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Background: Health literacy is an important determinant of health, but national health literacy levels are known for only some European countries. This study aims to examine to what extent national health literacy levels can be estimated based on publicly available census data. Method: Multivariate models were used to predict two types of health literacy on population level. Predictors were selected based on literature, the European Health Literacy Survey (HLS-EU) and the Adult Literacy and Life Skills Survey (ALL). The HLS-EU provides insight into self-assessed health literacy and the ALL into the performance of individuals on health literacy tasks (performance-based health literacy). Dutch HLS-EU and ALL data were used to construct prediction models based on 2/3 of this data, which were validated in the remaining 1/3 of the data and (in case of self-assessed health literacy) in data from seven other European countries. Results: Education is a significant predictor of perceived and performance-based health literacy. Age and working status are significant predictors of performance-based health literacy, whereas gender and income are significant predictors of self-assessed health literacy. Both typologies of health literacy can satisfactorily be predicted within samples of the Dutch population. The accuracy of estimated self-assessed health literacy varied between the seven other European countries. Conclusion: Prediction models based on publicly available census data can be used for estimating self-assessed and performance-based health literacy on population level. Observed health literacy levels or better prediction models are required when one is interested in ranking European countries. [ABSTRACT FROM AUTHOR]

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. Methods: 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. Results: 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 multi-variate 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. [ABSTRACT FROM AUTHOR]

Data on health literacy (HL) in the population is limited for Asian countries. This study aimed to test the validity of the Mandarin version of the European Health Literacy Survey Questionnaire (HLS-EU-Q) for use in the general public in Taiwan. Multistage stratification random sampling resulted in a sample of 2989 people aged 15 years and above. The HLS-EU-Q was validated by confirmatory factor analysis with excellent model data fit indices. The general HL of the Taiwanese population was 34.4 ± 6.6 on a scale of 50. Multivariate regression analysis showed that higher general HL is significantly associated with the higher ability to pay for medication, higher self-perceived social status, higher frequency of watching health-related TV, and community involvement but associated with younger age. HL is also associated with health status, health behaviors, and health care accessibility and use. The HLS-EU-Q was found to be a useful tool to assess HL and its associated factors in the general population. [ABSTRACT FROM AUTHOR]

This paper discusses the work of the EUHPID Project to develop a European Health Promotion Monitoring System based on a common set of health promotion indicators. The Project has established three working groups to progress this task -- health promotion policy and practice-driven, data-driven and theory-driven. The work of the latter group is reviewed in particular. EUHPID has taken a systems theory approach in order to develop a model as a common frame of reference and a rational basis for the selection, organization and interpretation of health promotion indicators. After reviewing the strengths and weaknesses of those health promotion models currently proposed for indicator development, the paper proposes a general systems model of health development, and specific analytical, socio-ecological models related to public health and health promotion. These are described and discussed in detail. Taking the Ottawa Charter as the preferred framework for health promotion, the socio-ecological model for health promotion adopts its five action areas to form five types of systems. The structure and processes for each of these five systems are proposed to form the basis of a classification system for health promotion indicators. The paper goes on to illustrate such a system with reference to indicators in the workplace setting. The EUHPID Consortium suggest that their socio-ecological model could become a common reference point for the public health field generally, and offer an invitation to interested readers to contribute to this development. [ABSTRACT FROM AUTHOR]

Novel statistical approaches to prediction have recently been shown to perform well in several scientific fields but have not, until now, been comprehensively evaluated for predicting air pollution. In this paper we report on a model inter-comparison exercise in which 15 different statistical techniques for ozone forecasting were applied to ten data sets representing different meteorological and emission conditions throughout Europe. We also attempt to compare the performance of the statistical techniques with a deterministic chemical trajectory model. Likewise, our exercise includes comparisons of sites, performance indices, forecasting horizons, etc. The comparative evaluation of forecasting performance (benchmarking) produced 1340 yearly time series of daily predictions and the results are described in terms of predefined performance indices.Through analysing associations between the performance indices, we found that the success index is of outstanding significance. For models that are excellent in predicting threshold exceedances and have a high success index, we also observe high performance in the overall goodness of fit. The 8-h average ozone concentration forecast accuracy was found to be superior to the 1-h mean ozone concentration forecast, which makes the former very significant for operational forecasting. The best forecasts were achieved for sites located in rural and suburban areas in Central Europe unaffected by extreme emissions (e.g. from industries).Our results demonstrate that a particular technique is often excellent in some respects but poor in others. For most situations, we recommend neural network and generalised additive models as the best compromise, as these can handle nonlinear associations and can be easily adapted to site specific conditions. In contrast, nonlinear modelling of the dynamical development of univariate ozone time-series was not profitable. [Copyright &y& Elsevier]

Due to the COVID-19 pandemic, higher educational institutions worldwide switched to emergency distance learning in early 2020. The less structured environment of distance learning forced students to regulate their learning and motivation more independently. According to self-determination theory (SDT), satisfaction of the three basic psychological needs for autonomy, competence and social relatedness affects intrinsic motivation, which in turn relates to more active or passive learning behavior. As the social context plays a major role for basic need satisfaction, distance learning may impair basic need satisfaction and thus intrinsic motivation and learning behavior. The aim of this study was to investigate the relationship between basic need satisfaction and procrastination and persistence in the context of emergency distance learning during the COVID-19 pandemic in a cross-sectional study. We also investigated the mediating role of intrinsic motivation in this relationship. Furthermore, to test the universal importance of SDT for intrinsic motivation and learning behavior under these circumstances in different countries, we collected data in Europe, Asia and North America. A total of N = 15,462 participants from Albania, Austria, China, Croatia, Estonia, Finland, Germany, Iceland, Japan, Kosovo, Lithuania, Poland, Malta, North Macedonia, Romania, Sweden, and the US answered questions regarding perceived competence, autonomy, social relatedness, intrinsic motivation, procrastination, persistence, and sociodemographic background. Our results support SDT's claim of universality regarding the relation between basic psychological need fulfilment, intrinsic motivation, procrastination, and persistence. However, whereas perceived competence had the highest direct effect on procrastination and persistence, social relatedness was mainly influential via intrinsic motivation., Competing Interests: The authors have declared that no competing interests exist.

The sudden switch to distance education to contain the outbreak of the COVID-19 pandemic has fundamentally altered adolescents' lives around the globe. The present research aims to identify psychological characteristics that relate to adolescents' well-being in terms of positive emotion and intrinsic learning motivation, and key characteristics of their learning behavior in a situation of unplanned, involuntary distance education. Following Self-Determination Theory, experienced competence, autonomy, and relatedness were assumed to relate to active learning behavior (i.e., engagement and persistence), and negatively relate to passive learning behavior (i.e., procrastination), mediated via positive emotion and intrinsic learning motivation. Data were collected via online questionnaires in altogether eight countries from Europe, Asia, and North America (N = 25,305) and comparable results across countries were expected. Experienced competence was consistently found to relate to positive emotion and intrinsic learning motivation, and, in turn, active learning behavior in terms of engagement and persistence. The study results further highlight the role of perceived relatedness for positive emotion. The high proportions of explained variance speak in favor of taking these central results into account when designing distance education in times of COVID-19., Competing Interests: The authors have declared that no competing interests exist.

This chapter provides an overview of health literacy measurement initiatives with a focus on the European Health Literacy Survey (HLS-EU) - describing where measuring population health literacy started, where it currently is, and providing an outlook to the upcoming European HL survey. In the first part of the chapter, the methodology and the main results of the initial HLS-EU study from 2011 will be introduced. In the second part the worldwide impact of the HLS-EU study will be mapped. Many publications and studies used the HLS-EU instruments in the original or few in an adapted way to measure comprehensive health literacy - in many different settings and in diverse countries. Finally, the chapter ends with an outlook to the M-POHL and HLS19 initiatives of WHO-Europe which are intended to advance HLS-EU as well as the measurement of population and organizational health literacy in a more coordinated, standardized, and institutionalized manner.

Background: Several measurement tools have been developed to measure health literacy. The tools vary in their approach and design, but few have focused on comprehensive health literacy in populations. This paper describes the design and development of the European Health Literacy Survey Questionnaire (HLS-EU-Q), an innovative, comprehensive tool to measure health literacy in populations., Methods: Based on a conceptual model and definition, the process involved item development, pre-testing, field-testing, external consultation, plain language check, and translation from English to Bulgarian, Dutch, German, Greek, Polish, and Spanish., Results: The development process resulted in the HLS-EU-Q, which entailed two sections, a core health literacy section and a section on determinants and outcomes associated to health literacy. The health literacy section included 47 items addressing self-reported difficulties in accessing, understanding, appraising and applying information in tasks concerning decisions making in healthcare, disease prevention, and health promotion. The second section included items related to, health behaviour, health status, health service use, community participation, socio-demographic and socio-economic factors., Conclusions: By illuminating the detailed steps in the design and development process of the HLS-EU-Q, it is the aim to provide a deeper understanding of its purpose, its capability and its limitations for others using the tool. By stimulating a wide application it is the vision that HLS-EU-Q will be validated in more countries to enhance the understanding of health literacy in different populations.

Health promoting hospitals (HPH) is a concept for hospital development that builds upon the health promotion concept of the WHO Ottawa Charter for health promotion, where the reorientation of health care services is considered as one of five major action areas for an overall health promotion development. The article outlines what such a re-orientation may mean for the main hospital functions. These include: the health promoting hospital setting; health promoting workplaces, the provision of health (related) services, training, education and research; the hospital as an advocate and "change agent" for health promotion in its community/environment; the "healthy" (metaphorically speaking) hospital organisation. Based on the concept, an international network of WHO, Europe has been developing since the late 1980s. The main projects of the international network so far were the first model project "health and hospital" (Vienna, 1989-1996), the European pilot hospital project of HPH (1993-1996), and the development of national/regional HPH networks (ongoing since 1995). It is argued that the further development of the HPH network will have to take into account some major changes that have occurred in the hospital landscape since the start of the network: the quality movement and, as a sub-set of this, the increasing importance of evidence based medicine.