Functional, communicative, and critical health literacy and stroke prevention behaviors among hypertensive patients in a Bugis Coastal Community, Indonesia

Background: Health literacy plays an important role in hypertension management and stroke prevention; however, conventional health literacy assessment approaches often overlook sociocultural contexts that shape health-related decision-making in culturally cohesive communities. This study assessed Functional, Communicative, and Critical (FCC) Health Literacy related to stroke prevention among hypertensive patients in a Bugis coastal community in Indonesia using a culturally contextualized approach informed by the Puangrimaggalatung framework. Methods: A cross-sectional survey was conducted among 108 hypertensive patients in the coastal area of Lake Tempe, Indonesia. Data were collected using a culturally adapted and validated FCC Health Literacy questionnaire and analyzed using descriptive, bivariate, repeated-measures, exploratory factor, and multivariable regression analyses. Results: Most respondents were older than 45 years, had low educational attainment, were predominantly homemakers, and had been diagnosed with hypertension for 1–5 years. Functional and communicative health literacy were generally adequate in understanding health information and communicating with healthcare providers. In contrast, critical health literacy was weaker, especially in evaluating and applying health information to decisions related to diet, physical activity, and hypertension management. Formal comparison confirmed that Critical Health Literacy scores were significantly lower than Functional and Communicative Health Literacy scores. Overall, health literacy was distributed in the moderate (50.0%) and high (48.15%) categories. Education level was significantly associated with critical health literacy, while occupation showed a weaker but significant association. Higher critical health literacy was additionally associated with better stroke prevention behaviors, including medication adherence, blood pressure monitoring, dietary restriction, and participation in hypertension education activities. Discussion: Local cultural contexts may influence dietary norms and health-related decisions. These findings indicate that moderate-to-high health literacy does not necessarily translate into strong critical health literacy and highlight the importance of culturally responsive interventions that strengthen individuals’ ability to critically evaluate health information for hypertension management and sustainable stroke prevention.