title: Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU).
abstract: BACKGROUND
  Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations.
  
  
  METHODS
  The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews.
  
  
  RESULTS
  The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model.
  
  
  CONCLUSIONS
  Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
authors.affiliation: 1 Maastricht University, Department of International Health/CAPHRI, Maastricht, the Netherlands K.Sorensen@maastrichtuniversity.nl.
authors.forename: Kristine
authors.initials: K
authors.lastname: Sørensen
authors.affiliation: 2 Ludwig Boltzmann Institute Health Promotion Research, Vienna, Austria.
authors.forename: Jürgen M
authors.initials: JM
authors.lastname: Pelikan
authors.affiliation: 2 Ludwig Boltzmann Institute Health Promotion Research, Vienna, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Röthlin
authors.affiliation: 2 Ludwig Boltzmann Institute Health Promotion Research, Vienna, Austria.
authors.forename: Kristin
authors.initials: K
authors.lastname: Ganahl
authors.affiliation: 3 The Cardinal Wyszyński Institute of Cardiology, Warsaw, Poland.
authors.forename: Zofia
authors.initials: Z
authors.lastname: Slonska
authors.affiliation: 4 University College Dublin, Dublin, Ireland.
authors.forename: Gerardine
authors.initials: G
authors.lastname: Doyle
authors.affiliation: 4 University College Dublin, Dublin, Ireland.
authors.forename: James
authors.initials: J
authors.lastname: Fullam
authors.affiliation: 5 Hellenic American University, Manchester, NH & Hellenic American College, Athens, Greece.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kondilis
authors.affiliation: 6 National School of Public Health, Athens, Greece.
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Agrafiotis
authors.affiliation: 7 Centre for Nutrition, Prevention and health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Uiters
authors.affiliation: 8 University of Murcia, Department of Legal Medicine, Murcia, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Falcon
authors.affiliation: 9 NRW Centre for Health, Bielefeld, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Mensing
authors.affiliation: 10 Medical University, Faculty of Public Health, Sofia, Bulgaria.
authors.forename: Kancho
authors.initials: K
authors.lastname: Tchamov
authors.affiliation: 11 Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
authors.forename: Stephan
authors.initials: S
authors.lastname: van den Broucke
authors.affiliation: 1 Maastricht University, Department of International Health/CAPHRI, Maastricht, the Netherlands.
authors.forename: Helmut
authors.initials: H
authors.lastname: Brand
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
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