Measuring health literacy: performance-based versus perception-based measures

Abstract

Abstract Background Many performance-based or perception-based measurement tools of health literacy (HL) have been developed. The aim of this study is to compare the results of performance-based versus perception-based measures of HL in a population-based sample in Florence (Italy). Methods 223 subjects were interviewed. To measure HL, HLS-EU-Q16 (perception-based measure of general HL) and NVS (performance-based measure of functional HL) were used. Sociodemographic characteristics were collected. Results The majority of the subjects had high school (36%) or university (44%) degree and gets to the end of the month quite or very easily with financial resources available (69%). Considering age classes, 22% was 18-45, 26% 46-55, 34% 56-65, 18% 66-70 year-old. According to HLS-EU-Q16, 11.8% had inadequate, 55.5% problematic and 33% sufficient HL; considering NVS, 11.7% had high likelihood of limited HL, 28.7% possibility of limited HL, 59.6% adequate HL. The percentage of people with low HL was higher for HLS-EU-Q16 than for NVS in each category of age class, educational level, and financial resources. For both measures, the percentage of people with low HL increased with age, becoming more similar for older people: for HLS-EU-Q16, from 59.2% for 18-45 to 78.4% for >65 years old; for NVS, from 20% for 18-45 to 67.5% for >65 years old. Similar results were observed for educational level and financial resources: for both tests, the percentage of people with low HL increased with the decreasing of educational level or financial resources; for the worst situations (less than high school diploma or having not enough financial resources), the percentage of people with low HL become similar comparing the two tests. Conclusions Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects, but in the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result. Key messages Perception-based measure of general HL and performance-based measure of functional HL investigate different aspects. In the worst situations (older people, low educational level and not enough financial resources) they tend to produce the same result.