National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults

BMC Public Health

Helle Terkildsen Maindal¹  Richard H Osborne³  Karina Friis²  Anne Bo¹ 

[1] Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark;Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark;Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australia

关键词: Health literacy questionnaire (HLQ);    Population survey;    Inequality in health;    Socioeconomic factors;    Health information;    Doctor-patient relations;    Patient participation;    Patient-centred care;    Health competence;    Health literacy;   

Others  :  1126053
DOI  :  10.1186/1471-2458-14-1095

 received in 2014-01-13, accepted in 2014-10-02,  发布年份 2014

【 摘 要 】

Background

Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy.

Methods

A population-based survey was conducted between January and April 2013 in the Central Denmark Region. Postal invitations were sent to a random sample of 46,354 individuals >25 years of age. Two health literacy dimensions were selected from the Health Literacy Questionnaire (HLQ™): i) Understanding health information well enough to know what to do (5 items), and ii) Ability to actively engage with health care providers (5 items). Response options ranged from 1 (very difficult) to 4 (very easy). We investigated the level of perceived difficulty of each task, and the associations between the two dimensions and socio-economic characteristics.

Results

A total of 29,473 (63.6%) responded to the survey. Between 8.8%, 95% CI: 8.4-9.2 and 20.2%, 95% CI: 19.6-20.8 of the general population perceived the health literacy tasks as difficult or very difficult at the individual item level. On the scale level, the mean rating for i) understanding health information was 3.10, 95% CI: 3.09-3.10, and 3.07, 95% CI: 3.07-3.08 for ii) engagement with health care providers. Low levels of the two dimensions were associated with low income, low education level, living alone, and to non-Danish ethnicity. Associations with sex and age differed by the specific health literacy dimension.

Conclusion

Estimates on two key dimensions of health literacy in a general population are now available. A substantial proportion of the Danish population perceives difficulties related to understanding health information and engaging with healthcare providers. The study supports previous findings of a socio-economic gradient in health literacy. New insight is provided on the feasibility of measuring health literacy which is of importance for optimising health systems.

【 授权许可】

   
2014 Bo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bodenheimer T, Lorig K, Holman H, Grumbach K: Patient self-management of chronic disease in primary care. JAMA 2002, 288(19):2469-2475.
• [2]Jordan JE, Osborne RH: Chronic disease self-management education programs: challenges ahead. Med J Aust 2007, 186(2):84-87.
• [3]Coleman K, Austin BT, Brach C, Wagner EH: Evidence on the chronic care model in the new millennium. Health Aff (Millwood) 2009, 28(1):75-85.
• [4]Joosten EA, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CP, de Jong CA: Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008, 77(4):219-226.
• [5]Charles C, Whelan T, Gafni A: What do we mean by partnership in making decisions about treatment? BMJ 1999, 319(7212):780-782.
• [6]Appelbaum PS: Assessment of Patients’ competence to consent to treatment. N Engl J Med 2007, 357(18):1834-1840.
• [7]Kickbusch I, Pelikan JM, Apfel F, Tsouros AD: Health Literacy, the Solid Facts. World Health Organization, Regional Office for Europe; 2013. [http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf webcite]
• [8]Nutbeam D: Health promotion glossary. Health Promot 1999, 12(4):349-364.
• [9]Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, Brand H, (HLS-EU) Consortium Health Literacy Project European: Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 2012, 12:80. BioMed Central Full Text
• [10]Nutbeam D: Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int 2006, 15(3):259-267.
• [11]Osborne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R: The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health 2013, 13:658. BioMed Central Full Text
• [12]Volandes AE, Paasche-Orlow MK: Health literacy, health inequality and a just healthcare system. Am J Bioeth 2007, 7(11):5-10.
• [13]Rudd RE: Needed action in health literacy. J Health Psychol 2013, 18(8):1004-1010.
• [14]Statistics Canada, OECD: Learning a Living: First Results from the Adult Literacy and Life Skills Survey. Minister of Industry, Canada and OECD; 2005:30. [http://www.oecd.org/edu/innovation-education/34867438.pdf webcite]
• [15]Rudd RE: Health literacy skills of U.S. adults. Am J Health Behav 2007, 31(Suppl 1):S8-S18.
• [16]Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K: Low health literacy and health outcomes: an updated systematic review. Ann Intern Med 2011, 155(2):97-107.
• [17]Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB: Association of health literacy with diabetes outcomes. JAMA 2002, 288(4):475-482.
• [18]Chinn D, McCarthy C: All Aspects of Health Literacy Scale (AAHLS): developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings. Patient Educ Couns 2013, 90(2):247-253.
• [19]Ishikawa H, Takeuchi T, Yano E: Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care 2008, 31(5):874-879.
• [20]Sorensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, Kondilis B, Stoffels V, Osborne RH, Brand H, HLS-EU Consortium: Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 2013, 13:948. BioMed Central Full Text
• [21]HLS-EU Consortium: Comparative Report of Health Literacy in Eight EU Member States. The European Health Literacy Survey HLS-EU; 2012. [http://www.health-literacy.eu webcite]
• [22]Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR: The prevalence of limited health literacy. J Gen Intern Med 2005, 20(2):175-184.
• [23]Barber MN, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R: Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. Health Promot Int 2009, 24(3):252-261.
• [24]Protheroe J, Nutbeam D, Rowlands G: Health literacy: a necessity for increasing participation in health care. Br J Gen Pract 2009, 59(567):721-723.
• [25]Ishikawa H, Yano E: Patient health literacy and participation in the health-care process. Health Expect 2008, 11(2):113-122.
• [26]Jordan JE, Osborne RH, Buchbinder R: Critical appraisal of health literacy indices revealed variable underlying constructs, narrow content and psychometric weaknesses. J Clin Epidemiol 2011, 64(4):366-379.
• [27]Christensen AI, Ekholm O, Glumer C, Andreasen AH, Hvidberg MF, Kristensen PL, Larsen FB, Ortiz B, Juel K: The Danish National Health Survey 2010. Study design and respondent characteristics. Scand J Public Health 2012, 40(4):391-397. 31
• [28]Särndal C, Lundström S: Estimation in surveys with nonresponse. Chichester: John Wiley & Sons Ltd; 2005.
• [29]Hawkins M, Osborne R: Questionnaire Translation and Cultural Adaptation Procedure. Deakin Population Health Strategic Research Centre, Deakin University; 2010. [http://www.deakin.edu.au/health/research/phi/Translation%20Procedure%20version%203.1%20for%20HLQ%20FINAL%20130422.pdf webcite]
• [30]Statistics Denmark: Indvandrere i Danmark 2012 (Immigrants in Denmark 2012). Statistics Denmark; 2012. [http://www.dst.dk/pukora/epub/upload/16601/indv.pdf webcite]
• [31]Arendt JN, Jensen BT, Nexøe J, Müntzberg G, Sørensen J: Low income and number of contacts with general practice. Ugeskrift for laeger - LA Danish 2010, 172(21):1591.
• [32]Danish Ministry of Health: Lov om videnskabsetisk behandling af sundhedsvidenskabelige forskningsprojekter (Law on ethical conduct in health science). 2011. [Lovtidende A, chapter 4, §14, section 2]
• [33]Rosdahl A, Fridberg T, Jacobsen V, Jørgensen M: Færdigheder i læsning, regning og problemløsning med IT i Danmark (Literacy, Numeracy and Problem Solving in IT in Denmark). The Danish National Centre for Social Research; 2013. [http://www.oecd.org/site/piaac/Denmark_1328-Danskernes-kompetencer.pdf webcite]
• [34]OECD: OECD Skills Outlook 2013: First Results from the Survey of Adult Skills. OECD Publishing; 2013. [http://dx.doi.org/10.1787/9789264204256-en webcite]
• [35]van der Heide I, Rademakers J, Schipper M, Droomers M, Sorensen K, Uiters E: Health literacy of Dutch adults: a cross sectional survey. BMC Public Health 2013, 13:179-2458. 13-179 BioMed Central Full Text
• [36]van der Heide I, Wang J, Droomers M, Spreeuwenberg P, Rademakers J, Uiters E: The relationship between health, education, and health literacy: results from the Dutch adult literacy and life skills survey. J Health Commun 2013, 18(Suppl 1):172-184.
• [37]Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G: Indicators of socioeconomic position (part 1). J Epidemiol Commun Health 2006, 60(1):7-12.
• [38]Nutbeam D: The evolving concept of health literacy. Soc Sci Med 2008, 67(12):2072-2078.
• [39]Andrulis DP, Brach C: Integrating literacy, culture, and language to improve health care quality for diverse populations. Am J Health Behav 2007, 31(Suppl 1):122-133.
• [40]Edwards M, Wood F, Davies M, Edwards A: ‘Distributed health literacy’: longitudinal qualitative analysis of the roles of health literacy mediators and social networks of people living with a long-term health condition. Health Expect 2013, 32. in press
• [41]Thomson S, Osborn R, Squires D, Jun M: International Profiles of Health Care Systems. The Commonwealth Fund; 2013. [http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Nov/1645_Squires_intl_profiles_hlt_care_systems_2012.pdf webcite]
• [42]Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, Holland A, Brasure M, Lohr KN, Harden E, Tant E, Wallace I, Viswanathan M: Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess (Full Rep) 2011, 199:1-941.
• [43]Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, Bradley KA, Nugent SM, Baines AD, Vanryn M: Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 2008, 23(5):561-566.