Introduction: Persons with limited health literacy (HL) have difficulty in utilization of healthcare resources, and understanding, assessing, and exploiting health-related information. Poor health literacy of primary care patients is often associated with poor health outcomes, poor medication adherence, poor control of chronic illness, and higher hospitalization rates. Limited health literacy is often underrecognized by health care providers and little research has been carried out in primary care facilites in Serbia, pharmacies in particular.

Methods: We evaluated and compared the performance of the European Health Literacy Survey - short version with 12 question (HLS- EU - Q12) for detecting patients with limited/not limited  health literacy in one primary health care center and two community pharmacies. This was a pilot study with the cross sectional design on a convenient sample, excluding patients with medical education or backgorund. We collected sociodemographic data. Out of 143 patients, majority were women (68.5%), with high education (63.6%). Slightly predominant were participants from small comminites (51.7%) than the capital city. Only 12.5% patients had excellent health literacy and 32.9% showed sufficient health literacy. The remaining 54.6% of the participants had limited health literacy, including 19.6% whose health literacy was inadequate. Mean HLS-EU scale score was 31.94 ( SD = 7.56). Higher levels of HL were associated with university and post-university education (p<0.001). No empirical evidence strengthening either the link with place of residence (p=0.290), gender (p=0.797), or social status (p=0.338) were found. Additionaly, no significant differences were observed for the chronic illness, self-reported general health, self-interest in health and sourse of health information participants use (p˃0.05).

Conclusions: In conclusion, when applying the HLS-EU-Q12 to measure HL in primary care, it was found that the prevalence of limited HL is high, and the high level of HL was associated with higher levels of education at primary care patients. Other factors that could contribute to the variance in HL should further be investigated in a larger sample of primary care patients in Serbia with particular focus on patients with chronic illness.

 Health literacy and clinical healthcare settings (incl primary care)