Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)
Kristine Sørensen, Jürgen M Pelikan, Florian Röthlin, Kristin Ganahl, Zofia Slonska, Gerardine Doyle, James Fullam, Barbara Kondilis, Demosthenes Agrafiotis, Ellen Uiters, Maria Falcon, Monika Mensing, Kancho Tchamov, Stephan van den Broucke, Helmut Brand, HLS-EU Consortium, Kristine Sørensen, Jürgen M Pelikan, Florian Röthlin, Kristin Ganahl, Zofia Slonska, Gerardine Doyle, James Fullam, Barbara Kondilis, Demosthenes Agrafiotis, Ellen Uiters, Maria Falcon, Monika Mensing, Kancho Tchamov, Stephan van den Broucke, Helmut Brand, HLS-EU Consortium
Abstract
Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.
M ethods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.
R esults: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.
Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association.
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References
- Kickbusch I, Maag D. Health literacy. In: Heggenhougen K, Quah S, editors. International Encyclopedia of Public Health. San Diego: Academic Press; 2008. pp. 204–11.
- Pleasant A, Kuruvilla S. A tale of two health literacies: public health and clinical approaches to health literacy. Health Promot Int. 2008;23:152–9.
- European Commission. Together for Health. A Strategic Approach for the EU 2008–2013. COM(2007) 630 final. Brussels: European Commision, 2007.
- The Lithuanian Presidency on behalf of the European Union 2013. The Vilnius Declaration. Call for Action. Sustainable Health Systems for Inclusive Growth in Europe. Vilnius: The Lithuanian Presidency on behalf of the European Union; 2013.
- World Health Organisation Regional Office for Europe. Health 2020. A European Policy Framework Supporting Action Across Government and Society for Health and Well-Being. Copenhagen: World Health Organisation Regional Office for Europe; 2012.
- Kickbusch I, Pelikan J, Apfel F, Agis T, editors. Health Literacy: The Solid Facts. 1st edn. Copenhagen: World Health Organisation Regional Office for Europe; 2013.
- Pleasant A. Health literacy around the world: Part 1. Health literacy efforts outside the United States. Appendix A. Round Table on Health Literacy. Roundtable on Health Literacy; Board on Population Health and Public Health Practice; Institute of Medicine. Washington (DC): National Academies Press (US); 2013.
- HLS-EU Consortium. The European Health Literacy Project Grant Agreement 2007113. Luxembourg: European Agency for Health and Consumers; 2008.
- Sorensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.
- WHO Regional Office for Europe. Ottawa Charter for Health Promotion. Copenhagen: WHO Regional Office for Europe; 1986.
- Sorensen K, Van den Broucke S, Pelikan J, et al. Measuring health literacy in populations: illuminating the design and development process of HLS-EU-Q. BMC Public Health. 2013;13:948.
- HLS-EU Consortium. Comparative Report on Health Literacy in Eight EU Member States. The European Health Literacy Project 2009–2012. Vienna: Ludwig Boltzmann Institute for Health Promotion Research; 2012.
- Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36:588–94.
- Parker RM, Ratzan SC. Health literacy: a second decade of distinction for Americans. J Health Commun. 2010;15:20–33.
- Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3:514–22.
- GESIS. Eurobarometer: Sampling and fieldwork [Internet]. [last retrieved 2015 March 10]. Available from:
- Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva; 2008.
- Van der Heide I, Rademakers J, Schipper M, et al. Health literacy of Dutch adults: a cross sectional survey. BMC Public Health. 2013;13:179.
- Brach C, Dreyer BP, Schyve P, et al. Attributes of a Health Literate Organization. New York: Institute of Medicine; 2012.
Source: PubMed