Low health literacy is a challenge affecting large segments of the population, data from a new project in the WHO European Region show. Health literacy is defined as the capability of an individual to access, understand, appraise and use health-related information, and limited health literacy can have significant health consequences.
Since 2019, the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) has been conducting a cross-national survey in 17 countries to create comparative data on health literacy levels in order to build a strong foundation for future action. The results, which show that between 25% and 75% of adult populations in participating countries have limited health literacy, reveal a pressing challenge to public health.
The survey focused on general health literacy alongside specific areas such as digital health literacy, vaccination health literacy, health systems navigation, and communicative health literacy with health professionals.
The results also show that health literacy can be associated with social factors. Financial deprivation proved the strongest social predictor for low health literacy, followed by low social status, low education level and old age. Assessing whether health information from mass media sources is trustworthy and dealing with information on mental health were particularly difficult for respondents.
The findings expose the need to prioritize vulnerable groups in health literacy interventions, and to target some of the structural inequalities across society that can limit well-being.
Through a cultural lens
The data show that immigration status is another social determinant linked to low health literacy in some countries. Linguistic and cultural barriers for immigrants can impact integration into society and limit health literacy, potentially leading to stigma and health inequity. Paying careful attention to immigrants is therefore important in efforts to both measure health literacy and level-up access to health care.
To do so, M-POHL researchers conducted the health literacy survey among Russian-speaking minorities in Germany and Israel. Acknowledging that questions may be understood in different ways in different cultures, the researchers ensured that the questionnaire was not only translated, but also linguistically and critically reviewed through a cultural lens and discussed in a user focus group prior to use.
This process resulted in a set of more appropriate and culturally sensitive questions, which allowed the project to secure more accurate data. This tailoring of health literacy measurements provides a good example of the power of collaborative, international and multicultural work in the context of health literacy.
Importance of health literacy
The survey found that people with lower health literacy are more likely to eat fewer fruits and vegetables, and to have more chronic illnesses or poorer self-perceived health. They also have a somewhat higher likelihood of using emergency services, along with regularly using other health services.
Based on these findings, M-POHL made recommendations for countries at the health-system level as well as at organizational and individual levels. These include providing accessible and high-quality information, improving communication between patients and health-care professionals, and reducing social and financial inequalities.
Several of the engaged countries have already started translating these recommendations into action. For example, Portugal’s COVID-19 influencer project suggests a new model for tailored information-sharing within communities.
The survey’s results were presented at a side event on health literacy run by WHO/Europe’s Behavioural and Cultural Insights team at the 71st session of the WHO Regional Committee for Europe. The full report is expected to be published in November 2021. It will also be discussed at a virtual launch event on 8 November 2021, organized by the Austrian Government and M-POHL.
M-POHL was launched in 2018 to enhance health literacy across the Region. Its expertise will also contribute to developing a WHO global measurement tool to assess population health literacy.