Exploring health literacy, Maastricht University

Exploring Health Literacy 

Kristine Sørensen; project coordinator 

Stephan van den Broucke; project leader 

on behalf of the HLS-EU consortium 

Dept. of International Health, Maastricht University, the Nederlands

Out of Africa… 

Faculty of Health, Medicine and Life Sciences







“The roads of life” 

By Karen Blixen in Out of Africa 


We hear the noise 

– do we see the stork? 

Exploring the concept of health literacy… 


Fi uoy nac daer siht, tup ruoy tfel 

dnah no ruoy thgir redluohs dna 

esiar eht thgir dnah ni eht ria. 


Fi uoy nac daer siht, tup ruoy tfel 

dnah no ruoy thgir redluohs dna 

esiar eht thgir dnah ni the ria. 

If you can read this, put your left 

hand on your right shoulder and 

raise the right hand in the air. 

Faculty of Health, Medicine and Life Sciences 

With acknowledgement to 

Prof. Rima Rudd, Harvard 

University, August 2009

Definitions 

Institute of Medicine 2004: The 

individual’s capacity to obtain, process 

and understand basic health information 

and services needed to make appropriate 

health decisions. 

Yost et al. 2009: Health literacy is the degree 

to which individuals have the capacity to read 

and comprehend health-related print material, 

indentify and interpret information presented in 

graphical format (charts, graphs, tables), and 

perform arithmetic operations in order to make 

appropriate health and care decisions. 


More definitions... 

WHO 1998: The cognitive and social skills 

which determine the motivation and ability 

of individuals to gain access to, understand 

and use information in ways which promote 

and maintain good health. 

Kicbusch et al. 2005:The ability to make 

sound health decision(s) in the context of 

everyday life – at home, in the community, at 

the workplace, the healthcare system, the 

market place and the political arena. 





Is health literacy the same as health 

communication? 


Is health literacy the same as health 

promotion? 


Is health literacy in fact The Emperor’s New 

Clothes? 


Looking back… 

• Appeared in 1970s in the US 

• Clinical approach mostly American 

• Public health approach in other 

countries such as Canada, Australia 

and Switzerland 

• Concepts and measurements mostly 

related to literacy and health 


Nutbeam (2000;2009) 

3 levels of health literacy 

– Functional health literacy 

– Interactive health literacy 

– Critical health literacy 

Health literacy as a risk or an asset. 


Paasche- 

Orlow et al. 

(2007) 


Mancuso (2008) 


Von Wagner et al. (2009) 


Health literacy in Europe 

• Only few national studies exist 

• Most studies have a patient-related 

focus 

• There is a need from decision-makers 

for a broader public-health perspective 

• E.g. is health literacy on the Agenda of 

the EU linked to empowerment 


WHO’s Nairobi Call To Action 



Maastricht University 



Department of International Health 

– Public health in Europe & European Public Health 

Reijn Dirksen 


Rem Koolhaas

The launch of the European study on health 

literacy 

9 European project partners, 16 international 

collaborating partners 

Lasting 32 months: 2009-2011 

Co-funded by the European Commission within the 

EU Health Programme (2003-2008) 


The HLS-EU consortium 

1. Austria 

2. Bulgaria 

3. Germany (NRW) 

4. Greece 

5. Ireland 

6. The Nederlands 

7. Poland 

8. Spain 


HLS●EU

Aim and objectives of the HLS-EU Project 

• To help establish the issue of health literacy 

in Europe 

• To contribute to further development of the 

concept 

• To discuss social and political significance of 

health literacy 

• To document ways to implement health 

literacy 


Results 

• A model instrument to measure Health 

Literacy in Europe (HLS-EU) 

– Concept validation approach 

– Integrated conceptual model 

– Delphi procedure to develop questionnaire 

– Validation of questionnaire 

– Datacollection: N=1000 in each country; Face to face 

interviews 

• Comparable datasets on health literacy 

from 8+ countries: Summer 2010 


Results II 

• Creating a European Network on 

Health Literacy 

• Advance input for priority setting and 

valorisation strategies on health 

literacy at national, regional and 

international level to support decision- 

makers in health 


The HLS-EU ‘all inclusive’ working definition 

Health literacy entails people’s capacities, 

skills, knowledge, motivation and 

confidence to access, understand, 

appraise and apply health information 

in written, spoken or digital form to 

form judgments and take decisions in 

everyday life in terms of healthcare, 

disease prevention and health 

promotion to improve quality of life 

during the life course. 


Sørensen et al. 2010

The HLS-EU conceptual framework 

Sørensen et al. 2010 


The HLS-EU instrument 

• Capturing the essence of health literacy as 

described in HLS-EU-C 

• Capturing health literacy in terms of 

healthcare, disease prevention and health 

promotion 

• Capturing functional, interactive and critical 


• Capturing health literacy in a broader 

population, not only in clinical settings 


The HLS-EU instrument 

• Capturing the essence of health literacy as 

described in HLS-EU-C 

• Capturing health literacy in terms of 

healthcare, disease prevention and health 

promotion 

• Capturing functional, interactive and critical 


• Capturing health literacy in a broader 

population, not only in clinical settings 

Under Construction 


Status of the HLS-EU survey 

• Conceptual framework 

• Delphi rounds to develop questionnaire 

• Validation planned 

• Survey before the summer 2010 

• Results to be disseminated at national, 

regional and international conferences 

and in papers 


The European Health Literacy Network 

• Starting up spring 2010 – mailing list 

• Knowledge sharing 

• Events 

• Networking 


Health literacy – taking up the challenge! 


Looking ahead… 

• How can health literacy be translated 

in the Nordic languages? 

• How can we make joint efforts to 

enhance health literacy in Europe? 

– Research 

– Implementation strategies 

– Stakeholders 


Out of Africa 

Nairobi Call to Action: Let us do it! 


Thank you! 


KRS

Exploring health literacy, Maastricht University

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