Low levels of health literacy have been consistently found in Ireland. Little is known about the contextual development of health literacy in Irish community settings, especially those identified as most deprived where improved health literacy can support better health outcomes. Individual interviews and focus groups were conducted with 105 participants across one rural and one urban community in Ireland. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. Accessing and understanding health information, health literacy changing over time, perceiving health literacy as an individual responsibility, and interpersonal and community influence on health literacy were common themes for participants across both settings. The themes of health access were discussed in both community settings but presented different challenges within the rural and urban communities of focus. Consequentially, rural-urban health literacy challenges should be contextualized. Equitable access to adequate healthcare is an emerging challenge observed in Irish rural communities and a systems approach should be employed to support overall development.