The rising prevalence of metabolic syndrome and its serious side-effects have drawn the attention of researchers to the importance of adherence to self-care behavior and recognizing its related factors such as patients' health literacy. Objective: This study aimed at determining the relationship of health literacy with adherence to self-care behaviors in patients with metabolic syndrome living in Rasht City, Iran, in 2016. Materials and Methods: This analytical cross-sectional study has been conducted on 184 patients with metabolic syndrome who referred to selective specialist clinics of Rasht. The subjects were recruited by consecutive sampling method. The study data were collected with a three-part research instrument consisting of a disease-related and demographic questionnaire, hypertension self-care activity level effects, and health literacy for Iranian adults. The obtained data were analyzed by descriptive and inferential statistics (The Chisquare test and multiple logistic regression). Results: The findings have shown that a high percentage of samples have adhered to not smoking (90.2%) and avoidance of alcohol consumption (98.9%), and a low percentage to diet (21.2%) and physical exercise (18.5%). Most samples had adequate health literacy (44.6%). Their total health literacy had only a significant relationship with self-care behaviors related to losing weight (P=0.0001). On the whole, regression test analyses confirmed the predicting ability of decision making and health literacy behaviors in adherence to medication (β=0.006; 95%CI=1.269-2.948; P=0.001), diet (β=1.525; 95%CI=2.108-10.006; P=0.001), smoking (β=1.244; 95%CI=1.814-6.632; P=0.001), and weight control (β=0.931; 95%CI=1.458-4.415; P=0.001). Conclusion: The findings of the research call for further attention to health literacy promotion, especially in decision making and behavior dimension in patients with metabolic syndrome.