, 64.86, 16.70, P<0.01). Multivariate analysis found that gender, only-child in the family, grade, living area, city, self-perceived academic performance, father’ s occupation and educational attainment were positively associated with health literacy among elementary students. Conclusion High level of health literacy has been found among primary school students in Shandong Province, but varied in area and different demographic characteristics, which needs further specific intervention.