Health Literacy, Patient Activation, and Antibiotic Use Among Hospitalized Patients

Objective: This study examined the associations of health literacy and patient activation with antibiotic use behavior among hospitalized patients. In addition, the mediating role of patient activation in the relationship between health literacy and antibiotic use behavior was examined.Methods: A descriptive cross-sectional study was conducted with 237 adult patients admitted to a public hospital. Data were obtained using the “Personal Information Form, Antibiotic Use Scale, Patient Activation Measure, and Health Literacy Scale”. Descriptive analyses, Pearson correlation, hierarchical linear regression, and mediation analysis using PROCESS Macro Model 4 were performed.Results: Greater health literacy (r = −0.339, p < 0.01) and higher patient activation (r = −0.293, p < 0.01) were both associated with lower levels of inappropriate antibiotic use. In the adjusted hierarchical regression model, health literacy remained significantly associated with inappropriate antibiotic use (β = −0.155, p = 0.049). Mediation analysis also showed a statistically significant indirect association through patient activation (B = −0.004, 95% CI [−0.008, −0.001]), consistent with partial mediation.Conclusion: The findings indicate that both health literacy and patient activation are associated with more appropriate antibiotic use among hospitalized patients. Strategies aimed at improving these factors may support antimicrobial stewardship by encouraging responsible antibiotic use. Furthermore, the observed indirect association through patient activation suggests that patients' active involvement in healthcare may be relevant to the association between health literacy and antibiotic use behavior.