Association between health literacy and antibiotic-related knowledge, attitudes, and behaviors

Antimicrobial resistance (AMR) poses a growing threat to global health, driven by antibiotic misuse. Health literacy (HL) may play an independent role in shaping how people understand and use antibiotics. This study aimed to evaluate the relationship between HL and antibiotic-related knowledge, attitudes, and behaviors (KAB) to inform public health strategies that promote rational antibiotic use.

A cross-sectional survey was conducted among 350 Turkish adults aged 18-65, using stratified quota sampling by age and gender. Data were collected via online forms and face-to-face interviews. Participants completed sociodemographic questions, the 6-item European Health Literacy Survey Questionnaire (HLS-EU-Q6), and a 16-item antibiotic-related KAB scale.

Of participants, 50% were female, mean age was 39.8 ± 12.2 years, and 62% had university education or higher. HL distribution was: inadequate 6.9%, problematic 78.6%, adequate 14.6%. Correlation analyses showed that HL was weakly associated with attitudes (r = 0.109, p = 0.041), behaviors (r = 0.150, p = 0.005), and total KAB (r = 0.130, p = 0.015), but not with knowledge. Knowledge was moderately correlated with attitudes (r = 0.307, p < 0.001) and weakly to moderately correlated with behaviors (r = 0.226, p < 0.001). Regression models indicated that attitudes were predicted by knowledge (β = 0.26, p < 0.001) and education (β = 0.16, p = 0.004), while behaviors were predicted by knowledge (β = 0.17, p = 0.002), HL (β = 0.14, p = 0.008), and age (β = 0.13, p = 0.023). Mediation/moderation revealed that HL and knowledge operated through independent pathways.

Antibiotic knowledge was the strongest predictor of attitudes, while HL contributed independently to behaviors. These findings highlight the need for interventions that enhance both antibiotic knowledge and HL to promote rational use of antibiotics and prevent AMR.