title: Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy.
abstract: BACKGROUND
  Health literacy, or the ability to access, understand, appraise and apply health information, is central to individuals' health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe.
  
  
  METHODS
  A total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy.
  
  
  RESULTS
  Internal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill.
  
  
  CONCLUSIONS
  This study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan. Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.
authors.affiliation: College of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan. nakayama@slcn.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nakayama
authors.affiliation: College of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan. osakawakako@gmail.com.
authors.forename: Wakako
authors.initials: W
authors.lastname: Osaka
authors.affiliation: Faculty of Liberal Arts, The Open University of Japan, Chiba, Japan. ttogari@ouj.ac.jp.
authors.forename: Taisuke
authors.initials: T
authors.lastname: Togari
authors.affiliation: Department of Health Communication, School of Public Health, The University of Tokyo, Tokyo, Japan. hirono-tky@umin.ac.jp.
authors.forename: Hirono
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Department of Hygiene and Preventive Medicine, Iwate Medical University, Iwate, Japan. yyonekura-tky@umin.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yonekura
authors.affiliation: College of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan. hamaoka.sekido.ai@gmail.com.
authors.forename: Ai
authors.initials: A
authors.lastname: Sekido
authors.affiliation: College of Nursing, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan. masamatsu.11@gmail.com.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005060:Europe; D005163:Factor Analysis, Statistical; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007564:Japan; D007802:Language; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014175:Translating