Search

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To date, there are only a few studies analyzing health professionals' health literacy (HL). Mostly, the focus has been on personal rather than professional HL. To bridge this gap, a new concept and an associated survey instrument have been developed in a three-country consortium. The aim of this article was to examine the professional HL of general practitioners (GPs) in Germany., Method: The survey instrument used consists of 34 items and assesses subjective difficulties in four dimensions to be addressed in promoting patients' HL: "information and knowledge management", "conveying information and knowledge", "patient-centred communication", "professional digital HL". A total of 297 GPs and internists working in general practice were surveyed online over the summer of 2022. The professional HL (score from 0 to 100) was analyzed descriptively and examined in relation to gender, selected job-related, and organizational characteristics, using multiple linear regression., Results: Depending on the four areas, GPs achieved approximately half to almost three-quarters of the highest possible score. The dimension "patient-centred communication" was perceived as the easiest, followed by "information and knowledge management", and "conveying information and knowledge". The most challenging dimension was "professional digital HL". According to the multivariate analysis, professional HL shows a relation to gender, organizational framework and training conditions, job duration, and coping with the diversity of digital information. The strength of correlation varies by area and is rather weak in some instances., Conclusions: The results demonstrate the importance of promoting professional HL of GPs and provide numerous indications of where to start. They also indicate that the regression models should be extended by additional determinants, since the included variables can explain only a small amount of variance., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

A key prerequisite for the successful digital transformation of the healthcare system is a well-developed level of digital health literacy (DHL) among the population. DHL is the ability to deal with health-relevant digital information and information options with the aim of promoting and maintaining health and well-being for oneself and one's environment. This article examines the discussions about digital health literacy, the existing studies and measurement tools used in them, the data situation in Germany, and current challenges.DHL consists of various sub-competencies that reflect current digital information behavior, opportunities, and risks. The data situation is very heterogeneous due to different study designs and instruments, which limits the informative value. Two representative studies, HLS-Ger‑2 by Bielefeld University and the study by AOK Rheinland/Hamburg and the Leibniz-WissenschaftsCampus, both indicate a high proportion of people with low DHL despite different methods. Both nationally and internationally, DHL is subject to a social gradient and is associated with educational level, social status, financial deprivation, and age.According to the current empirical data, the acquisition of DHL in Germany is still insufficient, so there is a great need for action. The necessary legal framework conditions have been established, but there is still a lack of reliable and financial resources, as well as a solid data basis on DHL at population level. This is essential to identify vulnerability factors and to prepare and evaluate the implementation of measures. In addition, there is a need for an in-depth conceptual discussion on DHL that builds on the established health literacy concept and addresses the emerging health-related infodemic and its consequences for DHL., (© 2024. The Author(s).)

Professional health literacy among nurses in Germany: Results of a quantitative, cross-sectional survey Abstract. Background: Little is known about the professional health literacy (HL) of nurses, i.e., how well they are able to promote patients' HL. Existing studies have focused on personal HL, which does not entirely align with professional HL. Therefore, a new concept and questionnaire for professional HL have been developed and implemented for the first time. The results obtained for nurses in Germany are analysed with this article. Research question: It is asked how professional health literacy (HL) is distributed among nurses and which factors are associated with it. Methods: Data were collected through an online survey where nurses were asked about the difficulties they encounter in managing tasks in four dimensions: (1) information and knowledge management, (2) explaining and conveying information, (3) patient-centered communication, and (4) professional digital health literacy. Descriptive and multivariate, linear regression methods were used for analysis. Results: The 624 respondents rated the fourth dimension as the most difficult. The first and second dimensions were rated as similarly difficult, while the third dimension was considered least difficult. Higher professional HL is linked to better self-assessed training and framework conditions. Conclusion: Despite a relatively positive self-assessment, the results indicate areas that require improvement and should be addressed urgently.

Aim: Many health care systems are characterized by their high complexity and intransparency. Finding one's way through the multitude of services and finding the right place requires high navigational health literacy (NHL). NHL is defined as the ability to manoeuvre through the health care system and deal with the information required to do so. However, so far, there has been a lack of data on the population's NHL. The objective of this article is to analyse empirically the NHL in Germany and its association with socio-demographic and economic factors., Method: NHL was surveyed with an instrument (HLS 19 -NAV) newly developed by an international working group, measuring the self-assessed difficulties in relation to 12 navigation-related information tasks. The HLS 19 -NAV has already been used in 8 countries, including Germany. In Germany, data on NHL was collected from 2,151 adult residents in a representative cross-sectional study. The relationship between socio-demographic and economic factors, and NHL was examined by using methods of analysis of variance and multivariate linear regression analysis., Results: Approximately 80% of the respondents showed low NHL with a mean score of 41.5 out of a possible 100 points. Those with low socio-economic resources, people of advanced age, people who had migrated to Germany or who were limited by health issues had a particularly low NHL. However, even people with good resources had a relatively low NHL. In contrast, the mean score was significantly higher among health professionals., Conclusions: In recent years, numerous efforts have been made to reduce navigational difficulties and to better guide patients through the German health care system. However, according to the results of the study, there is still need for further action. Above all, structural measures are required: this includes the creation of sufficient, reliable information on the health care system and its organizations as well as the implementation of navigation aids, health care pathways and the creation of a health-literate health care system including organizations and health professionals that contribute to strengthening NHL in general., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: So far, there are hardly any data on the health literacy of persons with a migration background in Germany. The aim of the article was to analyse the health literacy of this population group - particularly persons who originate in Turkey and the former Soviet Union (FSU)., Methodology: In summer 2020, face-to-face interviews with 525 persons with FSU and 512 persons with Turkish migration background above the age of 18 were carried out across Germany. The interviews were conducted in German, Russian or Turkish. Health literacy was assessed using the internationally developed HLS 19 -Q47 instrument. Bivariate and multivariate analyses were carried out for each immigration group separately considering demographic, socioeconomic, linguistic and migration-specific variables., Results: Overall, around half of the respondents had low health literacy, with no differences between the immigration groups. In both groups, low educational levels, socioeconomic disadvantages, limited German literacy skills, older age, multiple chronic illnesses and personal experience of immigration were linked with lower health literacy. In multivariate analyses, associations between health literacy and literacy skills, social status, financial deprivation, and chronic illness remained; however, after adjustment, no significant difference persisted by immigration generation., Conclusion: While a significant proportion of persons with Turkish or FSU migration background in Germany have difficulty dealing with health information, compared with existing studies, they do not have a lower health literacy than the population without a migration background. People with a migration background are therefore not to be regarded as vulnerable to low health literacy in general. Particularly socioeconomically disadvantaged subgroups display low health literacy. Interventions should therefore target these subgroups specifically and consider their living conditions. In addition, people with low literacy skills and German proficiency have greater difficulties in processing health information. This highlights the need for multilingual information, but also for multimedia materials in plain language. Structural measures are necessary for a health-literate health system and for reducing health inequalities., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: While the availability and variety of digital information on health offers a range of opportunities, they also pose a number of challenges, because the need for digital health literacy (DHL) is increasing along with the growing range of information possibilities. The aim of this study was to analyze the extent of DHL in the German population, key determinants, and consequences for the use of digital health information resources., Methodology: The analysis was based on data from the Second Health Literacy Survey Germany (HLS-GER 2), consisting of a representative sample of n=2,151. A questionnaire developed as part of the international comparative study HLS 19 was used to measure DHL, its determinants, and the use of digital health information resources. Bivariate and multivariate analyses were conducted., Results: Overall, 75.8% of the population had low DHL. In particular, low literacy skills, older age, a lower level of education and social status were associated with low DHL. Multivariate analysis also indicated a strong association between DHL and general health literacy (HL). Low DHL led to lower use of digital health information resources., Conclusion: The results underscore the importance of promoting DHL in the general population and especially among groups with low DHL. Efforts in this area should include general HL, as it is closely related to DHL. Strengthening DHL is also a socially important task in order to increase the still low use of digital health information resources in Germany and, in general, to meet the increasing digitalization of the health care system., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: This article compares the results of two health literacy (HL) surveys of the population in Germany over time. The first survey was conducted in 2014, the second in 2020. The changes in GK, measured by the degree of subjectively assessed difficulties in individual information tasks in the three areas of health care, prevention, health promotion, in the total population and in subgroups are examined., Methodology: The analyses were based on population-representative cross-sectional data collected in 2014 and 2020. An internationally coordinated questionnaire (HLS-EU-Q47) was used to measure GK. Changes in the population groups were analysed uni- and bivariately as well as multivariately in a trend analysis., Results: The HL of the German population has worsened statistically significantly within six years. This can be observed in all three overall domains. This effect was particularly evident among people with low social status and financial deprivation., Conclusion: Over time, dealing with health and disease-related information has become more difficult. As this development is mainly driven by socioeconomically disadvantaged population groups, it has apparently increased social inequality in the health sector. Promoting HL - as this and other studies show - is more important for the society than ever and should be given special attention in relation to the above-mentioned population groups., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The "DNVF Memorandum Health Literacy (Part 2): Operationalization and Measurement of Health Literacy from the Perspective of Health Services Research" of the German Network for Health Services Research represents the continuation of the memorandum "DNVF Memorandum Health Literacy (Part 1): Background, Subject and Issues in Health Services Research". In addition to the general requirements for the measurement of health literacy, this memorandum also deals with the specific requirements, such as the differentiation of health literacy from related constructs, the differences between performance-based and self-assessment methods, the differences between generic and specific instruments, the use of screening instruments, and the measurement of health literacy in special populations. Furthermore, special considerations about the measurement of digital health literacy, potentials of qualitative and participatory research approaches as well as research ethics in the measurement of health literacy will be elaborated on. A special emphasis is placed on practical relevance for health services researchers. Finally, the authors will give an outlook on challenges and research desiderata in connection with the measurement of health literacy in the context of health services research., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Aim: The aim of this study was to compare the general and digital health literacy (HL) of the German population before the outbreak of the COVID-19 pandemic and during its persistence and to investigate different changes in population groups., Methodology: The analyses are based on population representative cross-sectional data collected in 2019/2020 before and 2020 during the pandemic. An internationally coordinated questionnaire (HLS 19 ) was used. Changes in groups were analyzed bivariate., Results: The results showed that the HL of the population in Germany tended to improve during the pandemic. This effect was especially evident with regard to the evaluation of health information and in the area of digital HL. Women, people with low or medium education, younger people and those with a migration background appeared to have benefited to a more than average extent. For older people, there was no change, and for those with multiple chronic conditions, the results even indicated a worsening., Conclusion: The systematic exposure to clearly structured and continuously repeated health information during the COVID-19 pandemic seems to have improved the ability to process health-related information in the German population. In particular, there has been an increase in competence in dealing with digital information media, which are being increasingly used to communicate health information. However, there are some large differences between different population groups., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Recently, several acts have been passed by the German Ministry of Health to drive the digital transformation of the healthcare system. These aim at far-reaching innovations to improve care and increase the efficiency of the healthcare system. At the same time, the demands on users in dealing with digital applications and information are increasing. Digital health literacy is thus becoming particularly relevant. However, available studies show that the digital health literacy of the population in Germany is often limited. This paper explores challenges, gaps, and prospects regarding the implementation of these new digital health policies, particularly in terms of the implications for improving digital health literacy and increasing user involvement and participation by providing six major aspects that should be considered., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: People with chronic illnesses (Pwci) face a variety of challenges in managing their illness and using health care. Thus, their need for information and health literacy (HL) is high. While the topic has already been addressed in international research, there is a lack of studies on health literacy among Pwci in Germany., Objectives and Methods: The aim was to analyze HL among Pwci in Germany in more detail. For this purpose, cross-sectional data from a total of 499 Pwci of the German Health Literacy Survey (HLS-GER) were used. HL was assessed with the European Health Literacy Survey Questionnaire (HLS-EU-Q 47). Possible differences in the distribution of low HL by socio-demographic characteristics (gender, age, social status, financial resources, educational level and functional HL (assessed with the Newest Vital Sign (NVS)) and disease-related characteristics (number of diseases and disease duration) were tested using chi-square tests. To investigate the influence of these factors on low HL among Pwci, a multiple logistic regression was performed., Results: Low HL was found in 72.7% of Pwci. Low HL differed greatly according the single domains healthcare, prevention and health promotion. Low social status (OR: 4.4 [1.8; 10.7]), low financial resources (OR: 2.0 [1.2; 3.1]), limited literacy skills (OR: 2.7 [1.4; 5.0]), and an intermediate-level of education (OR: 0.5 [0.3; 0.9]) were associated with low HL in multiple logistic regression. Number and duration of chronic illnesses were not significantly associated with low HL., Conclusion: The analysis provides initial findings for Germany that need further investigation. However, they already provide important indications for intervention development. It is necessary to develop target group-specific interventions for strengthening personal health literacy of Pwci, specifically addressing people with low social status, low financial resources and limited literacy. To avoid stigmatization, it is also important to address the information demands in the personal environment. Interventions should make it easier to search for, acquire and process information and thus contribute to reducing inequality., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

More than half of the German population has difficulties in dealing with health information. It is an important task of health services research to examine how healthcare professionals and health care organizations can meet this challenge. The DNVF Memorandum Health Literacy (Part 1) defines the terms of individual and organizational health literacy, presents the national and international state of research and ethical aspects of health literacy research in health care settings. The relevance of health literacy research is worked out in different phases of life, for different target groups and in different healthcare contexts. Central research topics and future research desiderata are derived., Competing Interests: Dr. Christoph Kowalski ist Mitarbeiter der Deutschen Krebsgesellschaft. Alle anderen Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Health literacy is a frequently discussed concept. Previous studies indicate that older people more often experience difficulties in dealing with health-relevant information compared to the general population. However, existing studies consider older people as a homogeneous group. Therefore, there is a research gap on assessment of health literacy among different subpopulations of older adults., Objectives and Methods: The aim of the study is to make a detailed assessment of health literacy in old age. For this purpose, we conducted an age-specific analysis of HLS-GER study data using descriptive analytic procedures. Analysis of variance (ANOVA) was used to assess the association between mean health literacy scores and age., Results: A large proportion of the older population from the HLS-GER sample of 475 persons aged 65 and older has limited health literacy. Perceived difficulties arise in particular in the domains health care as well as in finding and assessing health information. The results also show statistically significant differences between the age groups. Especially those aged 76 and above have a significantly lower level of health literacy in all domains and dimensions than younger older people., Conclusion: These results underline the need for more age-differentiated health literacy research. Additionally, more attention needs to be given to age differentiation in the development of interventions as well., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

In recent years, studies on health literacy of the population have been conducted in many countries. Most of them show that health literacy levels are worse than expected and that large parts of the population have low health literacy levels. National strategies and action plans to promote health literacy have been developed in many countries to address these results. Following these examples, a National Action Plan on Health Literacy was also developed for Germany. A panel of 15 experts was involved in the 2-year development process. Based on an analysis of available literature on health literacy and existing action plans, the concept, objectives and priorities of the action plan were defined, and recommendations were developed. The National Action Plan on Health Literacy formulates recommendations in the fields of living environments, the healthcare system, chronic illness, and research., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

The Prevention Act has greatly promoted the implementation of interventions focusing on the physical activity of nursing home residents. However the goal-compliant implementation and long-term sustainability of such offers is often associated with major challenges.Over a period of 2.5 years, the program "Lübeck Worlds of Movement Model" was evaluated during its implementation in nursing homes in the city of Lübeck. The main objective was to discover promoting or inhibiting factors of the implementation process. Alongside other data collection, 52 partially structured, problem-oriented interviews were conducted with participating professionals (e.g., employees of the nursing homes, trainers). They were analyzed and structured in a topic-based manner.A number of promoting and inhibiting factors were identified. The structure of the program supports the participants' and trainers' motivation to stick to the program. However, it was not well received nor permanently adopted in all areas of the nursing homes. The lack of involvement of nursing staff and of anchoring the program in the organizational structure and culture of the facilities were two of the most important inhibiting factors. Furthermore the model is suitable only for a limited number of residents. Further adaptations and developments have to be tackled to meet the target group's needs and achieve the successful implementation and long-term sustainability of the program.

Following recent studies revealing deficits in general and specialised medical care of nursing home residents in Germany, the discussion on the quality of medical care of residents in residential care facilities has intensified in the past years. As a result, political efforts have been undertaken to facilitate improvements in this context. We collected data on the health status and medical care of 778 residents from 8 nursing homes in order to investigate the current situation regarding medical care for nursing home residents in Germany. Most of them were multimorbid, taking several prescribed medications. Our results showed that about 91% of the residents had personal contact to general practitioners or internists quarterly and only 1.3% had no such contacts within a year. The frequency of contacts to other medical specialists was comparably low. For example, within a year, only 18.9% of the residents had contact to urologists; only 16.7% had contact to ophthalmologists; only 39.6% had contact to dentists and only 10.6% of the female residents had contact to gynaecologists. Despite the fact that many of the residents showed specific medical care needs, these rates were below the utilisation rates of older population groups not living in long-term care homes. This leads to the conclusion that previous efforts to optimise medical care in nursing homes were only partially successful. Well known deficits are still remaining. Considering potential consequences for residents, further and consequent actions are required to improve the general and specialised medical care in institutionalised long-term care., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Not everyone seems to have adequate health literacy to take care of their own health. Especially older people, people with migration background, and adolescents with lower educational attainment face challenges when dealing with the healthcare system. Our cross-sectional study focuses on these vulnerable groups. We found that vulnerable populations showed high prevalence of limited health literacy, and there were considerable differences between these groups. Older people were more likely to have limited health literacy compared to younger people. Older people with migration background had the lowest health literacy., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Health literacy is known to influence health. Findings on the unequal distribution of health literacy among less well-educated young people are presented. The influence of socio-demographic factors and the consequences of a low level of health literacy with regard to health-related behaviour are discussed., Materials and Methods: Data from a survey on the health literacy of young people with a lower level of education, older people and migrants (n = 1,000) were used. Health literacy was measured using the instruments of the European Health Literacy Survey (HLS-EU-Q47)., Results: The results demonstrate a lower level of health literacy among young people with less education and especially among young migrants. Explanations for a lower level of health literacy among young people with less well-educated young people were parents' educational background and parents' wealth. Migration-related factors had no influence on young people. Further correlations between health literacy and health behaviour were explored., Conclusion: It is concluded that health literacy is linked to health behaviour and that unequal distributions of health literacy among young people may increase health inequalities.

The concept of "health literacy", which has gained attention in English-speaking countries during the last decade, is becoming increasingly popular in Germany. While studies on an international level indicate that people with migration background are often limited in their health literacy, there is a lack of empirical data on that topic in Germany. However, it is well known that they are exposed to health-related risks and problems comparatively often whereas they use health care services less frequently. This article focuses on the native speaking counseling services of the Independent Patient Counseling Germany (UPD gGmbH) as an example of good practice and introduces the results of the evaluation of this counseling service. Qualitative interviews were conducted with UPD-consultants as well as with users of the services. It became apparent that Turkish and Russian-speaking immigrants often have limited health-related literacy. Therefore, support and counseling services should focus not only on issues concerning language and cultural aspects. Furthermore, strategies strengthening the health literacy of persons with migration background are required. Therefore, instruments and strategies will be developed in cooperation with the UPD which aim to improve such skills of the UPD-consultants.

Health literacy is a relatively recent concept in Europe. First international investigations indicate that a substantial part of the population has significantly impaired subjective health literacy. In Germany there is a lack of meaningful data. Therefore, 2 comprehensive studies have been started that will provide population representative results, as well as take the health literacy level of vulnerable groups such as older people and migrants into consideration., (© Georg Thieme Verlag KG Stuttgart · New York.)

Municipalities in Germany have to advance health care structures to be resistant to demographic transitions and to the changing health care needs of the regional population in upcoming years. Therefore, it is important to note that needs vary from region to region and that care structures have to be differentiated according to this. Indeed regionality and community care have been increasingly referred to in current debate on improving care structures. But the discussed approaches remain relatively unclear and, moreover, fail to overcome care fragmentation and legal or sectoral perspectives. This paper points out the current lack of systematic knowledge about regional health disparities as well as knowledge about models of health care that are appropriate especially for disadvantaged communities and also rural regions. Moreover, knowledge of steering mechanisms that enforce the development of regional care systems are not developed yet.

A synthesis of current nursing knowledge by means of nursing theory construction is missing in German speaking countries. Unfortunately, due to this the nursing discipline cannot counterbalance the influence of other scientific disciplines with a self-created nursing specific theory. The level of theory construction in a discipline serves as sensitive indicator of intellectual state in this discipline. After the fruitful period from 1980 to 1990, the theoretical discourse in nursing almost disrupted while the number of empirical studies is increasing. This deserves to be discussed thoroughly with respect to further development of nursing theory. The theoretical discourse in nursing should generalise research findings in order to develop nursing theory in an inductive way - combined with a focus on patient's perspective in research and theory construction. New aspects and themes in health care as the demographical development and its epidemiological consequences, the increase and transformation of chronic illness as well as the changing role of the patient (participation, self-management) should be considered. The reanimation of a culture of discussion is only possible if scholars can dedicate time to it. Only under this condition reading and discussing research findings of other disciplines will be again on the agenda of scientific working and will - last but not least - inspire the construction of a nursing specific theory.