Background: Health literacy is a determinant of health and assessed globally to inform the development of health interventions. However, little is known about health literacy in countries with one of the poorest health indicators worldwide, such as Afghanistan. Studies worldwide demonstrate that women play a key role in developing health literacy. Hence, this study's purpose is to explore health literacy of women in Afghanistan and the associated factors.Methods: From May to June 2017, we randomly recruited 7–10 women per day at the hospital in Ghazni, a representative province of Afghanistan. Two trained female interviewers interviewed 322 women (15–61 years old) orally in Dari or Pashto on a voluntary basis and assessed their health literacy using the HLS-EU-Q16, associated socio-demographics, and health behavior.Results: Health literacy of women (among educated and illiterates) is low even compared to other Asian countries. Health literacy is linked to age and education. We found mixed evidence of the relationship between health literacy and contextual factors, help-seeking, and health-related behavior.Conclusion: This study provides novel data on health literacy and astonishing insights into its association with health behavior of women in Afghanistan, thus contributing to health status. The study calls for recognition of health literacy as a public health challenge be addressed in Afghanistan and other low-income countries affected by crises.

Issue addressed While multiple studies worldwide reveal the strong impact of various determinants on health literacy, empirical data on the link between health literacy and other important dimensions of health equity (such as quality of life, beliefs and health literacy in crisis‐affected religious countries such as Afghanistan) is scarce. To inform and develop promising health promotion for people in need, we analysed the relationship between health literacy, quality of life and spiritual and religious beliefs. Methods In this first study on health literacy in Afghanistan, we interviewed 522 men and 324 women in the Ghazni province. Besides the HLS‐EU‐16, we used Quality of Life (WHO‐QoL‐BREF) and the WHO‐SRPB‐BREF questionnaires in Dari and Pashto. We performed descriptive, uni‐ and multivariate analyses. Results The levels of HL, QoL and SRPB_coping are comparatively low among Afghan men from the Ghazni province, but higher among women on all scales. HL and QoL are positively associated with education and negatively with age (in the female subsample). HL and QoL show a moderate correlation among women but not among men. We found mixed results for the relationship between SRPB and HL or QoL. Conclusions The study highlights that health literacy is not a singular factor but related to wellbeing. So What? Health education might be promising while combining health literacy to the idea of quality of life of everyone, even those living in poor and illiterate environments.

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