title: A mismatch between population health literacy and the complexity of health information: an observational study.
abstract: BACKGROUND
  Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health.
  
  
  OBJECTIVE
  To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population skills in relation to these.
  
  
  METHODS
  An English observational study comparing health materials with national working-age population skills.
  
  
  METHODS
  Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified. The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described.
  
  
  RESULTS
  Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text + numeracy; 2515/5795 participants (43%) were below the text-only threshold, while 2905/4767 (61%) were below the text + numeracy threshold. Univariable analyses of social determinants of health showed that those groups more at risk of socioeconomic deprivation had higher odds of being below the health literacy competency threshold than those at lower risk of deprivation. Multivariable analysis resulted in some variables becoming non-significant or reduced in effect.
  
  
  CONCLUSIONS
  Levels of low health literacy mirror those found in other industrialised countries, with a mismatch between the complexity of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals' communication, and improving written health information.
authors.affiliation: Institute of Public Health, Aarhus University, Aarhus, Denmark and Institute for Health and Society, Newcastle University, Newcastle, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Rowlands
authors.affiliation: Research Institute for Primary Health Care & Health Sciences, Keele University, Keele, UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Protheroe
authors.affiliation: AlphaPlus Consultancy Ltd, Manchester, UK.
authors.forename: John
authors.initials: J
authors.lastname: Winkley
authors.affiliation: Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK.
authors.forename: Marty
authors.initials: M
authors.lastname: Richardson
authors.affiliation: Division of Women's Health, King's College London, London, UK.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Seed
authors.affiliation: Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, US.
authors.forename: Rima
authors.initials: R
authors.lastname: Rudd
mesh_terms: D000293:Adolescent; D000328:Adult; D032882:Comprehension; D054626:Consumer Health Information; D004739:England / Q000453:epidemiology; D005260:Female; D006266:Health Education / Q000458:organization & administration / Q000706:statistics & numerical data*; D057220:Health Literacy / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors
keywords: health information; health literacy; numeracy; primary care; public health