Determinants of health literacy in the general population: results of the Catalan health survey

Abstract

Background Health Literacy (HL) is the knowledge and competence to access, understand, appraise, and apply health information for health judgment. We analyze for the first time HL level of Catalonia’s population. Our objective was to assess HL of population in our area and to identify social determinants of HL in order to improve the strategies of the Healthcare Plan, aimed at establishing a person-centered system and reducing social inequalities in health. Methods This was a cross-sectional study based on the Health Survey for Catalonia (ESCA, Enquesta de Salut de Catalunya ), which included the 16 items of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). The statements in the questionnaire cover three different health literacy domains: Health Care, Disease Prevention, and Health Promotion. HL was categorized in three levels: Sufficient, Problematic and Inadequate. Chi-square tests were performed to compare the percentages of subjects with adequate or inadequate HL across sociodemographic and health-related variables. Variables showing significant differences were included in a stepwise logistic regression to predict inadequate HL level. Results The questionnaire was administered to 2433 subjects aged between 15 and 98 years old (mean of 45.9 years, SD 18.0). Overall, 2059 subjects (84.6%) showed sufficient HL, 250 (10.3%) inadequate HL, and 124 (5.1%) problematic HL, with no significant differences between men and women ( p = 0.070). A logistic regression analysis showed that low health literacy is associated with a lower level of education (OR 2.08, CI 95% 1.32–3.28, p = 0.002), low socioeconomic status (OR 2.11, CI 95% 1.42–3.15, p < 0.001) and a physical limitation to perform everyday activities (OR 2.50, CI 95% 1.34–4.66, p = 0.004). We also found a more modest association with low physical activity, having a self-perceived chronic disorder and performing preventive activities. Conclusions Catalonia has a high percentage of subjects with sufficient HL. Education level, socioeconomic status and physical limitations were the factors with the strongest contribution to inadequate or problematic health literacy. Although these results are likely to be country-specific, the factors identified will allow policymakers of areas with similar socioeconomic profiles to identify groups with high risk of problematic or inadequate HL, which is essential for a successful patient-centered model of care.

Determinants and Consequences of Limited Health Literacy in Polish Society

“…The frequency of limited HL in Polish society was much higher than among respondents from Catalonia as reported in a recent study by Garcia-Codina et al [29]. They performed a survey of HL on a group of 2433 inhabitants [27].…”

“…Other studies, in which national versions of the HL questionnaire developed within the HLS-EU project were used, confirmed that low HL may be associated with people's poor self-assessment of health status [12,20], the prevalence of long-term illnesses [12], the higher utilisation of health care resources [14,21], and a lower level of physical activity [22][23][24].Although the scope of information which arises from the HLS-EU-Q47 is extensive, it appears that the size of the tool may result in reduced compliance of respondents, especially if the questionnaire is used as a part of a survey which is also focused on other issues. Therefore, a shortened but also validated, the 16-item version has been used in many surveys (HLS-EU-Q16) [5,12,[25][26][27][28][29]. The HLS-EU-Q16 questionnaire has been used not only in direct interviews with respondents [27,29] but also for telephone-based studies [12,26,30] or online surveys [31].…”

“…Therefore, a shortened but also validated, the 16-item version has been used in many surveys (HLS-EU-Q16) [5,12,[25][26][27][28][29]. The HLS-EU-Q16 questionnaire has been used not only in direct interviews with respondents [27,29] but also for telephone-based studies [12,26,30] or online surveys [31]. In some studies, the paper-based questionnaire was self-administered by respondents [32].The only previous study of HL on a nationally representative sample of the Polish population was undertaken as part of the HLS-EU project [4] using the HLS-EU-Q47 questionnaire.…”

“…Although the scope of information which arises from the HLS-EU-Q47 is extensive, it appears that the size of the tool may result in reduced compliance of respondents, especially if the questionnaire is used as a part of a survey which is also focused on other issues. Therefore, a shortened but also validated, the 16-item version has been used in many surveys (HLS-EU-Q16) [5,12,[25][26][27][28][29]. The HLS-EU-Q16 questionnaire has been used not only in direct interviews with respondents [27,29] but also for telephone-based studies [12,26,30] or online surveys [31].…”

Pandemic related Health literacy – A Systematic Review of literature in COVID-19, SARS and MERS pandemics

“…(15,16) Variations in general health literacy have been linked to multiple determinants ranging from education to socioeconomic statuses. (17) Likewise, this is expected for pandemic related health literacy.…”