Health literacy, vaccine literacy, and lifestyle behaviours among young adults in Pakistan: A cross-sectional study

Health literacy (HL) is a critical determinant of health behaviours and outcomes. Vaccine literacy (VL), a domain-specific extension of HL, has emerged as an important determinant of vaccination attitudes. However, evidence examining the combined relationship of HL and VL with lifestyle behaviours remains limited, particularly among young adults in Pakistan. A cross-sectional study was conducted among 587 participants aged 18 years and above in Pakistan. HL was assessed using the European Health Literacy Population Survey 2019-2021 questionnaire (HLS19-Q; 17 items; 5-point Likert scale; score range 0-100) and VL was assessed using the HLS19 vaccine literacy instrument (HLS19-VAC), both developed by the Measuring Population and Organizational Health Literacy (M-POHL) Consortium. Data were analysed using IBM SPSS Statistics (v.29) with descriptive statistics, chi-square tests, Spearmans correlation, and multiple linear regression. Mean HL score was 86.29 {+/-} 22.04 and mean VL score was 18.29 {+/-} 2.72. HL was significantly associated with gender (p < 0.001) and was the strongest independent predictor of physical activity ({beta} = 0.735, R{superscript 2} = 0.627, p < 0.001). VL was strongly associated with vaccination attitudes (r = 0.735, p < 0.001) but not with physical activity or smoking. HL and VL function as enabling rather than deterministic factors for health behaviour. Multi-component public health interventions combining HL promotion with environmental and policy-level strategies are needed.