Comprehensive health literacy in general populations – An international comparison

Abstract

Background The HLS-EU study in 2011 demonstrated for 8 EU Member States that there exists limited comprehensive health literacy for considerable proportions of the general population, that there is a social gradient for health literacy and that limited health literacy has problematic consequences for healthy lifestyles, self-reported health and utilization of professional health services. It was also shown that distributions and associations of health literacy differ considerable between countries. WHO-Europe started the Acton Network on Measuring Population and Organizational Health Literacy (M-POHL) to measure health literacy regularly with the Health Literacy Survey 2019 (HLS19). Methods Based on the design and instrument of the HLS-EU study (to allow comparisons for countries participating in both surveys) a core questionnaire was developed for measuring comprehensive health literacy and its relevant correlates. Optional packages were created to measure, among others, digital health literacy and its most relevant correlates. Data were collected from probability samples of at least 1.000 respondents per country for the general population 18+ by personal interviews, telephone interviews or internet surveys in at least 15 member states of the WHO-Europe region. Results Distributions for indices, scales and levels of comprehensive health literacy will be presented as well as correlations and regressions for associations of health literacy with social determinants and with consequences for selected life style indicators, indicators for self-reported health and use of professional health care services. Conclusions Preliminary results show that the general trends of the HLS-EU study concerning health literacy hold true for HLS19 and that there are considerable differences between participating countries. Health literacy is relevant for health policy in all countries, but to understand the differences between countries a more detailed analysis is necessary.

Psychometric qualities of the HLS-EU-Q16 instrument for parental health literacy in Swedish multicultural settings

“…Existing translations of HLS-EU-Q16 into different languages (Arabic, Dari, Farsi, Somali and Sorani) were also available as a support to interpreters. Each question of HLS-EU-Q16 was answered by choosing one response of the available choices: ‘very difficult’, ‘fairly difficult’, ‘fairly easy’ and ‘very easy’ [ 7 ]. The original version of HLS-EU-Q16 measures HL in the three domains of health care (seven items), disease prevention (five items) and health promotion (four items) [ 7 ].…”

“…For the psychometric analyses of HLS-EU-Q16, each of the 16 questions were coded according to the following: ‘very difficult’ = 1 point, ‘fairly difficult’ = 2 points, ‘fairly easy’ = 3 points or ‘very easy’ = 4 points, giving a total of 16–64 scores [ 7 ]. The HLS-EU-Q16 manual recommends dichotomising the answers from HLS-EU-Q16 (‘very difficult’/‘fairly difficult’ = 0, ‘fairly easy’/‘very easy’ = 1; total 0–16 scores) and dividing the total scores into three categories of HL (‘likely inadequate HL ‘(0–8 scores), ‘likely problematic HL’ (9–12 scores) and ‘likely sufficient HL’ (13–16 scores) [ 7 ], which in this study was merely used for the pre-analysis of HL.…”

“…Initially three participants with more than two incomplete responses in the HLS-EU-Q16 items were excluded from the analyses according to the HLS-EU-Q16 manual [ 7 ]. Incomplete responses from HLS-EU-Q16 items ( N = 29 (9.5%)) were treated as missing values and replaced in the analyses by series means as the percentage of missing values for each item in HLS-EU-Q16 was < 5% (Additional file 1 : Table 1).…”

“…Pre-analyses ( N = 190), based on the dichotomisation of the HLS-EU-Q16 scores [ 7 ] showed that the majority, more than 60% of the participants, would end up in the category of ‘likely sufficient HL’. For this reason, the analyses of psychometric properties were based on the sum of the total HLS-EU-Q16 scores, giving a wider distribution of HL scores.…”

“…HLS-EU-Q16 (in English) is a constructed and validated short version of HLS-EU-Q47. However, as a short version it has a more limited conceptual representation [ 6 , 7 ].…”