Background and Objective: Health literacy critically shapes health outcomes across the lifespan. However, determinants influencing its development during childhood remain inadequately understood, particularly within culturally diverse populations. Iranian children face distinctive socio-cultural challenges that may impact health literacy formation, though empirical research on contributing factors is limited.To investigate multifactorial determinants influencing health literacy development among Iranian children aged ۹–۱۲ years, drawing on perspectives of children, mothers, and educators.Materials and Methods: This exploratory qualitative study employed conventional content analysis following Graneheim and Lundman's methodology. Conducted in Isfahan Province, Iran (February ۲۰۲۳–May ۲۰۲۴), purposive sampling using maximum variation recruited ۲۱ participants: children aged ۹–۱۲ years (n=۱۴), mothers (n=۳), and elementary school educators (n=۴). Semi-structured interviews averaged ۳۴ minutes, yielding ۷۶۰ minutes of recorded material. Data analysis used MAXQDA ۲۰۲۲ software with independent verification.Results: Content analysis of ۱,۰۷۷ initial codes yielded four overarching categories encompassing ۱۵ subcategories: ۱) Child-level determinants: health knowledge and understanding, mental and emotional well-being, health skills and self-management; ۲) Family and home environment determinants: family health literacy and awareness, maternal roles and practices, family structure and dynamics; ۳) Educational and institutional determinants: school environment and policies, curriculum and learning content, teaching methodologies, educator competence; ۴) Socio-cultural and systemic determinants: economic status, cultural and religious context, information environment, policy and governance, environmental quality.Conclusion: This study identified four interconnected categories of determinants influencing health literacy development among Iranian children aged ۹-۱۲ years. Findings revealed children's capacity for health reasoning and the central role of family environments, particularly maternal influences. Educational approaches emphasizing interactive learning methods and educator competence emerged as important factors. Economic constraints, cultural values, and environmental conditions represented significant systemic determinants, providing evidence for developing culturally responsive, multi-level interventions.
