Abstract
BackgroundHealth literacy (HL) is defined as necessary competencies to make well-informed decisions. As patients’ decision making is a key element of patient-centered health care, insight in patients’ HL might help healthcare professionals to organize their care accordingly. This is particularly true for people in a vulnerable situation, potentially with limited HL, who are, for instance, at greater risk of having limited access to care [1, 2].As HL correlates with education, instruments should allow inclusion of low literate people. To that end, the relatively new instrument, HLS-EU-Q47, was subjected to a comprehensibility test, its shorter version, HLS-EU-Q16, was not. Therefore, the goal of this study was to examine feasibility of HLS-EU-Q16 (in Dutch) for use in a population of people with low literacy.MethodsPurposive sampling of adults with low (yearly) income (< €16,965.47) and limited education (maximum high school), with Dutch language proficiency. Exclusion criteria were: psychiatric, neurodegenerative diseases or impairments. To determine suitability (length, comprehension and layout) participants were randomly distributed either HLS-EU-Q16 or a modified version and were interviewed directly afterwards by one researcher. To determine feasibility a qualitative approach was chosen: cognitive interviews were carried out using the verbal probing technique.ResultsThirteen participants completed HLS-EU-Q16 (n = 7) or the modified version (n = 6). Questions about ‘disease prevention’ or ‘appraisal’ of information are frequently reported to be incomprehensible. Difficulties are attributed to vocabulary, sentence structure and the decision process (abstraction, distinguishing ‘appraising’ from ‘applying’ information, indecisive on the appropriate response).ConclusionsHLS-EU-Q16 is a suitable instrument to determine HL in people with limited literacy. However, to facilitate the use and interpretation, some questions would benefit from minor adjustments: by simplifying wording or providing explanatory, contextual information.
Highlights
Health literacy (HL) is defined as necessary competencies to make well-informed decisions
* Correspondence: hannelore.storms@uhasselt.be 1Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium 2Campus Diepenbeek, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Gebouw D, B-3590 Diepenbeek, Belgium Full list of author information is available at the end of the article context, this involves more complex and interconnected abilities, such as acting upon written health information, communicating needs to health professionals, understanding health instructions, applying them correctly to their personal situations, and taking action if needed [5]. These competencies are contained in the concept of health literacy (HL), which can be defined as a person’s knowledge, motivation and competencies to access, understand, appraise, and apply health information in order to make judgments and take decisions concerning health [6]
A growing number of studies show that people with low HL have a lower adherence to medication, poor self-care and worse treatment outcomes, but are less likely to engage in health promoting behaviour, participate in screening programs, or make use of preventive services [8,9,10,11]
Summary
Health literacy (HL) is defined as necessary competencies to make well-informed decisions. As patients’ decision making is a key element of patient-centered health care, insight in patients’ HL might help healthcare professionals to organize their care This is true for people in a vulnerable situation, potentially with limited HL, who are, for instance, at greater risk of having limited access to care [1, 2]. In addition to reading and numerical skills applied in a medical These competencies are contained in the concept of health literacy (HL), which can be defined as a person’s knowledge, motivation and competencies to access, understand, appraise, and apply health information in order to make judgments and take decisions concerning health [6]. Examples of the second kind are the Critical Health Competence Test (CHC) [17], the Swiss Health Literacy Survey [13, 18], the Health Literacy Management Scale (HeLMS) [19] and the Health Literacy Questionnaire (HLQ) [20]
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