BackgroundHealth literacy, or the ability to access, understand, appraise and apply health information, is central to individuals’ health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe.MethodsA total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy.ResultsInternal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill.ConclusionsThis study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan.Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1835-x) contains supplementary material, which is available to authorized users.
A three-item sense of coherence (SOC) scale was developed, incorporating the definitions of the three subordinate concepts of SOC for use in population surveys. A cross-sectional internet survey was conducted in the latter part of July 2006. Cronbach's alpha was 0.84. The correlation coefficient of SOC-13 and the newly devised University of Tokyo Health Sociology version of the SOC Scale (SOC-3-UTHS) was 0.51. As regards correlation with a health index, SOC-3-UTHS had a significant association, although this association was somewhat weaker than that of SOC-13. Therefore, certain levels of convergent and concurrent validities of SOC-3-UTHS have been indicated.
The Japanese version of the PHCS has a Cronbach a coefficient of 0.83 and is considered reliable. In research subjects, a relationship was observed between high PHCS and good health habits such as eating breakfast, efforts to eat 30 different kinds of food every day, controlling sodium intake, abstaining from drinking and smoking, weight control, exercise, and awareness of one's own health indicators. No relation was found between PHCS results and environmental factors and health related habits such as the tendency to snack between meals or attend regular health checkups. In contrast, PHCS was influenced by age and educational background, as well as generalized self efficacy and barriers to health related information access. Accordingly, the research was largely successful in showing the reliability and validity of the Japanese version of PHCS.
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