The Antecedents and Consequences of Health Literacy in an Ecological Perspective: Results from an Experimental Analysis

Abstract

This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was measured using the 47-item HLS-EU questionnaire (HLS-EUQ47) and the Newest Vital Sign (NVS). The two measures stood in significant correlation to the outcomes of the sub-discipline of the Euro Health Consumer Index (r = 0.790 for HLS-EUQ47; r = 0.789 for NVS). The HLS-EUQ47 also stood in correlation to the percentage of population with post-secondary education (r = 0.810), the reading performance for 15-year-old students (r = 0.905), the presence of a national screening program for breast (r = 0.732) or cervical cancer (r = 0.873). The NVS stood in correlation with the unemployment rate (r = −0.778), the Gross Domestic Product (r = 0.719), the Gini coefficient (r = −0.743), the rank of the Euro Patient Empowerment Index (r = −0.826), the expenditure on social protection (r = 0.814), the Consumer Empowerment Index (r = 0.898), the percentage of adults using the internet for seeking health information (r = 0.759), the prevalence of overweight individuals (r = −0.843), the health expenditure (r = 0.766), as well as the percentage of individuals using the internet for interacting with public authorities (r = 0.755). This study provides some preliminary considerations regarding alternative means by which to study HL and proposes new methods for experimentation. The methods and the results could offer a means by which the relationship between society and overall healthcare protection could be strengthened.

Determinants and Consequences of Limited Health Literacy in Polish Society

“…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].…”

“…It revealed that limited health literacy was associated with poor health status, having more than one long-term illness and the higher use of health care services involving six or more consultations with doctors in the last 12 months [4]. 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].…”

“…It revealed that limited health literacy was associated with poor health status, having more than one long-term illness and the higher use of health care services involving six or more consultations with doctors in the last 12 months [4]. 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].…”

“…The available evidence from population studies shows that health literacy may depend on sex, age, level of education, economic and/or social status, and the type of vocational activities. In the research carried out to date, it has been demonstrated that lower HL is displayed by men rather than by women [4][5][6][7], by people having lower levels of educational attainment than by those with higher levels [4][5][6][7][8][9][10][11][12], by single people than by married people [7,13], by people with lower social status than by those with a higher status [8,11,14], by people of lower rather than those of higher economic status or income [4,[7][8][9]13,15,16] and, finally, by people living in more challenging conditions [6,8]. In most studies, there was also a general trend for HL decreasing with age [4,6,8,9,15].The efforts undertaken in the last decade resulted in a comprehensive assessment of the consequences of limited health literacy.…”

“…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.…”