Health literacy in Europe: the development and validation of health literacy prediction models.
Health literacy is an important determinant of health, but national health literacy levels are known for only some European countries. This study aims to examine to what extent national health literacy levels can be estimated based on publicly available census data.



Multivariate models were used to predict two types of health literacy on population level. Predictors were selected based on literature, the European Health Literacy Survey (HLS-EU) and the Adult Literacy and Life Skills Survey (ALL). The HLS-EU provides insight into self-assessed health literacy and the ALL into the performance of individuals on health literacy tasks (performance-based health literacy). Dutch HLS-EU and ALL data were used to construct prediction models based on 2/3 of this data, which were validated in the remaining 1/3 of the data and (in case of self-assessed health literacy) in data from seven other European countries.



Education is a significant predictor of perceived and performance-based health literacy. Age and working status are significant predictors of performance-based health literacy, whereas gender and income are significant predictors of self-assessed health literacy. Both typologies of health literacy can satisfactorily be predicted within samples of the Dutch population. The accuracy of estimated self-assessed health literacy varied between the seven other European countries.



Prediction models based on publicly available census data can be used for estimating self-assessed and performance-based health literacy on population level. Observed health literacy levels or better prediction models are required when one is interested in ranking European countries.
Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, PO Box 22700, 1100 DE, Amsterdam, The Netherlands j.rademakers@nivel.nl.
Iris
I
van der Heide
National Institute of Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, MA Bilthoven, 3721, The Netherlands.
Ellen
E
Uiters
CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 61, 6200 MD, Maastricht, The Netherlands.
Kristine
K
Sørensen
Gesundheit Österreich GmbH, Stubenring 6, 1010, Vienna, Austria.
Florian
F
Röthlin
Ludwig Boltzmann Institut Health Promotion Research, Untere Donaustraße 47, A-1020, Vienna, Austria.
Jürgen
J
Pelikan
CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 61, 6200 MD, Maastricht, The Netherlands.|Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, The Netherlands.
Jany
J
Rademakers
National Institute of Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, MA Bilthoven, 3721, The Netherlands.|Biometrics, Wageningen University, PO Box 16, 6700 AA, Wageningen, The Netherlands.
Hendriek
H
Boshuizen
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004522:Educational Status; D005060:Europe; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015203:Reproducibility of Results; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult