Research Article: Assessment of health literacy among older Finns

Date Published: December 21, 2018

Publisher: Springer International Publishing

Author(s): Johanna Eronen, Leena Paakkari, Erja Portegijs, Milla Saajanaho, Taina Rantanen.


This study examined the feasibility of the HLS-EU-Q16 (in Finnish) for use among older Finns and whether the health literacy score correlates with indicators of health and functioning.

To determine the feasibility of the instrument, we first conducted a focus group discussion with nine participants. For the quantitative analyses, we used data from the AGNES cohort study, collected between October 2017 and April 2018 at the University of Jyväskylä in Finland. 292 75-year-old Finnish men and women were interviewed face-to-face in their homes. Health literacy was measured with the HLS-EU-Q16 and health literacy score, ranging from 0 to 50, computed. The reproducibility of the instrument was test-retested. Chi-square tests were used to compare health literacy scores between participants by different socioeconomic variables, and Spearman correlation coefficients were calculated to study the associations of health literacy with cognition, depressive symptoms, chronic conditions, life-space mobility and physical performance.

The mean health literacy score for all participants was 35.05 (SD 6.32). Participants who rated their financial situation and self-rated health as very good had the highest health literacy scores (38.85, SD 5.09 and 39.22, SD 6.77, respectively). Better health literacy was associated with better cognitive status, fewer depressive symptoms and chronic conditions, higher life-space mobility and better physical performance.

The HLS-EU-Q16 is a feasible measure for research purposes among older Finns. The associations between health literacy and indicators of health and functioning need to be more closely investigated in larger samples with a wider age-range.

Partial Text

Health literacy means the competence to access, understand, appraise and apply health information to be able to make decisions concerning one’s health care, disease prevention and health promotion [1]. This definition views health literacy from the public health perspective as a broad concept which encompasses an individual’s understanding of and ability to use health information and ability to navigate a complex health care system [2].

The HLS-EU-Q16 instrument proved a feasible method for investigating health literacy in older Finnish individuals. The participants found the questionnaire items relevant and understandable, and the questionnaire was easy to administer as part of a larger study. The repeatability of the individual items in the retest was fair, with dissimilar responses to nine items; however, the health literacy score means did not differ between the two test occasions.

This study yielded novel information on the role of health literacy in health and functioning among older persons. We found the HLS-EU-Q16 to be a feasible measure for use in older populations and that enabled us to find correlations between health literacy and indicators of health and functioning. These preliminary findings on the role of health literacy in health and functioning in old age lay a foundation for more detailed analyses with different study designs.




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