Health literacy as a driver of health outcomes and economic burden among patients visiting community pharmacies in Pakistan

Health literacy (HL) is a critical determinant of health outcomes, influencing individuals' ability to understand health information, make informed decisions, and engage in self-care practices. By understanding the comparisons of HL levels, healthcare providers can develop targeted interventions. This study investigates the determinants of HL levels among patients who visit community pharmacies, specifically in Gujrat and Islamabad, Pakistan, to identify factors associated with low HL. A cross-sectional study using the European Health Literacy Survey Questionnaire (HLS-EU-Q) was conducted to assess patients' demographic and socioeconomic characteristics and their HL levels. Spearman correlation analyses and multiple regression models explored the relationship between HL and its determinants. The study revealed that 61.3% of participants in Gujrat were male, compared to 52.7% in Islamabad, with the largest age group being 18−25 years (31%) in Islamabad versus 18% in Gujrat. HL was problematic in both regions, with 74% in Gujrat and 60% in Islamabad experiencing inadequate or problematic levels. Age, financial status, education, and social status were positively correlated with HL, while gender, part-time employment, and unemployment were negatively correlated. Frequent healthcare visits were associated with lower HL in Gujrat, while higher degrees and social status were associated with higher HL. It was concluded that the prevalence of inadequate HL is higher in Gujrat and is associated with factors such as challenges in understanding healthcare, disease prevention, and health promotion, compared to Islamabad. Our findings not only advance understanding of HL in Pakistan but also provide evidence to inform cost-effective public health strategies and policies aimed at reducing healthcare inequities, improving medication adherence, and optimising resource utilisation.