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


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          Background: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. M ethods: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain ( n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. R esults: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29–62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. Discussion: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

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          Most cited references11

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          Brief questions to identify patients with inadequate health literacy.

          No practical method for identifying patients with low heath literacy exists. We sought to develop screening questions for identifying patients with inadequate or marginal health literacy. Patients (n=332) at a VA preoperative clinic completed in-person interviews that included 16 health literacy screening questions on a 5-point Likert scale, followed by a validated health literacy measure, the Short Test of Functional Health Literacy in Adults (STOHFLA). Based on the STOFHLA, patients were classified as having either inadequate, marginal, or adequate health literacy. Each of the 16 screening questions was evaluated and compared to two comparison standards: (1) inadequate health literacy and (2) inadequate or marginal health literacy on the STOHFLA. Fifteen participants (4.5%) had inadequate health literacy and 25 (7.5%) had marginal health literacy on the STOHFLA. Three of the screening questions, "How often do you have someone help you read hospital materials?" "How confident are you filling out medical forms by yourself?" and "How often do you have problems learning about your medical condition because of difficulty understanding written information?" were effective in detecting inadequate health literacy (area under the receiver operating characteristic curve of 0.87, 0.80, and 0.76, respectively). These questions were weaker for identifying patients with marginal health literacy. Three questions were each effective screening tests for inadequate health literacy in this population.
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            Otawa Charter for health promotion

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              Health Literacy


                Author and article information

                Eur J Public Health
                Eur J Public Health
                The European Journal of Public Health
                Oxford University Press
                December 2015
                05 April 2015
                05 April 2015
                : 25
                : 6
                : 1053-1058
                1 Maastricht University, Department of International Health/CAPHRI, Maastricht, the Netherlands
                2 Ludwig Boltzmann Institute Health Promotion Research, Vienna, Austria
                3 The Cardinal Wyszyński Institute of Cardiology, Warsaw, Poland
                4 University College Dublin, Dublin, Ireland
                5 Hellenic American University, Manchester, NH & Hellenic American College, Athens, Greece
                6 National School of Public Health, Athens, Greece
                7 Centre for Nutrition, Prevention and health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
                8 University of Murcia, Department of Legal Medicine, Murcia, Spain
                9 NRW Centre for Health, Bielefeld, Germany
                10 Medical University, Faculty of Public Health, Sofia, Bulgaria
                11 Université Catholique de Louvain, Louvain-la-Neuve, Belgium
                Author notes
                Correspondence: Kristine Sørensen, Department of International Health/CAPHRI, Faculty of Health, Medicine and Life Science, Maastricht University, P.O. Box 616, 6200MD Maastricht, the Netherlands. Telephone: +31 433881717 e-mail: K.Sorensen@ 123456maastrichtuniversity.nl
                © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 6
                Health Behaviour and Mental Health

                Public health
                Public health


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