Health Literacy Survey Research Articles

A Prospective Evaluation of Health Literacy Levels of Pregnant Women in Antenatal Classes: Impact on Delivery Outcomes in Nulliparous and Multiparous Women

Backgrounds/Objectives: Modern technology and educational activities, such as antenatal classes (ACs), increase patient informedness in medicine and improve collaboration between physicians and patients. The present study aimed to evaluate and compare the impact of maternal health literacy (HL) on delivery outcomes between nulliparous and multiparous women who attended antenatal classes. Methods: This prospective study recruited 281 pregnant women who regularly attended ACs, but only 188 who gave birth at our academic tertiary hospital were included in the final analysis. Socio-demographic characteristics, peripartum data (cervical dilatation at the time of admission to the hospital, duration of labor, and mode of delivery), and obstetric interventions (cesarean section (C/S) rate and rate of instrumental vaginal birth and episiotomy) were recorded, and the level of HL was assessed using the European Health Literacy Survey Questionnaire (HLS-EU-Q16). HL levels did not significantly affect peripartum and postpartum outcomes. Results: The study results showed that HL levels did not impact labor duration and newborn Apgar scores (p > 0.05). Patient education levels and employment status affected the peripartum duration of labor (p = 0.048 and p = 0.001, respectively). There were no differences in the HL total score and subscale scores (p > 0.05) between nulliparous and multiparous patients, and the rate of primary C/S was similar in both groups. Conclusions: HL levels did not impact delivery (peripartum) outcomes in pregnant women who attended antenatal classes. However, the primary C/S rate was similar between the nulliparous and multiparous groups, which may indicate that antenatal education services can correct the negative impact of low HL levels on the primary C/S rate.

Association of Maternal Immigration Status with Emotional Eating in Taiwanese Children: The Mediating Roles of Health Literacy and Feeding Practices.

Emotional eating has been linked to childhood obesity. A variety of emotions often trigger this form of eating, which has been associated with stress-induced overeating, loss of control eating, and binge eating in children. However, research on how maternal immigration status and feeding practices influence emotional eating in children within Asian contexts is sparse. This study examines the association between maternal immigration status and emotional eating in children, exploring the mediating roles of health literacy and feeding practices. The study focused on children aged 10-11 and their mothers in Taiwan, utilizing a sample of 2,308 mother-child dyads. The Child Feeding Questionnaire (CFQ) was used to assess mothers' feeding practices, while emotional eating was measured using a subscale of the Three-Factor Eating Questionnaire-Revised 18 (TFEQ-R18). Health literacy was evaluated using the Health Literacy Survey Questionnaire (HLS-EU-Q12). Confirmatory factor analysis, Pearson's correlation, and Structural Equation Models (SEMs) were employed to explore the potential pathways leading to children's emotional eating. Children of mothers with foreign nationality demonstrate higher emotional eating scores compared to those with native-born mothers (5.73 vs. 5.35, p = 0.04). These mothers also have significantly lower health literacy levels (35.21 vs. 38.52, p < 0.0001). They are more inclined to use rewarding and pressure-to-eat feeding practices while showing reduced tendencies toward monitoring and restriction. Serial mediation models suggest that maternal foreign nationality influences children's emotional eating primarily by increasing rewarding and pressure-to-eat practices alongside reduced health literacy, which ultimately lowers monitoring practices. Interventions should improve maternal health literacy and promote healthy feeding practices. Future research should investigate these pathways across various geographic regions and age groups to develop targeted interventions for immigrant families.

The Paradox of Digital Health: Why Middle-Aged Adults Outperform Young Adults in Health Management Utilization via Technology

Background/Objectives: Globally, life expectancy has been increasing with South Korea focusing on improving health to enhance quality of life. The COVID-19 pandemic further emphasized the need for digital transformation in healthcare, accelerating digital health adoption. This study explores the digital divide between ‘Digital Natives (20–39 Y)’ and ‘Digital Immigrants (40–69 Y)’, focusing on digital device usage and confidence. Methods: This study utilized national survey data from the Digital Health Literacy Survey Results and Policy Implications, focusing on differences in digital device use and confidence between young adults (20–39 Y) and middle-aged adults (40–69 Y). The participants comprised 1000 adults aged 20 to 69 in the Republic of Korea. Respondents were queried about their use of digital health tools, such as wearable devices and mobile apps. Confidence in using digital systems and managing health via digital tools was assessed using a five-point Likert scale. Results: The findings indicated that while young adults have lower rates of using digital devices for healthcare, they exhibit higher confidence in using such devices. In contrast, middle-aged adults, despite having lower confidence, report higher usage of digital devices for healthcare purposes. Conclusions: This study explored differences in digital confidence and healthcare usage between age groups and aimed to propose effective health management strategies based on digital accessibility.

Psychometric validation of the French version of two scales measuring general (HLS19-Q12) and navigational (HLS19-NAV) health literacy using the Rasch model

BackgroundTo examine the psychometrics properties of the French version of two scales measuring general (HLS19-Q12) and navigational (HLS19-NAV) health literacy (HL) using validation methods based on modern psychometric test theories: a Rasch model analysis.MethodsThe data on representative samples of the French adult population came from the Health Literacy Survey (N = 2 003), conducted in France in two waves (2020 and 2021), and from the third wave of SLAVACO study (N = 2 022), conducted in December 2021. A Rasch analysis was performed using a partial credit model with marginal maximum likelihood estimation adapted to polytomous data. Category probability curves were used to examine whether participants found it consistently difficult to distinguish between response options. Differential item functioning (DIF) was also examined for each item in the two scales as a function of age, gender, and economic status. A Person Separation Index (PSI) of 0.7 has conventionally been considered to be the minimum acceptable PSI level. Chi-square fit statistics, expressed as infit and outfit mean square statistics, were calculated for each item in the two scales. An acceptable fit corresponded to average values between 0.7 and 1.3. The dimensionality of the scales was assessed using Principal Components Analysis (PCA) on the residual correlation matrix to identify whether items are locally independent. Additionally, Smith’s method was employed to detect potential multidimensionality.ResultsThe PSI values for both scales were greater than 0.90. No disordered categories were observed. No evidence of significant DIF was found when associated with gender and economic status. However, two items for both scales had a DIF which was dependent on age but did not have a significant impact on scale scores between younger and older people. Minor local dependence was noted on the HLS19-NAV scale. However, a PCA and Smith’s method demonstrated the unidimensionality of the French version of the scales measuring general and navigational HL.ConclusionsOur results, based on a rigorous statistical analysis, verified the psychometric parameters of the French version of the HLS19-Q12 and HLS19-NAV scales. Despite strong correlation between both scales, each measured a different latent trait. Moreover, despite the fact that presence of DIF was weak, attention must nonetheless be paid when comparing scale response scores between young and older respondents.

The M-POHL Health Literacy Population Survey 2024-2026 (HLS24)

Abstract Background Inspired by the first European Health Literacy Survey (HLS-EU) and its policy impact, the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) was established in 2018 under the auspices of WHO Europe to monitor and strengthen health literacy (HL) in Europe. The Health Literacy Survey 2019-2021 (HLS19) was the first project of M-POHL, focusing on both general and specific aspects of HL. The follow-up survey (HLS24) builds on this work and will provide even more comprehensive data on HL by including more countries and new aspects of HL. By also focusing on NCDs and prevention, HLS24 is a key partner in the European Joint Action PreventNCD. Methods The HLS24 is a cross-sectional study based on nationally representative samples of the adult population (18+) in more than 20 participating countries. The HLS24 core questionnaire includes items on general HL, sociodemographics, health behavior, health status, and health care utilization. Some countries also include questions on prevention and early detection of chronic diseases and health problems. Five optional packages (OPs) enable countries to focus on specific aspects of HL, namely digital, communicative, navigational, vaccination and mental HL. Results HLS24 uses a harmonized set of HL instruments that provide a solid database for health policy decisions to strengthen HL and health equity in Europe. In addition to the three OPs on digital, communicative and navigational HL discussed in the following presentations, an 11-item set on vaccination literacy and a 21-item set on mental HL are provided. Conclusions Covering NCDs, prevention, digital health, immunization, and mental health, the HLS24 provides important data on current health challenges and highlights the needs of the European population regarding health information and services upon which policy and action interventions can be based.

Cross-sectional survey of health literacy among high school students in Armenia

Abstract Background We assessed the level of health literacy (HL) and explored its predictors among 15-17 years old adolescents in Armenia. Methods We conducted a survey among adolescents in public and private schools in the capital Yerevan and an adjacent province in 2023. The instrument included items on HL, general interest in health and socio-demographics. Ten questions measuring HL with four answer options were summed into the HL score (0-30). Multivariable regression model explored the independent associations of socio-demographic factors and interest in health issues with the HL. Results Overall, 366 students completed the survey. About 64% were females. The majority were interested in health issues (80.7%). Most participants felt they, in general, received sufficient health information (75.1%), could follow physician’s instructions (80.1%), were confident in advising family or friends on health improvements (70.5%), could easily give examples of health-promoting actions (76.8%), and explain their choices for health (77.6%). Additionally, 82.2% could judge the environmental impact of their actions, 82.0% could find understandable health information when needed, and 85.3% could assess how their behavior affects their health. Fewer respondents were confident in figuring out if the health information is correct (68.2%) or identifying correct health information when faced with conflicting data (67.1%). The average HL score was 17.41 (SD = 4.47), with a 58.0% percent score. In the regression analysis, being from private school vs. public and being interested in health vs. not were significant predictors of higher HL. Conclusions Despite having moderate HL level, a significant portion of Armenian adolescents lacked confidence in discerning correct health information. Interventions should prioritize enhancing HL, emphasizing critical evaluation skills and providing accessible and reliable health information resources tailored to adolescents, particularly in public schools. Key messages • The health literacy among Armenian adolescents was moderate with many lacking confidence in identifying correct health information and differentiating when faced with conflicting data. • Attending a private school and having an interest in health were significant predictors for higher health literacy, emphasizing the need for targeted health and policy interventions.

Factors Influencing Health Literacy among South Korean Adults: A Nationwide Study

Abstract Background Health literacy is crucial for health knowledge, behaviors, and outcomes, but research on health literacy has been limited to specific populations and settings in South Korea. This study aimed to identify factors influencing health literacy in a nationally representative sample of South Korean adults to inform public policies. Methods This cross-sectional study utilized data from the 2020 Korea Health Panel survey (10,262 adults aged 18-84 years). Sociodemographic factors (age, gender, education level, monthly household income, employment status, marital status, household characteristics, and region) and health (subjective health status, presence of chronic diseases, depression, and health insurance status) factors were examined. Health literacy was assessed using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Linear regression analysis was performed to identify factors associated with health literacy. Results The mean health literacy score was 9.1 (SD 1.60), with significant differences across age groups (p &amp;lt; 0.001). Linear regression analysis (adjusted R2=0.287, F = 322.83, P &amp;lt; 0.001) revealed that higher age, female gender, lower education, lower household income, being single, living outside a metropolitan area, having chronic diseases, lower subjective health, depression, and being uninsured or receiving medical aid were significantly associated with lower health literacy (all p &amp;lt; 0.001). Conclusions This study identified several socio-economic and health-related factors significantly associated with health literacy among South Korean adults. The findings suggest that older individuals, who may require more time to understand and use health information, are particularly vulnerable to low health literacy. These results provide valuable insights for developing targeted interventions and public health policies aimed at promoting health literacy and successful aging in the context of a rapidly aging society. Key messages • Various socio-economic and health-related factors significantly influence health literacy among South Korean adults. • Older individuals are particularly vulnerable to low health literacy, which has implications for successful aging in a rapidly aging society.

Measuring digital health literacy in Europe – developing a new tool to capture innovation

Abstract Background Rapid advancement of digital resources for health and healthcare in Europe has widened the scope of opportunities to promote health, but also raises concerns about accessibility and health equity. Measuring digital health literacy (DHL) in populations is critical for assessing digital resource appropriateness in general and specifically among vulnerable populations. The DHL measure used in the M-POHL Health Literacy Survey 2019-2021 (HLS19) in 13 countries showed inadequate DHL in large parts of the population, reflecting a social gradient. As digital resources become increasingly interactive, potentially widening the digital divide, a need to refine the DHL HLS19 tool was evident. Methods Building on the HLS19 tool, an additional measure was developed to assess interactive aspects of DHL by representatives from 16 countries in a co-productive way, based on discussions about the diverse digital challenges. The additional scale was to be generic enough to be relevant for all countries, yet specific enough to discern the diverse needs regarding various public health/healthcare service formats across Europe. Results The new tool is divided into 2 parts: a scale measuring the skills to access, understand, appraise, and apply digital health information as applied and validated in HLS19, and a new set of items assessing the use and ease of use of interactive digital resources including health promotion apps, digital tools for managing health/medical conditions, navigating the healthcare system, and communicating online with health professionals. The tool has been translated into several languages and is currently undergoing piloting/cognitive testing. Conclusions Collaborative work among countries is essential for developing relevant measurement tools on the European level. Just as the technology undergoes rapid change, likewise tools for assessing DHL must be updated acknowledging the diversity of digital resources and needs on country levels.

First insights in children’s health literacy in the Netherlands–results in a sample of 8-11 year olds

Abstract Background There are few valid, age-appropriate tools to assess children’s HL. The German-language European Health Literacy Survey Questionnaire Adapted for Children (HLS-Child-Q15-DE) is a self-report questionnaire adapted from the adult European Health Literacy Survey Questionnaire. In 2021, this instrument was translated and validated in the Netherlands. In this presentation, we will describe the distribution of Health literacy in a sample of Dutch children, and relate their Health literacy level to certain aspects of their health behaviour such as food intake and physical activity. Methods The HLS-Child-Q15-DE was translated following WHO guidelines and administered digitally to 209 Dutch schoolchildren (eight-to-eleven-year-olds). Its psychometric properties were assessed and the sample’s HL distribution was explored by demographic characteristics. Associations with food intake and physical activity were computed. Results Of the sample, 17.2% had a low health literacy score (first quintile), 61.1% medium (second to fourth quintile) and 21.7% high (fifth quintile). Higher HL scores were observed for ten-to-eleven-year-olds (compared with eight-to-nine-year-olds; p = 0.021) and fourth-grade students (compared with third-grade; p = 0.019). A positive association between children’s HL and their vegetable consumption and PA behaviour was observed. Conclusions Children’s health literacy can have an impact on some aspects of their lifestyle. This supports the idea that health literacy evolves throughout life and stresses the importance of both parents and schools in this process.

Vaccination health literacy: cultural validation and pilot testing of the HLS19-VAC instrument

Abstract Introduction Vaccinаtion health literacy (VHL) is considered an extremely important aspect of health literacy. HLS19-VAC questionnaire is a 14-item ‘subjective’ perception-based instrument used for measuring VHL in the M-POHL Health Literacy Survey 2019-2021, which Serbia was not part of. Aim Translation and cultural validation of the HLS19-VAC questionnaire and using the validated Serbian version (HLS19-VAC_RS) for pilot study research. Materials and methods The English version of HLS19-VAC was translated using a systematic approach; three forward and one back-translations were synthesized and compared by an expert committee. Thereafter, cognitive interviews with 11 participants produced a version that was culturally validated by an expert panel. We conducted a cross-sectional pilot study using a HLS19-VAC_RS, on a convenient sample of the general population in Serbia. VHL was assessed by calculating the score for 4 out of 14 questions. Additional data were collected through a general questionnaire with 30 questions. Descriptive and inferential statistics were used. Results Cognitive interviews showed some problems in wording, and cultural adaptation resulted in minor refinements to eight out of 14 items. The instrument was pretested by 11 experts who adjusted it accordingly to produce culturally validated HLS19 -VAC_RS. Of 439 respondents in a pilot study, 15% had problematic VHL, while the levels of sufficient and excellent VHL were nearly the same (38.5% and 35.1%, respectively). There was difficulty in deciding whether to receive the flu vaccine (15.0%) and to find information about recommended vaccines (12.3%). There was a significant statistical difference in responses to VHL and monthly income and alcohol consumption. Most of the respondents contacted pharmacists as primary sources of information about medication (42.7%). Conclusions HLS19 -VAC_RS could be implemented in a local context as culturally appropriate. Further testing on a population level is needed. Key messages • HLS19-VAC_RS Questionnaire is culturally appropriate for assessing vaccination health literacy in Serbia. • Majority of respodents had sufficient or excellent vaccination health literacy.

The relationship between health literacy level and quality of life in bariatric surgery patients

Abstract Background Today, obesity is an important public health problem. In addition to the intervention programmes developed to prevent obesity, the necessity of medical and surgical treatment is increasing with the growing population. This study was conducted to determine the relationship between health literacy and quality of life in patients undergoing bariatric surgery. Methods This cross-sectional study was conducted with the participation of 136 patients aged 18 years and older who underwent bariatric surgery in a general surgery service between January 2021 and December 2023 and whose contact information was available. The survey participation rate was 75.1%. The questionnaire used for data collection consisted of questions about the sociodemographic information of the participants, The European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the Postbariatric Surgery Quality of Life Scale items. Descriptive statistics, Mann Whitney U, Kruskal Wallis H test and Spearman correlation analysis were used to analyze the data. A value of p &amp;lt; 0.05 was considered statistically significant. Results The mean age of the patients who participated in the study was 38.2 ± 10.8 years; mean BMI was 42.3 ± 6.4 before surgery and 29.0 ± 6.2 after surgery. In the study, 44.1% of the patients who underwent bariatric surgery were found to have inadequate/problematic health literacy level. Participants who had less than a bachelor’s degree (p = 0.009) and low income (p &amp;lt; 0.001) had significantly lower health literacy levels. In addition, a moderate positive correlation was found between overall health literacy score and quality of life score (r = 0.252; p = 0.003). Conclusions In conclusion, this study shows that improved health literacy positively affects quality of life in patients undergoing bariatric surgery and that health literacy education should be emphasized in this context. Key messages • The level of health literacy of bariatric surgery patients is a determining factor on quality of life, and therefore health literacy education is important, especially in identified risk groups. • Increased health literacy can have positive results in terms of psychosocial and physical health and improve quality of life after bariatric surgery.

Assessment of the level of health literacy in students with specific learning disorders

Abstract Background Specific Learning Disorders (SLDs) include dyslexia, dysorthography, dysgraphia, and dyscalculia and are referred to as specific educational learning disabilities. For students with SLDs, the issue of health literacy (HL) arises because understanding, evaluating and utilising health information are critical to making informed decisions about one’s health. This study aims to determine the level of HL in students with a certified SLD. Methods From November 2023 to April 2024, students with an SLD studying at the University of Udine (Italy) who agreed to participate, were surveyed using an online questionnaire on the EUSurvey platform. This consisted of the HLS-EU-Q47 to measure HL, followed by a socio-demographic section. The HLS-EU-Q47 classified HL into 4 levels: inadequate, problematic, sufficient and excellent; descriptive analysis was performed and the correlation with the sociodemographic data was examined using χ² test. Results 38 students participated (mean age 24 years, 60.5% female), 60% of whom are in an undergraduate degree program. 42% of the sample had a single SLD (26% dyslexia, 13% dysgraphia), while 58% of them have multiple SLDs. Overall, 42% of students were found to have a problematic HL level, 24% inadequate, only 24% sufficient and 11% excellent. No statistically significant association was found between) HL level and gender, number of SLDs, school attended at the time of SLD certification, and use of supports (all p-values&amp;gt;0.05). Conclusions The level of HL in students with SLDs appears to be consistent with data from the Italian population (58% inadequate or problematic) from the 2019-HLS19 Health Literacy Survey. This suggests that the presence of an SLD does not affect the level of HL and that it is likely that the university degree is able compensate for HL difficulties that could be related to the presence of an SLD. A larger sample is needed to see if it is confirmed that there is no association between the investigated variables. Key messages • Despite the presence of SLDs, the HL of academic students follows the same trend compared to the general Italian population. • The structural use of supportive measures by these students probably bridges the gap in access to and correct use of health information.

The role of health literacy in adherence to the Mediterranean diet

Abstract Background Health literacy has emerged as a crucial concept in public health. It is considered a modifiable determinant influencing health-related decision. One such decision is the adoption of specific dietary patterns. The Mediterranean diet has garnered recognition as one of the healthiest diets. This study aims to explore the association between health literacy levels among adults in socially vulnerable contexts and their adherence to the Mediterranean diet. Methods This study is part of a cluster-randomized trial conducted in primary schools from socially vulnerable contexts. A total of 469 parents of school-aged children agreed to participate. Health literacy was assessed using the Health Literacy Survey Questionnaire. Adherence to the Mediterranean diet was evaluated using the MEDAS questionnaire. Anthropometric and sociodemographic variables were self-reported via questionnaire. Parental BMI was calculated using weight/height^2. Education level was categorized into two groups (less than higher education and higher education), while professional status was classified based on the occupational categories of collar color. Generalized linear models were utilized for the analysis. Results Individuals with higher levels of health literacy present a greater odd to adhere to the Mediterranean diet (B = 0.022, 95% CI 0.010-0.035), even after adjusting for potential confounders (B = 0.019, 95% CI 0.006-0.032). Conclusions Health literacy emerges as a crucial factor influencing individuals’ dietary choices, as evidenced by its association with higher adherence to the Mediterranean diet. These findings underscore the importance of implementing policies and initiatives aimed at promoting health literacy, particularly among individuals from socially vulnerable contexts. Enhancing public health interventions to bolster health literacy should be prioritized to foster better dietary decision-making. Key messages • Health literacy plays an important role in the adoption of Mediterranean diet among adults from socially vulnerable contexts. • Implementing policies to aim the promotion of health literacy, particularly among individuals from socially vulnerable contexts are necessary.

Exploring the Relationship Between Health Literacy and Alcohol Consumption Patterns in Tuscany

Abstract Introduction Alcohol consumption is a prevalent aspect of social and cultural life worldwide. However, high and binge consumption has become a significant public health concern. Inadequate health literacy (HL) may contribute to poor awareness and/or knowledge regarding the risks of alcohol-related behaviors. However, to date, only a few studies have examined the relationship between HL and different types of alcohol consumption. This study aimed to investigate the relationship between HL, other sociodemographic determinants, and their influence on high and binge consumption among the general population aged 18-69 in Tuscany. Methods The study analyzed data from 2017 to 2022 from a Tuscan population subsample in the Italian Behavioral Risk Factor Surveillance System PASSI. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Results Among the 12,953 interviewees, binge drinking was reported by 8.3%, while high consumption by 3.6% of the entire sample. In the multivariate logistic regression, participants aged between 50 and 69 years with problematic or inadequate HL levels had an increased adjusted odds ratio for high alcohol consumption. Instead, females, individuals older than 34 years, and those of foreign nationality had a reduced odds ratio for binge drinking. Low HL was a predictor of high alcohol consumption but not of binge drinking. Discussion As expected, young males are more likely to engage in binge drinking, while older individuals are more likely to have high consumption. In a challenging period for healthcare system sustainability, it is mandatory to use economic resources efficiently and target the right population with tailored interventions: given that HL impacts on high consumption, research and policy should focus HL interventions specifically on high alcohol consumers. Conversely, educational campaigns aimed at increasing HL in binge drinkers risk to have a lesser impact. Key messages • Health literacy does not influence binge drinking. • Inadequate levels of health literacy predict high alcohol consumption.

3.X.1. Health literacy in Europe: Building a comparative database for shaping public health policy

Abstract Health literacy (HL) is a key determinant of health and a lever for health equity. It refers to the extent to which individuals are able to deal with health-related information, communicate with health professionals, and navigate the health care system to restore, maintain, protect, and improve their health and well-being. It is the result of an interplay between personal motivation, individual competencies and the health information and service environment. HL is strongly related to health behaviors and issues such as obesity, the social determinants of health, and the use of health systems, which have been under pressure since COVID-19. The development and implementation of targeted public health interventions to promote HL in the European Region require reliable and comparable data on population HL to identify the main HL challenges and the most affected population groups. The WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) has started monitoring population HL and conducted the first M-POHL Health Literacy Survey (HLS19) in 17 countries in the WHO European Region between 2019 and 2021. In preparation for the 2nd M-POHL Health Literacy Survey (2024-2026; HLS24), the HLS19 instruments were further improved and supplemented by a new measure on mental HL. These instruments are also of interest to the European Joint Action PreventNCD with its specific task on HL and non-communicable diseases (7.4). The workshop will provide insights into the M-POHL HLS24, the largest HL survey in Europe, and the HL instruments used. It consists of four presentations, one describing the M-POHL HLS24 project and three on specific HL instruments used to assess different aspects of HL in the European general population: HLS24-DIGI for digital HL; HLS24-COM-P for communicative HL; HLS24-NAV for navigational HL. Each presentation will describe the revised item set and results from pretests. We invite the audience to ask questions and to engage in a (cross-cutting) discussion with the presenters. Expected impact: The presentations will provide a comprehensive overview of the advanced family of instruments used in the HLS24 study, their quality, and the expected HL data for Europe. They will provide a deeper understanding of how HL will be measured in the M-POHL HLS24 project. Key messages • The advanced family of HL instruments used in the M-POHL HLS24 project enables comprehensive HL monitoring in Europe. • The data collected in HLS24 will provide a solid database for shaping public health policy to strengthen population HL and promote health equity in Europe.

The association between health literacy and colorectal cancer screening uptake in Taiwan

Abstract Background Population-based cancer screening programs have been confirmed as a cost-effective strategy for early detection of colorectal cancer, leading to reduced mortality and morbidity. In Taiwan, the government has provided an immunochemical fecal occult blood test (iFOBT) every two years to all citizens aged 50 to 74 years since 2013. The study aims to determine the association between iFOBT uptake and health literacy (HL). Methods Data from the National Health Interview Survey (NHIS), a population-based cross-sectional survey conducted in 2021-22 in Taiwan, were applied. The European Health Literacy Survey Short Form (HLS-EU-Q16), self-reported iFOBT participation within the past 2 years, and covariates assessed by face-to-face interview. The present analysis included those age-eligible for screening (n = 3,871) and applied the survey-weighted multivariable logistic regression to estimate odds of iFOBT uptake between HL skill levels, controlling for age, education attainment, socioeconomic status, health status, and household urbanicity level. Results In general, 44.6% of participants had utilized the iFOBT, and 79.9% had adequate HL skills which reported higher iFOBT uptake rates (45.9%) than their counterparts (39.4%). Multivariable analysis showed that having adequate HL was associated with greater odds of iFOBT utilization (adjusted odds ratio [aOR] = 1.79; 95% CI: 1.29-2.49). Additionally, compared to those households registered in the township, participants in higher urbanicity levels had lower iFOBT uptake: city (aOR = 0.62; 95% CI: 0.47-0.82). Other predictors that contributed significantly were participants’ gender and having 2 or more chronic diseases. Conclusions Inadequate HL skills and urban residency may reduce participation in the CRC screening program, despite its free availability. More efforts should include literacy-friendly designed materials and the provision of tailored support in urban settings. Key messages • HL skills are significantly associated with the CRC screening uptake in Taiwan. Improving HL could have positive effects on people’s participation. • Urbanicity levels are also predictors associated with screening utilization. Disseminating health service information in localized ways should be a potential option.

Measuring communicative health literacy – a revision of the HLS19-COM-P scale

Abstract Background Communicative health literacy (COM-HL) is important for patients being able to actively participate in communication with health care professionals, such as physicians. The HLS19-COM-P scale was developed for measuring COM-HL in the M-POHL HLS19 survey. However, two items under-discriminated according to the Rasch model and the item set did not sufficiently capture the aspect of appraising health information. Consolidating both a long and short version into a single scale was deemed appropriate. Hence, this study aimed to develop a revised version of the COM-HL scale. Methods The revision and development of new items followed a Delphi process. Items that worked well psychometrically in the six-item version of the HLS19-COM-P were kept, and new items concerning appraising information were developed. The revised version of the scale has so far been translated into nine languages (BG, CZ, DE, FR, HU, IT, NO, SK, UA). Challenging translation terms underwent multiple discussions to ensure language consistency. The interpretability of items has been explored in cognitive interviews in six countries (AT, CZ, HU, IT, SK, and UA) so far. Items that were difficult to understand were revised and tested in new interviews. The evaluation of the scale’s psychometric properties is scheduled for May and June 2024. Results The revised scale consists of eight items - two items for each of the cognitive domains of accessing, understanding, appraising, and applying health information. One item in each of these domains focuses on the interactive aspect of communication. An instruction for translation of terms that were challenging to translate has been developed. Overall, the revised HLS19-COM-P was well accepted in the cognitive interviews. Results from the quantitative testing will be presented. Conclusions The adapted HLS24-COM-P scale developed for the M-POHL Health Literacy Survey 2024-2026, is a short and conceptually sound instrument for measuring COM-HL.

Inadequate health literacy and higher healthcare utilisation among older adults in Switzerland: cross-sectional evidence from a population-based study.

Population ageing in Switzerland poses significant challenges, including for the healthcare system. Inadequate health literacy can hinder individuals' ability to seek appropriate treatments and navigate the healthcare system efficiently. This study explores the associations between health literacy and the number of consultations with general practitioners and healthcare specialists in a population-based sample of adults aged 58+ in Switzerland. We used data from 1424 older adults who participated in Wave 8 (2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis focuses on two outcomes: the reported number of consultations with (1) general practitioners or (2) healthcare specialists in the year prior to the interview. Health literacy, i.e. the ability to find, understand, assess and apply health information, is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The final health literacy score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12) and sufficient (13-16). Bivariate analyses were conducted using Kruskal-Wallis tests. Partial associations were examined using multivariate generalised Poisson regression models controlling for key sociodemographic, regional and health-related variables. Overall, 68.5% of the respondents were classified as having sufficient health literacy, while the health literacy level of 23.5% and 7.9% of respondents was classified as problematic or inadequate, respectively. The median number of general practitioner consultations and specialist visits was 2 and 1, respectively, both with an interquartile range of 1. Lower levels of health literacy were statistically significantly associated (p = 0.0011) with a higher number of general practitioner consultations in the year prior to the interview. By contrast, we did not find any significant association between health literacy and the number of specialist consultations. This study finds that lower health literacy is associated with higher healthcare utilisation for older adults in Switzerland. The findings may suggest that general practitioners could have a significant role as advisors for individuals with low levels of health literacy, while a similar pattern is not observed for specialists. This discrepancy might be attributed, at least in part, to the role of general practitioners as intermediaries between patients and specialised care providers. Ensuring accessibility to general practitioners, particularly for individuals with low health literacy, could prove to be a beneficial strategy in addressing the healthcare requirements of this particularly vulnerable patient group. Additionally, improving health literacy in the population may provide further health benefits and lead to resource savings.

Health Literacy and Health-Related Habits among Conscripts in the Norwegian Armed Forces-A Cross-Sectional Survey.

Although health information is widely available to the Norwegian population a lack of health literacy is still common and considered a public health challenge. However, there is limited information on the health literacy of the adolescent population in Norway. The purpose of this pilot study was to assess health literacy and self-reported health habits among soldiers in basic military training, both in field, camp, and home settings. Furthermore, we aimed to investigate which health habits characterize soldiers with inadequate health literacy. An electronic questionnaire was sent out to conscripts who completed first-time military service in 2022 and was answered by 2,225 conscripts. Descriptive statistics were performed using cross-tabulations, correlations, and chi-squared tests. The survey is part of an internal quality study of the Norwegian Armed Forces routines. It is approved by the Norwegian Armed Forces joint medical services. In the study population, 43% scored inadequate health literacy on the European Health Literacy Survey Questionnaire-Q12 (HLS-Q12), and 57% scored adequate health literacy. We found a significant difference between those having inadequate and adequate HLS-Q12 scores in categories of self-rated health habits of oral health and diet with lower scores in the inadequate score group. The use of tobacco during field exercise in camp and at home was higher in the group of conscripts with adequate health literacy scores. The conscripts generally reported a lower standard of health habits during field exercises with significantly less brushing and flossing, higher use of tobacco products and higher consumption of energy drinks and sugary snacks compared to reported habits in camp and at home. The results from our study suggest that the conscripts in the Norwegian Armed Forces have a lower health literacy than the general population, and this is reflected in reported higher frequency of unhealthy habits in service settings than at home. The Armed Forces have an opportunity to take responsibility to optimize the health skills of their soldiers and to encourage them to make informed decisions about their own health. Improved adaptation to the national recommendations regarding nutrition, tobacco use, and oral health are areas having the potential to greatly improve the overall health habits of conscripts.

DOES HEALTH LITERACY AND LIFE SATISFACTION PROMOTE HEALTHY EATING AMONG MARRIED WOMEN IN TURKEY?

Healthy nutrition is very important in preventing chronic diseases and promoting overall health. This study aimed to assess the influence of health literacy (HL) and life satisfaction on healthy eating habits among married women aged 18-64. The present cross-sectional study was conducted from 2022 to 2023. Data were collected through face-to-face interviews with women attending family health centers in the central district of Yozgat province. Data collection instruments included a sociodemographic questionnaire, the Healthy Eating Attitudes Scale (HEAS), the Adult Life Satisfaction Scale (ALSS), and the European Health Literacy Survey Questionnaire-Short Form (EHLS-TR-16). A total of 303 women participated in the study. It was found that 59.4% of the women in the research group exhibited high levels of dietary attitudes, with 26.1% achieving an ideal high level. Women's dietary attitudes were influenced by increased life satisfaction (β=0.359), receiving nutritional information from healthcare professionals (β=0.124), and higher health literacy (β=0.113). No significant relationships were observed between healthy eating attitudes and factors such as age, body mass index, family income level, education level, household size, profession and spouse's profession, and education level. Women with higher life satisfaction, those who receive nutritional information from healthcare professionals, and those with higher health literacy have more positive attitudes toward healthy eating. It is recommended that women receive education on both health literacy and healthy eating.