Search

International audience; Objective: To simultaneously investigate the psychometric properties of three recently developed health literacy measurement scales throughout adolescence in the general population. Methods: French versions of the Health Literacy for School-Aged Children (HLSAC, unidimensional) scale, the Health Literacy Assessment Scale for Adolescents (HAS-A, multidimensional) and the 16-item European Health Literacy Survey questionnaire (HLS-EU-Q16, unidimensional) were completed by 1 444 adolescents in 8th, 9th, 11th grade in general school and 11-12th grade in vocational school. Psychometric properties were studied using confirmatory factor analysis, McDonald's omega coefficient and hypothesis testing. Results: Structural validity was acceptable (HLS-EU-Q16) to good (HAS-A and HLSAC), no measurement invariance issue was found and internal consistency was acceptable for the three scales (0.68-0.84). Convergent validity was low (Pearson correlation coefficients < 0.5) and the only scale for which results were in agreement with a priori hypotheses was the HLSAC. Conclusions: Our results were supportive of the use of HLSAC to assess health literacy during adolescence but the HAS-A, with a slightly better structural validity, can also be promoted due to its three measured dimensions. Practice implications: The use of these scales in practice will help to focus on health literacy, a critical factor for prevention and health promotion in adolescence.

Health literacy (HL) is a competence to find, understand, appraise, and apply health information and is necessary to maneuver the health system successfully. People with low HL are, e.g., under the risk of poor quality and safety of care. Previous research has shown that low HL is more prevalent among, e.g., people with lower social status, lower educational level, and among the elderly. In Germany, people with substitutive private health insurance (PHI) account for 11% of the population and tend to have a higher level of education and social status, but in-detail assessments of their HL are missing so far. Therefore, this study aimed to investigate the HL of PHI insureds in Germany, and to analyze their assessment of the health system according to their HL level. In 2018, 20,000 PHI insureds were invited to participate in a survey, which contained the HLS-EU-Q16, and items covering patient characteristics and the World Health Organization health systems framework goals (e.g., access, quality, safety, responsiveness). Low HL was found for 46.2% of respondents and was more prevalent, e.g., among men and insureds with a low subjective social status. The health system performance was perceived poorer by respondents with low HL. Future initiatives to strengthen health systems should focus on promoting HL.

Health literacy (HL) is a competence to find, understand, appraise, and apply health information and is necessary to maneuver the health system successfully. People with low HL are, e.g., under the risk of poor quality and safety of care. Previous research has shown that low HL is more prevalent among, e.g., people with lower social status, lower educational level, and among the elderly. In Germany, people with substitutive private health insurance (PHI) account for 11% of the population and tend to have a higher level of education and social status, but in-detail assessments of their HL are missing so far. Therefore, this study aimed to investigate the HL of PHI insureds in Germany, and to analyze their assessment of the health system according to their HL level. In 2018, 20,000 PHI insureds were invited to participate in a survey, which contained the HLS-EU-Q16, and items covering patient characteristics and the World Health Organization health systems framework goals (e.g., access, quality, safety, responsiveness). Low HL was found for 46.2% of respondents and was more prevalent, e.g., among men and insureds with a low subjective social status. The health system performance was perceived poorer by respondents with low HL. Future initiatives to strengthen health systems should focus on promoting HL.

BACKGROUND: Health literacy (HL) is defined as the knowledge and competences of people to meet the complex demands of health in modern society. It is an important factor in ensuring positive health outcomes, yet Iceland is one of many countries with limited knowledge of HL and no valid HL measurement. The aim of this study was to translate the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16) into Icelandic, adapt the version, explore its psychometric properties and establish preliminary norms. METHODS: The HLS-EU-Q16 translation model included three steps: 1) translation-back-translation of HLS-EU-Q16 including specialists' review (n = 6); 2) cognitive interviewing of lay people (n = 17); and 3) psychometric analysis with survey participants. The HLS-EU-Q16 includes 16 items, with scores ranges from zero (low/no HL) to 16 (high HL). Statistics included were descriptive, internal consistency measured by Cronbach's α, exploratory factor analysis, and multivariate linear regression. RESULTS: After the translation and cognitive interviewing, 11 of the HLS-EU-Q16 items were reworded to adapt the instrument to Icelandic culture while maintaining their conceptual objectives. Survey participants were 251. Internal consistency of the translated and adapted instrument was α = .88. Four factors with eigenvalues > 1.0 explained 62.6% of variance. Principal component analysis with Oblimin rotation presented four latent constructs, "Processing and Using Information from the Doctor" (4 items, α = .77), "Processing and Using Information from the Family and Media" (4 items, α = .85), "Processing Information in Connection to Healthy Lifestyle" (5 items, α = .76), and "Finding Information about Health Problems/Illnesses" (3 items, α = .73). Lower self-rated health was an independent predictor of lower HL (β = -.484, p = .008). Preliminary norms for HL ranged from five to 16 (M 13.7, SD ± 2.6) with 72.5% with sufficient HL (score 13-16), 22% with problematic HL (score 9-12) and 5.5% with inadequate HL (score 0-8). CONCLUSIONS: The Icelandic version of HLS-EU-Q16 is psychometrically sound, with reasonably clear factor structure, and comparable to the original model. This opens possibilities to study HL in Iceland and compare the results internationally. The translation model introduced might be helpful for other countries where information on HL is missing based on lack of validated tools., Háskólinn á Akureyri (IS) research fund

Dissertação de Mestrado em Gestão e Economia da Saúde apresentada à Faculdade de Economia Health literacy is essential for health promotion, disease prevention and the effective and efficient use of available healthcare services. Besides that, it is also important for the sustainability of the National Health Service (NHS). Inadequate levels of health literacy can have significant implications for healthcare outcomes and, consequently, for healthcare expenditures. Therefore, it is important to measure the health literacy level of the Portuguese population, especially in particular groups. Thus, and given that research on health literacy in higher education in Portugal is still insufficient, it is essential to develop studies that reflect reality. The aim of this study is to identify the health literacy levels of the population of higher education at the University of Coimbra (UC) and to evaluate an association with the areas of knowledge and with the information-seeking behavior. Based on data collected after the application of the HLS-EU-Q16 questionnaire, an observational, descriptive, cross-sectional study was carried out with a quantitative approach. In addition to analyzing and describing the variables, an attempt was made to analyze and explain the relationship between them through a correlational study. The HLS-EU-Q16 applied shows excellent psychometric properties, especially a good internal consistency, with Cronbach's alpha values between 0.753 and 0.836 in the three literacy domains and 0.915 in the global index, being comparable to versions used by other countries. In the UC’s population it appears that 58.6% of individuals have sufficient or excellent levels of health literacy. On the other hand, 41.4% of participants have a problematic or inadequate level of health literacy. In addition, the health literacy index was higher in the healthcare domain (35.6) and lower in the disease prevention domain (33.7). It is concluded that, despite most of the sample presenting a sufficient or excellent level of health literacy, there is also a large percentage (41.4%) with insufficient or problematic health literacy. Universities should not assume that all students have the proper skills to act on a day-to-day basis. Collaborative efforts between professors, university staff and healthcare professionals should be a priority for the development of healthcare education programs to improve the functional and critical health literacy skills of students and professors. A Literacia em Saúde é fundamental para a promoção da saúde, para a prevenção da doença e para a utilização eficaz e eficiente dos serviços de saúde disponíveis, sendo importante também para a sustentabilidade do Serviço Nacional de Saúde (SNS). Níveis inadequados de Literacia em Saúde podem ter implicações significativas nos resultados em saúde e, consequentemente, nos gastos em saúde tornando-se importante medir o nível de literacia da população portuguesa, especialmente em grupos específicos. Em Portugal a investigação nesta área no ensino superior é ainda insuficiente, tornando-se fundamental desenvolver estudos que aprofundem o seu conhecimento. O objetivo deste trabalho é identificar o nível de Literacia em Saúde da população do ensino superior da Universidade de Coimbra (UC) e avaliar a associação com as áreas de conhecimento e com o comportamento de procura de informação. Tendo por base os dados recolhidos com o questionário HLS-EU-Q16, foi realizado um estudo do tipo observacional, descritivo, transversal, com abordagem quantitativa. Para além da análise e descrição das variáveis, procurou-se analisar e explicar a relação entre estas através de um estudo correlacional. O questionário HLS-EU-Q16 aplicado evidencia uma consistência interna muito boa, com valores do alfa de Cronbach entre 0,753 e 0,836 nos três domínios da literacia, e 0,915 no índice global, sendo comparável a versões utilizadas por outros países. Na população universitária da UC verifica-se que 58,6% dos inquiridos apresentam um nível de Literacia em Saúde suficiente ou excelente. Por outro lado, 41,4% dos inquiridos apresenta um nível de Literacia em Saúde problemático ou inadequado. O índice de Literacia em Saúde foi maior no domínio dos cuidados de saúde (35,6), e menor no domínio da prevenção da doença (33,7). Conclui-se que apesar da maioria da amostra apresentar um nível suficiente de Literacia em Saúde, também existe uma grande percentagem (41,4%) com Literacia em Saúde insuficiente ou problemática. As universidades não devem presumir que todos os alunos têm as capacidades adequadas para agir no dia-a-dia. Esforços colaborativos entre docentes, funcionários do ensino superior e profissionais de saúde devem ser uma prioridade para o desenvolvimento de programas de educação na saúde tendo por objetivo a melhoria das competências de Literacia em Saúde funcional e crítica da população do ensino superior.

An adequate level of health literacy is essential for clear communication between patients and health care workers. The internationalization of universities is increasing in the field of health care. The aims of our research were to measure (1) the level of health literacy and its correlation among university students and (2) the relationship between the different instruments measuring health literacy. A cross-sectional study was conducted in the 2020/2021 academic year. The questionnaire included questions on sociodemographic status, study data, health status, and health literacy level. According to the HLS-EU-Q16 health literacy questionnaire, more than half of the students had a limited HL level in disease prevention (52.4%) and health promotion (58.4%) subindexes. Nationality was found to be an influencing factor (p < 0.001). According to the NVS, 80.1% of the students had an adequate HL level. A significant correlation was found between the results and nationality (p = 0.005). None of the Chew questions demonstrated a correlation with nationality (q1 p = 0.269, q2 p = 0.368, q3 p = 0.528). Nationality is a key factor in the level of subjective and functional health literacy. We need to measure both types of levels to see the real results.

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

Background Low health literacy is believed to be associated with behaviours that increase the risk of type 2 diabetes. But there is limited knowledge on the relation between health literacy (HL) and diabetes risk, and whether improving HL could be a potential prevention strategy. Therefore, the main purpose of this study was to examine the link between HL and diabetes risk among non-diabetic adults. Methods We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. One thousand, two hundred and fifty-five non-diabetic subjects aged 18–60 years were eligible. The German Diabetes Risk Score (GDRS, ranging 0 to 123 points) was used to determine the individual risk of type 2 diabetes. The short version of the European Health Literacy Questionnaire (HLS-EU-Q16, ranging 0 to 16 points) was applied to assess the individual self-reported HL. Subjects were asked to self-estimate their diabetes risk, which was then compared with the calculated GDRS. Descriptive statistics were calculated to investigate group differences in the GDRS and self-estimated diabetes risk. Linear as well as logistic regression models were performed to analyse potential influencing variables of the GDRS as well as incorrect self-estimated diabetes risk. In three nested statistical models for each outcome, these analyses were adjusted for age, gender, educational level and the presence of chronic conditions. Results According to the criteria of the GDRS, 996 (79.4%) subjects showed “low risk”, 176 (14.0%) “still low risk”, 53 (4.2%) “elevated risk”, and 30 (2.4%) “high to very high risk” to develop type 2 diabetes within the next 5 years. In the statistical models including all control variables, subjects with “inadequate HL” scored 2.38 points higher on the GDRS (95% CI 0.378 to 4.336; P = 0.020) and had a 2.04 greater chance to estimate their diabetes risk incorrectly (OR 2.04; 95% CI 1.33 to 3.14; P = 0.001) compared to those with “sufficient HL”. Conclusion The risk of type 2 diabetes is increased in people with inadequate self-reported HL. People with high diabetes risk and inadequate HL might be provided with educational programs to improve diabetes knowledge and reduce behavioural risk factors.

Objectives: Examining whether specific population groups who are not working and those who have an employment have the same health literacy level. Methods: Data were retrieved from a nationally representative cross-sectional study of the Danish population conducted with the health literacy questionnaire (HLS-EU-Q16) in 2016 and 2017. Socio-demographic characteristics were drawn from national registers. Odds ratio for the association between employment status and health literacy was estimated from logistic regression models, adjusted for socio-demographic characteristics. Probability weights were used to adjust for differences in responses. Results: Logistic regression analyses showed that receiving unemployment benefits, social assistance, employment and support allowance, retirement pension and sickness benefit were significantly associated with having inadequate health literacy compared to being employed in any industry. The highest odds ratio for inadequate health literacy was present for receiving unemployment benefit OR = 1.78 (95 1.23-2.56). Conclusion: Population groups not working and receiving economic public support have higher odds of inadequate health literacy competencies compared to those active in the labor force, considering age and socioeconomic factors. The result contributes to understanding health disparities in connection to occupational situation. Objectives: Examining whether specific population groups who are not working and those who have an employment have the same health literacy level. Methods: Data were retrieved from a nationally representative cross-sectional study of the Danish population conducted with the health literacy questionnaire (HLS-EU-Q16) in 2016 and 2017. Socio-demographic characteristics were drawn from national registers. Odds ratio for the association between employment status and health literacy was estimated from logistic regression models, adjusted for socio-demographic characteristics. Probability weights were used to adjust for differences in responses. Results: Logistic regression analyses showed that receiving unemployment benefits, social assistance, employment and support allowance, retirement pension and sickness benefit were significantly associated with having inadequate health literacy compared to being employed in any industry. The highest odds ratio for inadequate health literacy was present for receiving unemployment benefit OR = 1.78 (95% CI: 1.23-2.56). Conclusion: Population groups not working and receiving economic public support have higher odds of inadequate health literacy competencies compared to those active in the labor force, considering age and socioeconomic factors. The result contributes to understanding health disparities in connection to occupational situation.

La alfabetización en salud según la OMS representa las habilidades cognitivas y sociales que determinan la motivación y la habilidad de los individuos para ganar acceso a entender y usar la información de forma que promuevan y mantengan una buena salud. La necesidad de alfabetización en salud ha sido notable en la pandemia, debido al bombardeo de información sufrido y a la necesidad de discernir la fiabilidad de la información, así que para evaluar si es adecuado el nivel de alfabetización en salud, se ha realizado el presente estudio en una farmacia de Sevilla ubicada en el Distrito Macarena. Los resultados de esta población están muy marcados por su contexto al pertenecer a un barrio humilde y de nivel socioeconómico limitado. Se escogió para el estudio a la población que venía a la farmacia mayor de 60 años y se le realizó un cuestionario con tres partes: el instrumento HLS-EU-Q16, unas preguntas acerca de la actuación del farmacéutico en la pandemia y la herramienta SAHLSA. El 75% de personas que realizaron la encuesta eran mujeres y el rango de edad de la mayoría de las personas iba de los 80 a los 89 años, de manera que sólo el 34% de la población encuestada tenía sólo estudios primarios. En el cuestionario HLS-EU-Q16 los resultados se dividían en 3 niveles, Suficiente, insuficiente y deficiente, mientras que en el cuestionario SAHLSA si superaban los 37 puntos se consideraba un nivel de alfabetización en salud apto y si no se superaban se consideraba un nivel de alfabetización no apto. Al final del estudio, en el cuestionario HLS-EU-Q16 se obtuvo un resultado de alfabetización insuficiente en el 70% de la población, mientras que en el otro cuestionario se tuvo que revisar sus resultados por las limitaciones del estudio Universidad de Sevilla. Grado en Farmacia

Introduktion: Hälsokompetens är viktigt för individen för att på ett adekvat sätt kunna ta till sig hälsoinformation, bearbeta, reflektera samt omvandla kunskaperna till praktik. Skolan är en viktig arena för hälsofrämjande arbete, då elever oavsett bakgrund ingår i skolsystemet. Grundskolläraren har en viktig roll i det hälsofrämjande arbetet som sker på skolan riktat mot eleverna. Syfte: Syftet med studien var att utforska grundskollärares totala nivå av hälsokompetens och på vilket sätt nivån skiljer sig mellan variablerna i instrumentet HLS-EU-Q16. Metod: En tvärsnittsstudie genomfördes med hjälp av en webbaserad enkätundersökning. Instrumentet HLS-EU-Q16 inkluderades i enkäten för att undersöka nivån av hälsokompetens. Rekrytering skedde via sociala medier. Frekvens och Chi2-test genomfördes. Resultat: Bland grundskollärarna (n=22) hade 90.9% en tillräcklig hälsokompetensnivå, medan 9,1 % hade problematisk hälsokompetens. Medelålder var 46.7 år och medelarbetslivserfarenhet var 16 år. Självskattat allmänt hälsotillstånd var 39.7% mycket bra, 51.6% bra, samt 9.7 någorlunda. Av deltagarna hade 35.5% en utbildning på fyra år eller mindre, och 64,5% hade över fyra års utbildning. Det fanns frågor inom instrumentet HLS-EU-Q16 som varierade. Självskattad allmänt hälsotillstånd tenderade att påverkas av ålder och utbildningsnivå. Demografiska variablerna ålder, arbetslivserfarenhet, hälsotillstånd, utbildningsnivå samt kön kunde inte inkluderas i en sambandsanalys med utfallsvariabeln hälsokompetensindex på grund av för litet stickprov. Slutsats: Hälsokompetensnivån var hög i studiepopulationen Introduction: A high health literacy level is important for the individual to be able to adequately absorb, process and reflect over health information, and transform health knowledge into practice. The school is an important arena for health promotive work, as students, regardless of background, are part of the Swedish school system. Primary school teachers have important roles in health promotive school interventions, when students are the target population. Aim: The study aim was to explore primary school teachers' level of health literacy and in what way the level differs between included demographic variables. Method: A cross-sectional study was conducted using a web-based survey. The instrument HLS-EU-Q16 was included in the questionnaire to examine the level of health literacy. Participants were recruited through Facebook. Results: Among primary school teachers, 90.9% had sufficient health literacy and 9.1% problematic. The average age was 46.7 years and the average work experience was 16 years. Self-rated general health condition was 39.7% very good, 51.6% good, and 9.7% reasonably. The education level among participants differed,where 35.5% had an education that were four years or less and 64.5% had over four years of education. The demographic variables age, work experience, state of health, level of education and gender could not be included in a correlation analysis with the outcome variable health literacy index due to too small sample group. Conclusion: The level of health literacy is high in the study group of primary school teachers.

BackgroundHealth inequities arise when the public cannot access and understand health information in an easy, accessible, and understandable way. Evidence supports that health literacy (HL) is a determinant for health outcomes, and when HL is limited this may have a major impact on morbidity as well as mortality. Migrants are known to have limited HL. Therefore, this study aimed to explore comprehensive health literacy (CHL) and electronic health literacy (eHL) among Arabic-speaking migrants in Sweden.MethodsThis was a cross-sectional observational study conducted in Sweden. A total of 703 persons were invited to participate between February and September 2019. Two questionnaires – the Health Literacy Survey European Questionnaire (HLS-EU-Q16) and the eHealth Literacy Scale (eHEALS) – and questions about self-perceived health and Internet use were distributed in Swedish and Arabic. Various statistical analyses were performed to determine the associations for limited CHL and eHL.ResultsA total of 681 respondents were included in the analysis. Of these, 334 (49%) were native Arabic-speaking migrants and 347 (51%) were native Swedish-speaking residents. CHL and eHL differed between the groups. The Arabic speakers had significantly lower mean sum scores in eHL 28.1 (SD 6.1) vs 29.3 (6.2),p = 0.012 and lower proportion of sufficient CHL 125 (38.9%) vs 239 (71.3%),p p< 0.01).ConclusionsCHL and eHL differ between Arabic-speaking migrants and native Swedish speakers, but also between Arabic speakers who have lived different lengths of time in Sweden. Though it seems that the eHealth literacy is less affected by language spoken, the Internet is suggested to be an appropriate channel for disseminating health information to Arabic-speaking migrants.

Background Health literacy concerns the ability of citizens to meet the complex demands of health in modern society. Data on the distribution of health literacy in general populations and how health literacy impacts health behavior and general health remains scarce. The present study aims to investigate the prevalence of health literacy levels and associations of health literacy with socioeconomic position, health risk behavior, and health status at a population level. Methods A nationwide cross-sectional survey linked to administrative registry data was applied to a randomly selected sample of 15,728 Danish individuals aged ≥25 years. By the short form HLS-EU-Q16 health literacy was measured for the domains of healthcare, disease prevention, and health promotion. Adjusted multinomial logistic regression analyses were used to estimate associations of health literacy with demographic and socioeconomic characteristics, health risk behavior (physical activity, smoking, alcohol consumption, body weight), and health status (sickness benefits, self-assessed health). Results Overall, 9007 (57.3%) individuals responded to the survey. Nearly 4 in 10 respondents faced difficulties in accessing, understanding, appraising, and applying health information. Notably, 8.18% presented with inadequate health literacy and 30.94% with problematic health literacy. Adjusted for potential confounders, regression analyses showed that males, younger individuals, immigrants, individuals with basic education or income below the national average, and individuals receiving social benefits had substantially higher odds of inadequate health literacy. Among health behavior factors (smoking, high alcohol consumption, and inactivity), only physical behavior [sedentary: OR: 2.31 (95% CI: 1.81; 2.95)] was associated with inadequate health literacy in the adjusted models. The long-term health risk indicator body-weight showed that individuals with obesity [OR: 1.78 (95% CI: 1.39; 2.28)] had significantly higher odds of lower health literacy scores. Poor self-assessed health [OR: 4.03 (95% CI: 3.26; 5.00)] and payments of sickness absence compensation benefits [OR: 1.74 (95% CI: 1.35; 2.23)] were associated with lower health literacy scores. Conclusions Despite a relatively highly educated population, the prevalence of inadequate health literacy is high. Inadequate health literacy is strongly associated with a low socioeconomic position, poor health status, inactivity, and overweight, but to a lesser extent with health behavior factors such as smoking and high alcohol consumption.

Low health literacy is associated with poorer health and quality of life. An open question is whether a regional integrated healthcare system whose management strives to enable and empower its members with regard to health issues can contribute to a higher level of health literacy in the population. Against this background, in a cross-sectional study we surveyed a random selection of members of an integrated healthcare system in southwestern Germany (n = 180). The standardized questionnaire included, inter alia, questions on health literacy and subjective health. In this sample we wanted to (1) determine the proportion of respondents with sufficient health literacy and (2) investigate whether the association between health literacy and quality of life and subjective health status&mdash, as found in other studies&mdash, can be replicated. In our sample a health literacy score could be calculated in 126 subjects (70%). A sufficient level of health literacy was detected in 62% of respondents. Confirming the findings of a meta-analysis based on international studies, we found moderate correlations between health literacy and quality of life (r = 0.41) and health literacy and subjective health status (r = 0.40), these correlations hardly decreased when we controlled for various sociodemographic characteristics. As the proportion of respondents with sufficient health literacy was higher in our sample than in comparable studies conducted in Germany, we may hypothesize that an integrated healthcare system like the one we surveyed could have contributed to increased health literacy in the population. Thus, it could be worthwhile to investigate this research question with a more rigorous study design and a larger sample.

Low health literacy is associated with poorer health and quality of life. An open question is whether a regional integrated healthcare system whose management strives to enable and empower its members with regard to health issues can contribute to a higher level of health literacy in the population. Against this background, in a cross-sectional study we surveyed a random selection of members of an integrated healthcare system in southwestern Germany (n = 180). The standardized questionnaire included, inter alia, questions on health literacy and subjective health. In this sample we wanted to (1) determine the proportion of respondents with sufficient health literacy and (2) investigate whether the association between health literacy and quality of life and subjective health status—as found in other studies—can be replicated. In our sample a health literacy score could be calculated in 126 subjects (70%). A sufficient level of health literacy was detected in 62% of respondents. Confirming the findings of a meta-analysis based on international studies, we found moderate correlations between health literacy and quality of life (r = 0.41) and health literacy and subjective health status (r = 0.40); these correlations hardly decreased when we controlled for various sociodemographic characteristics. As the proportion of respondents with sufficient health literacy was higher in our sample than in comparable studies conducted in Germany, we may hypothesize that an integrated healthcare system like the one we surveyed could have contributed to increased health literacy in the population. Thus, it could be worthwhile to investigate this research question with a more rigorous study design and a larger sample.

Background Health literacy is of growing importance in public health research in Germany. People with good health literacy are likely to make better health decisions. A large proportion of the German population, not just vulnerable groups, has a problematic or insufficient health literacy. Aims The study describes the health literacy of students at a German health university. It investigates the influence of sociodemographic and course-related factors on health literacy. The results are compared with those of the general population from Germany. Methodology Study participants were recruited by email. 203 students took part in the online survey (response rate 20.2%). From the European Health Literacy Questionaire 16 (HLS-EU-Q16) 127 datasets of students were completely available and were analyzed in this study. In addition to health literacy, sociodemographic and course-related factors were ascertained. Results 39 (30.7%) of the students have a sufficient or excellent health literacy. On average, health literacy is lower in the group of students of health-related courses (M=30.6) than in the normal German population (M=34.5). The levels are particularly low in the dimensions of appraising and applying of health information. Conclusion The results must be interpreted with care. They can be used as a base for long-term monitoring of students’ health literacy and provide starting points for health promotion within the academic setting. Students of health-related degree should be encouraged to reflect on their own and others health literacy, as this is important for their future work with patients or clients.

Health literacy (HL) is the capacity of individuals, families, and communities to make sound health decisions in the context of everyday life: at home, at the workplace, and in the community, marketplace, healthcare sector, and political arena. The aim of this study, as a part of a research conducted in Florence (Italy) and its surrounding, is to validate the Italian version of the short form (HLS-EU-Q16) and of the short-short form (HLS-EU-Q6) of the HLS-EU-Q47, as a part of a research conducted to assess the level of HL in a population-based sample in Florence. Two-hundred twenty-three subjects (57% females; age: 53.7 ± 11.8 years) were interviewed. The results provided the first evidence for the reliability and validity of the HLS-EU-Q instruments (HLS-EU-Q16, HLS-EU-Q6, General-HL Index) in Italian general population. The differences in some of the results with respect to other published studies lay for specific cultural characteristics, that affect HL level and the relationships between HL, antecedents, and outcomes.

The overall aim of this thesis was to examine the distribution of health literacy (HL) levels in newly arrived Arabic-, Dari-, or Somali-speaking refugees in Sweden. Further aims were to investigate sociodemographic characteristics associated with inadequate HL in this group, and to investigate whether HL levels are associated with experiences of the health examination for asylum seekers (HEA), health seeking behaviour and health. Three quantitative cross-sectional studies, using data from two different surveys, were conducted among Arabic-, Dari-, and Somali-speaking, newly arrived refugees taking part in courses in Swedish for immigrants or civic orientation. In addition, an explorative qualitative study, based on focus group discussions, was performed on Arabic- and Somali-speaking newly arrived refugees who had taken part in an HEA. All data were collected 2013-2016. The quantitative data were analysed using different statistical methods, foremost descriptive statistics and univariate and multivariate binary logistic regression analyses. The qualitative data were analysed using Graneheim and Lundman’s method for latent content analysis. The main findings were that the majority of Arabic-, Dari-, or Somali-speaking refugees in Sweden have limited functional health literacy (FHL) and/or limited comprehensive health literacy (CHL). Having a low education level and/or being born in Somalia were associated with having inadequate FHL, but not with having inadequate CHL. Limited FHL was associated with inadequate CHL. Experiences of poor quality of communication and having benefited little from the HEA were more common among those with limited CHL, as compared to those with higher CHL. Experiences of communication problems and a lack of information related to the HEA were found in the qualitative studies as well. In addition, it was more common that those with limited CHL reported poor general health and impaired psychological well-being, and that they had refrained from seeking healthcare. In conclusion: limited HL is common among newly arrived refugees in Sweden and seems to be of importance for the experience of the HEA, health-seeking behaviour and health. HL needs to be taken into consideration in the work with refugees in order to increase equity in healthcare and health.

Background Refugees have poorer health compared to indigenous populations, which may be explained by lower health literacy, i.e. not being able to access, understand, appraise or apply health information. This study aims to determine levels of functional and comprehensive health literacy, and factors associated with inadequate health literacy, in refugees coming to Sweden. Method A cross-sectional study was performed among 455 adult refugees speaking Arabic, Dari, Somali or English. Participants in 16 strategically selected language schools for immigrants responded to a questionnaire. Health literacy was measured using the Swedish Functional Health Literacy Scale and the HLS-EU-Q16 questionnaire. Uni- and multivariate statistical methods were used to investigate group differences. Results The majority of the participating refugees had inadequate or limited functional health literacy and comprehensive health literacy. About 60% of them had inadequate functional health literacy and 27% had inadequate comprehensive health literacy. Low education and/or being born in Somalia were factors associated with an increased risk of having inadequate functional health literacy. Having inadequate functional health literacy was associated with an increased risk of having inadequate comprehensive health literacy. Conclusions The majority of refugees in the language schools had limited or poor health literacy. Health literacy should be taken into consideration in contexts and in activities addressing migrants. More research is needed to better understand health literacy among refugees and to develop strategies and methods to increase health literacy and make life easier for those with low health literacy. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1030) contains supplementary material, which is available to authorized users.

Background The purpose of the health examination for asylum seekers in most countries is to identify poor health in order to secure the well-being of seekers of asylum and to guarantee the safety of the population in the host country. Functional health literacy is an individual’s ability to read information and instructions about health and to function effectively as a patient in the health system, and comprehensive health literacy is an individual’s competence in accessing, understanding, appraising and applying health information. Little is known about refugees’ health literacy and their experiences of the health examination for asylum seekers. The purposes of the study were to investigate refugees’ experiences of communication during their health examination for asylum seekers and the usefulness of that examination, and whether health literacy is associated with those experiences. Methods A cross-sectional study was made among 360 adult refugees speaking Arabic, Dari, Somali or English. Health literacy was measured using the Swedish Functional Health Literacy Scale and the short European Health Literacy Questionnaire. Experiences of communication and the usefulness of the health examination were measured in several questions. Associations were sought using univariate and multivariate statistical models. Results In the health examination for asylum seekers, a poor quality of communication was experienced by 36 %, receiving little information about health care by 55 %, and receiving little new knowledge by 41 % and/or help by 26 %. Having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of a poorer quality of communication (OR: 9.64, CI 95 %: 3.25–28.58) and the experience of receiving little valuable health care information (OR: 6.54, CI 95 %: 2.45–17.47). Furthermore, having inadequate as compared to sufficient comprehensive health literacy was associated with the experience of not receiving new knowledge (OR: 7.94, CI 95 %: 3.00–21.06) or receiving help with health problems (OR: 8.07, 95 % CI: 2.50–26.07. Functional healthy literacy was not associated with experiences of HEA. Conclusion Refugees’ experiences indicate that a low level of comprehensive health literacy can act as a barrier to fulfilling the purposes of the health examination for asylum seekers. Comprehensive health literacy seems to be of greater importance in that context than functional health literacy. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2513-8) contains supplementary material, which is available to authorized users.