Relationship Between Health Literacy and Rational Antibiotic Use in Adults in Türkiye

Background

Antibiotic resistance is a critical global public health threat. Health literacy (HL) is a fundamental determinant that influences how individuals access, understand, and apply health information to make decisions. This study aimed to evaluate the relationship between HL levels and rational antibiotic use (RAU) knowledge, attitudes and behaviors among adults in the capital city of Türkiye.

Methods

This cross-sectional study was conducted in April 2025 at Family Health Centers in four districts of Ankara. Data were collected from 1,098 adults via face-to-face interviews. Measuring tools included the HLS-EU-Q16 for health literacy and the Rational Antibiotic Use Knowledge and Attitude Scale. Statistical analyses included descriptive statistics, Mann–Whitney U, Kruskal–Wallis, and Spearman correlation tests.

Results

The mean HL index score was 34.20±8.08, with 45.4% of participants categorized as having inadequate or problematic-limited HL. The mean knowledge and attitude scores for RAU were 43.28±8.54 (max 60) and 61.46±11.18 (max 80), respectively. Within the last year, 59.9% used antibiotics and 27.2% demanded antibiotics from physicians even if deemed unnecessary. Additionally, 72.9% reported storing leftover antibiotics. HL index scores were positively correlated with both RAU knowledge (r = 0.447, p < 0.001) and attitude scores (r = 0.389, p < 0.001). Higher HL was significantly associated with a lower number of antibiotics used in the past year (r=-0.217, p < 0.001). Participants with sufficient/excellent HL were less likely to demand unnecessary antibiotics or store leftovers compared to those with limited HL (p < 0.001).

Conclusions

Limited health literacy is a significant barrier to rational antibiotic use. Enhancing HL through targeted public health interventions and primary care education is essential to improve RAU knowledge and attitudes, which can ultimately reduce irrational consumption and help mitigate antibiotic resistance.

Key messages

• Higher health literacy scores are positively correlated with better knowledge and attitudes toward rational antibiotic use, while also leading to lower overall antibiotic consumption.

• Individuals with limited health literacy are more likely to demand unnecessary antibiotics and store leftovers, necessitating educational interventions in primary care settings.