Many European citizens find it difficult to judge different treatment options or use media information to prevent disease or find information on how to manage mental health problems.
Ten years after the first European study on health literacy (hls-eu) in eight EU countries, the results of the second European study on health literacy (hls19) are now available, based on the experiences of 42,445 respondents in 17 countries of the WHO European region.
Countries included are Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Ireland, Israel, Italy, Norway, Portugal, Russian Federation, Slovakia, Slovenia and Switzerland.
The study (at this link the full report) focused on general health literacy and specific types of health literacy such as health literacy related to web browsing, health literacy related to communicating with doctors, literacy digital health and health literacy related to vaccinations. Health literacy and health-related quality of life were analyzed in relation to health costs.
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The Italian situation
The overall percentage of the 3,500 respondents who selected ‘very difficult’ or ‘difficult’ to the questions of the common 12-item questionnaire (hls19-q12) was 31%, compared to an average of 23% for 17 countries; 53% answered ‘easy’ and 16% ‘very easy’.
This is reflected, in the Italian sample, in 23% of people with ‘inadequate’, 35% ‘problematic’, 34% ‘sufficient’ and 9% ‘excellent’ health literacy levels; the corresponding percentages in the overall sample of the 17 participating countries are 13%, 32%, 40% and 15%.
Given the emergency of the Covid-19 pandemic, Italy added a specific form of 16 questions regarding the difficulties in finding, understanding, evaluating and making decisions based on the health information available, from which it emerged that 6% answered ‘very difficult’, 25% ‘difficult’, 52% ‘easy’ and 17% ‘very easy’.
The European situation
In Europe: Between 25% and 72% of respondents were identified as having health literacy problems, therefore, depending on the country, one in four to three in four residents have limited health literacy.
The distribution of health literacy levels varies widely within countries and between countries and may also be influenced by differences in methodologies applied.
A large percentage found it difficult to judge the different ones pharmaceutical or surgical treatment options, in using media information to prevent disease and in finding information on how to manage mental problems.
As for health literacy related to surfing the web, participants found it very difficult to understand information on health care reforms, judge the suitability of health services, find out about patients’ rights, and judge the extent of health insurance coverage.
Regarding health literacy related to communication with doctors, getting enough time from doctors and expressing personal opinions and preferences was pursued with greater difficulty. In addition, participants with lower health literacy were found to have more contact with family doctors and emergency services.
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As for thedigital health literacy, judging the reliability of the information, judging whether the information is offered with commercial interests, and using the information to help solve a health problem was found to be more difficult.
For health literacy on vaccinations, judging which vaccinations one needs and finding information on recommended vaccinations were perceived as the most difficult tasks. Furthermore, improved vaccination health literacy has shown a positive effect on self-reported vaccination behavior, a relationship that is at least in part mediated by confidence in vaccination, knowledge of risk and perception of risk.
The lower the socio-economic status, the lower the literacy
Self-perceived poor health, low socioeconomic status, and financial poverty were associated with both lower general health literacy and the specific health literacies analyzed. Low educational attainment was also associated with low general health literacy, as well as poor digital and vaccination health literacy.
A social gradient was highlighted for all countries, albeit to a different degree from one country to another. Financial deprivation and low self-perception in society were significant predictors of lower health literacy across all five measures.
The consequences on health and choices
The condition of low health literacy is associated with less physical activity and less consumption of fruit and vegetables, less self-perception, greater limitations in activities due to health problems and more diseases / health problems for a long time term.
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The differences between the various countries
Due to the different methods and timing of data collection, differences between individual countries must be interpreted with caution, as well as any causal assumptions about the potential effects of the cross-sectional study design. Variations between countries confirm that health literacy is a contextual concept to be measured and evaluated regularly at the country and community level. The next European Health Literacy Survey is scheduled for 2024.
What to do to bridge the gap
To bridge the health literacy gap, the report presents a list of recommendations on how to improve policy, research and practice, including: focus efforts to empower people to better access, understand, evaluate and use information to strengthen health care, disease prevention and health promotion; implement regular and periodic measurement of the status and progress of health literacy in the population; systematically implement health literacy in schools, adult education, the media, etc .; Identify groups at risk to reduce health literacy inequalities.
For mental health; improve communication and interaction in contexts relevant to health; develop the health literacy capacity of the workforce to improve health and well-being; improve health systems and organizations to make them more responsive to health literacy, for example, easier to navigate; increase the reliability of information and communication on vaccinations.
Ruediger Krech, director of the WHO Department of Health Promotion stressed that “We need targeted solutions to overcome the social gradient of health literacy. Health literacy is a cornerstone of health promotion and support for people to address the complex challenges of today’s times “.
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