Measuring health literacy among very low literate people: a feasibility study with the HLS-EU questionnaire

Abstract

Introduction Health literacy (HL) is defined as necessary competences to make well-informed decisions. As patients’ decision making is a key element of patient-centered health care, detecting people with limited HL is crucial. 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 suitability of HLS-EU-Q16 for use in a population of people with low literacy. Method Purposive sampling of adults with low (yearly) income (< €16,965.47) and limited education (maximum high school), with Dutch language proficiency. Excluding criteria were: psychiatric, neurodegenerative diseases or impairments. To determine suitability (length, comprehension and layout) participants were randomly distributed either HLS-EU-Q16 or a simplified version and were interviewed directly afterwards by one researcher. Qualitative and quantitative analyses were performed on respectively interviews and questionnaires. Results Thirteen participants completed HLS-EU-Q16 (n= 7) or the simplified 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). Non-responses were highest and HL was predominantly scored ‘inadequate’ for HLS-EU-Q16 questionnaire. Conclusions HLS-EU-Q16 is a suitable instrument to determine HL in people with limited literacy. However, to facilitate interpretation, some questions would benefit from minor adjustments and from the provision of explanatory, contextual information.