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      The Relationship Between Health Literacy Level and Media Used as a Source of Health-Related Information

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          Abstract

          Background:

          Previous studies have not shown the level of health literacy or associated factors on a national level in Turkey using a scale that has been adapted to the country and its culture.

          Objective:

          This study aimed to determine health literacy levels in Turkey and to investigate the association of health literacy with socioeconomic factors as well as with the instruments used as sources of health-related information.

          Methods:

          This cross-sectional, nationally representative study was conducted using a computer-assisted personal interview approach and included 6,228 households (response rate, 70.9%). The Turkey Health Literacy Scale was used to measure health literacy. Sources of health-related information, such as newspapers, television, internet, and smartphones, were included in the regression model for health literacy.

          Key Results:

          The proportion of participants with inadequate and problematic health literacy was 30.9% and 38%, respectively, showing that approximately 7 of 10 participants had limited health literacy. The frequencies of inadequate and problematic health literacy were higher in the disease prevention and promotion domains (37.4% and 34.2%, respectively) compared with those in the health care domain (27.1% and 31.3%, respectively). The most frequently used medium as a source of health-related information was the internet (48.6%), followed by television (33%). In controlled models, higher health literacy scores were associated with higher education and income levels. The effects of television (β = 1,917), internet (β = 2,803), newspapers (β = 1,489), and smartphones (β = 1,974) as sources of health-related information were statistically significant in the general health literacy index model.

          Conclusions:

          Health literacy in Turkey reflects social inequalities. The model accounting for socioeconomic variables demonstrated the relevance of sources of health information to level of health literacy. These findings emphasize the importance of improving sources of health information to improve health literacy. [ HLRP: Health Literacy Research and Practice. 2021;5(2):e109–e117.]

          Plain Language Summary:

          This is a cross-sectional study that is representative of the population of Turkey. We reported that health literacy scores were higher for people in higher levels of socioeconomic status. We showed that using the television, internet, newspapers, and smartphones as a source of health-related information is associated with health literacy even when accounting for socioeconomic variables.

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          Most cited references40

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          Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)

          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 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.
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            Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q)

            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.
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              Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

              Background Recent advances in the measurement of health literacy allow description of a broad range of personal and social dimensions of the concept. Identifying differences in patterns of health literacy between population sub-groups will increase understanding of how health literacy contributes to health inequities and inform intervention development. The aim of this study was to use a multi-dimensional measurement tool to describe the health literacy of adults in urban and rural Victoria, Australia. Methods Data were collected from clients (n = 813) of 8 health and community care organisations, using the Health Literacy Questionnaire (HLQ). Demographic and health service data were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between demographic sub-groups. Results Mean age of respondents was 72.1 (range 19–99) years. Females comprised 63 % of the sample, 48 % had not completed secondary education, and 96 % reported at least one existing health condition. Small to large ES were seen for mean differences in HLQ scales between most demographic groups. Compared with participants who spoke English at home, those not speaking English at home had much lower scores for most HLQ scales including the scales ‘Understanding health information well enough to know what to do’ (ES −1.09 [95 % confidence interval (CI) -1.33 to −0.84]), ‘Ability to actively engage with healthcare providers’ (ES −1.00 [95 % CI −1.24, −0.75]), and ‘Navigating the healthcare system’ (ES −0.72 [95 % CI −0.97, −0.48]). Similar patterns and ES were seen for participants born overseas compared with those born in Australia. Smaller ES were seen for sex, age group, private health insurance status, number of chronic conditions, and living alone. Conclusions This study has revealed some large health literacy differences across nine domains of health literacy in adults using health services in Victoria. These findings provide insights into the relationship between health literacy and socioeconomic position in vulnerable groups and, given the focus of the HLQ, provide guidance for the development of equitable interventions.
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                Author and article information

                Journal
                Health Lit Res Pract
                Health Lit Res Pract
                HLRP
                HLRP: Health Literacy Research and Practice
                SLACK Incorporated (Thorofare, NJ )
                2475-6024
                2474-8307
                April 2021
                10 May 2021
                : 5
                : 2
                : e109-e117
                Author notes

                Seçil Özkan, MD, is a Professor, Department of Public Health, Faculty of Medicine, Gazi University. Hakan Tüzün, MD, is a Public Health Specialist, Ministry of Health, General Directorate of Health Promotion, Turkey. Asiye Uğraş Dikmen, MD, is an Assistant Professor, Department of Public Health, Faculty of Medicine, Gazi University. Nur Baran Aksakal, MD, is a Professor, Department of Public Health, Faculty of Medicine, Gazi University. Deniz Çalışkan, MD, is a Professor, Department of Public Health, Faculty of Medicine, Ankara University. Özge Taşçı, BS, is a Pedagogue, Ministry of Health, General Directorate of Health Promotion, Turkey. Selime Ceylan Güneş, BS, is a Folklorist, Ministry of Health, General Directorate of Health Promotion, Turkey.

                Address correspondence to Hakan Tüzün, MD, Ministry of Health, General Directorate of Health Promotion, Sağlik Bakanliği, Bilkent Yerleşkesi, Ankara, Turkey; email: drtuzunh@ 123456yahoo.com .

                Grant: The research conducted to obtain data for this study was funded by the Directorate General for Health Promotion of the Ministry of Health within the scope of the loan agreement between the Republic of Turkey and the World Bank (SGGM/2016/NCS/C.1.1.1.2.b/NCB/1).

                Disclosure: The authors have no relevant financial relationships to disclose.

                Article
                10.3928_24748307-20210330-01
                10.3928/24748307-20210330-01
                8241229
                34251938
                92e7ee89-5c3a-4e0a-9524-a70fe80bf44b
                ©2021 Özkan, Tüzün, Dikmen, et al.; licensee SLACK Incorporated

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International ( https://creativecommons.org/licenses/by/4.0). This license allows users to copy and distribute, to remix, transform, and build upon the article, for any purpose, even commercially, provided the author is attributed and is not represented as endorsing the use made of the work.

                History
                : 08 January 2020
                : 09 July 2020
                Categories
                Original Research

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