Health literacy as a modifiable determinant of hypertension self-management in primary care

Background Blood pressure control remains suboptimal worldwide despite effective pharmacological treatments. Limited patient capacity for sustained self-management is a key barrier. Health literacy is a modifiable determinant of adherence self-management, self-monitoring, and patient-provider interaction, yet its role in hypertension control remains underexplored in Eastern European primary care. This study assesses health literacy profiles among adults with hypertension and examines their association with self-management behaviours using the Health Literacy Questionnaire (HLQ) within the Ophelia (Optimising Health Literacy and Access) framework. Methods A pilot mixed-methods study was conducted in four primary healthcare centres in the Lviv and Khmelnytskyi regions of Ukraine. Quantitative analysis of routine hypertension care indicators (2021–2024) was combined with a cross-sectional HLQ survey of 440 patients aged 30–60 years. Cluster analysis identified distinct health literacy profiles. Qualitative data from 44 in-depth interviews and co-design workshops were used to contextualise findings and generate intervention ideas. Results Marked regional variation in health literacy was observed. High health literacy was identified in 20.0% of participants in Lviv and 8.6% in Khmelnytskyi, while low health literacy was present in 31.8% and 16.8%, respectively. Higher HLQ scores were associated with regular blood pressure monitoring, medication adherence, use of blood pressure diaries, and active engagement with healthcare providers. Lower health literacy clusters showed difficulties in navigating healthcare services, appraising information, and sustaining self-management behaviours. Conclusions Health literacy is a key determinant of effective hypertension self-management. The Ophelia approach enables context-sensitive identification of patient needs and supports development of scalable primary care strategies to improve hypertension control. Key messages • Addressing health literacy gaps is essential to improve hypertension self-management and reduce cardiovascular risk. • Health literacy is a key determinant of hypertension self-management and should be integrated into primary care and community-based strategies to reduce cardiovascular risk.