Health Literacy as a Key Determinant of Patient Safety among Nurses in Pakistan

Articles in Press

Document Type : Original Article

Authors

Lahore School of Nursing, The University of Lahore, Lahore, Pakistan.

Abstract

Background and objective: Patient safety remains a critical concern in low- and middle-income countries such as Pakistan. Nurses’ health literacy may contribute to improved patient safety through better clinical decision-making; however, factors such as heavy workload and limited training may compromise both health literacy and safety practices. This study aimed to examine the relationship between health literacy and patient safety culture among nurses in a single hospital in Pakistan.

Materials and Methods: This cross-sectional study was conducted in 2026 in one hospital in Pakistan. A total of 150 nurses participated. Data were collected using the Health Literacy Questionnaire (HLQ) and the Hospital Survey on Patient Safety Culture (HSOPSC).

Results: Participants demonstrated moderate levels of health literacy (mean = 3.13) and patient safety culture (mean = 3.27). A moderate positive correlation was observed between health literacy and patient safety culture (r = 0.42, p < 0.01). However, these findings should be interpreted cautiously due to the cross-sectional design, which limits causal inference, and the single-center sampling, which restricts generalizability. Therefore, the results should be considered preliminary.

Conclusion: This study provides preliminary evidence of an association between nurses’ health literacy and patient safety culture in a limited hospital setting. However, the observed relationship cannot be interpreted causally. Further large-scale, multi-center, and longitudinal studies are required to confirm these findings and explore additional contextual and organizational factors influencing patient safety.

Keywords

Acknowledgments: The researchers appreciate the sincere collaboration of all nurses who participated in this study.


Availability of data and materials: The datasets used or analyzed during the current study available from the corresponding author on reasonable request.


Conflict of Interest: There is no conflict of interest in this study.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki; the study protocol and informed-consent procedures were assessed and approved by Institutional Research Ethics Board of the University of Lahore (UOL/IREB/26/17/03/07), and written informed consent was obtained from all participants. 


Funding: This research does not receive any funding.


Authors' Contribution: SH.S.A conceptualized and designed the study. A.Kh, A.I, I.Z and A.A collected the data. SH.S.A performed the analysis, interpreted the findings, drafted the manuscript, provided supervision and critically reviewed the manuscript for important intellectual content. All authors approved the final version for submission.  

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ 

References

  1. Anselmann V, Halder S, Sauer S. Nursing Students' Health Literacy and Strategies to Foster Patients' Health Literacy. Int J Environ Res Public Health. 2024 Aug 9;21(8):1048. https://doi.org/10.3390/ijerph21081048 PMid:39200657 PMCid:PMC11354901
  2. Garcia S, Turnage DM, Fisher TM. At the Heart of Nursing: A Literature Review on Health Literacy Education. J Nurs Educ. 2025;64(11):709-714. https://doi.org/10.3928/01484834-20250624-02 PMid:41191424
  3. Moghri J, Raesi R, Jafari R, Kokabi saghi F, Mahdizadeh M, Reihany yassavoli A, et al. Unveiling the roadblocks: Explaining the Threatening Factors to Patient Safety in Hospitals Receiving COVID-19 Patients: A Qualitative Study. Razavi Journal of Medicine. 2026;14(3):62-84.
  4. Connell L, Finn Y, Sixsmith J. Health literacy education programmes developed for qualified health professionals: a scoping review. BMJ Open. 2023;13:e070734. https://doi.org/10.1136/bmjopen-2022-070734 PMid:36997248 PMCid:PMC10069593
  5. Yang Y. Effects of health literacy competencies on patient-centered care among nurses. BMC Health Serv Res. 2022 Sep 19;22(1):1172. https://doi.org/10.1186/s12913-022-08550-w PMid:36123686 PMCid:PMC9484165
  6. Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promot Int. 2019 Oct 1;34(5):e1-e17. https://doi.org/10.1093/heapro/day062 PMid:30107564
  7. Morrison AK, Glick A, Yin HS. Health Literacy: Implications for Child Health. Pediatr Rev. 2019;40(6):263-277. https://doi.org/10.1542/pir.2018-0027 PMid:31152099
  8. Abel T, McQueen D. Critical health literacy and the COVID-19 crisis. Health Promot Int. 2020 Dec 1;35(6):1612-1613. https://doi.org/10.1093/heapro/daaa040 PMid:32239213 PMCid:PMC7184450
  9. Hameed S, Humayun A, Yaqoob M, Rehm MH. Patient Safety Culture: A Healthcare Provider's Prospect. Cureus. 2023 Dec 5;15(12):e49989. https://doi.org/10.7759/cureus.49989
  10. Rahman M, Awan MA, Awab O, Khan SS, Ahmed S, Rashid A. Assessment of patient safety culture in Pakistani Hospitals: A Baseline study for development of patient safety framework. RMJ. 2019; 44(3): 432-435.
  11. Liu R, Zhao Q, Yu M, Chen H, Yang X, Liu S, Okan O, Chen X, Xing Y, Guo S. Measuring General Health Literacy in Chinese adults: validation of the HLS19-Q12 instrument. BMC Public Health. 2024 Apr 15;24(1):1036. https://doi.org/10.1186/s12889-024-17977-1 PMid:38622565 PMCid:PMC11017570
  12. Sorra J, Yount N, Famolaro T, et al. AHRQ Hospital Survey on Patient Safety Culture Version 2.0: User's Guide. (Prepared by Westat, under Contract No. HHSP233201500026I/HHSP23337004T). Rockville, MD: Agency for Healthcare Research and Quality; September 2019. AHRQ Publication No. 19-007.
  13. Cocchieri A, Pezzullo AM, Cesare M, De Rinaldis M, Cristofori E, D'Agostino F. Association between health literacy and nursing care in hospital: A retrospective study. J Clin Nurs. 2024;33(2):642-652. https://doi.org/10.1111/jocn.16899 PMid:37807642
  14. McCaskill A, Gasch-Gallen A, Montero-Marco J. The effect of nurse health literacy interventions on patient health literacy scores in specialty consultations: a quasi-experimental study. BMC Nurs. 2024 Oct 25;23(1):786. https://doi.org/10.1186/s12912-024-02447-1 PMid:39455966 PMCid:PMC11520141
  15. Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, Montazeri A. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One. 2022 Jul 15;17(7):e0271524. https://doi.org/10.1371/journal.pone.0271524 PMid:35839272 PMCid:PMC9286266
  16. Rochefort CM, Beauchamp ME, Audet LA, Abrahamowicz M, Bourgault P. Associations of 4 nurse staffing practices with hospital mortality. Med Care. 2020;58(10):912-918. https://doi.org/10.1097/MLR.0000000000001397 PMid:32833938 PMCid:PMC7641184
  17. Halinen M, Tiirinki H, Rauhala A, Kiili S, Ikonen T. Root causes behind patient safety incidents in the emergency department and suggestions for improving patient safety - an analysis in a Finnish teaching hospital. BMC Emerg Med. 2024 Nov 7;24(1):209. https://doi.org/10.1186/s12873-024-01120-9 PMid:39506678 PMCid:PMC11542263
  18. Paakkari L, Okan O. COVID-19: health literacy is an underestimated problem. Lancet Public Health. 2020;5(5):e249-e250. DOI: 10.1016/S2468-2667(20)30048-8 https://doi.org/10.1016/S2468-2667(20)30086-4 PMid:32302535 PMCid:PMC7156243
  19. Okan O, Bauer U, Levin-Zamir D, Pinheiro P, Sørensen K. International Handbook of Health Literacy. Bristol: Policy Press; 2019. https://doi.org/10.56687/9781447344520
  20. Voigt-Barbarowicz M, Brütt AL. The Agreement between Patients' and Healthcare Professionals' Assessment of Patients' Health Literacy-A Systematic Review. Int. J. Environ. Res. Public Health. 2020; 17(7):2372. DOI: 10.3390/ijerph17072372 https://doi.org/10.3390/ijerph17072372 PMid:32244459 PMCid:PMC7177784
  21. Yen PH, Leasure AR. Use and Effectiveness of the Teach-Back Method in Patient Education and Health Outcomes. Fed Pract. 2019 Jun;36(6):284-289
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 26 May 2026

Files

Share

How to cite

Statistics