ABSTRACTAimTo explore health literacy levels of primary care patients, and associations with demographic variables, frequency of visits, hospitalization rates, and self-perception of health.BackgroundHealth literacy is the ability to obtain, read, understand and apply healthcare information to inform decision-making to commence or adhere to treatment. The benefits of a population proficient in health literacy include enhanced communication, adherence to treatment, engagement in self-care, and ultimately improved health with financial savings for healthcare providers.DesignCross-sectional epidemiological study, reported using STROBE guidelines.Materials and MethodsData were collected from patients attending a primary care center in Prishtina, Kosovo from August to September 2018. Data collection included the Short Test of Functional Health Literacy in Adults (S-TOFHLA), gender, age, socioeconomic status, education, self-perception of health, number of visits to the doctor and hospital. Data were analyzed with SPSS software (version 20).ResultsParticipants (n=557) ages ranged from 15 to >65 (mean 27.82) years, were female (57.85%), Albanian (97.13%), with a response rate of 92.83%, 79% were health literate, 9% had moderate health literacy, 12% were health illiterate. Four variables determined health literacy, level of education (p < .01), gender (p = .033), hospitalization rates (p < .05), socioeconomic status of unemployed compared to being a student (p<.01).ConclusionsThere remains a need to address health literacy levels in Kosovo, through the development or adaptation of health literacy tools appropriate for this population, which will support and positively impact on patient’s wellbeing. Nurses are the best-placed professionals to implement these tools and support patients with low health literacy.Relevance to clinical practiceNurses have a key role in implementing health literacy tools and supporting patients by adapting their communication styles in accordance with each patient’s level of health literacy, which will support adherence to advice, safety and treatment outcomes.What does this paper contribute to the wider global clinical community?Health literacy is associated with level of education, gender and socioeconomic status and hospitalization rates of primary care patients.A focus on health literacy is essential to address the inequalities of health for those with marginal or inadequate health literacy.Nurses are the best-placed health care professionals to support individuals with low levels of health literacy through interventions, and adapting their communication styles.