What is health literacy and why is it important?
Health literacy is “the ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” [1,2].
Understanding health literacy from a population health perspective, including the various strengths and weaknesses individuals and groups may have, is a recognised information gap. Reporting data in this area will allow policymakers to understand the diversity of health literacy within Australia and identify relationships between health literacy and access, equity and outcomes.
A better understanding of health literacy can inform the development of appropriate public health strategies to improve access to health services and health information. Health literacy should not be interpreted as a deficit of knowledge or understanding at the individual-level, but as a tool for policymakers and health providers to use to improve services for individuals, families and communities.
The Health Literacy Survey
The Health Literacy Survey (HLS) was conducted by the ABS in 2018. The sample for the HLS was respondents aged 18 years and over who had already participated in the National Health Survey (NHS 2017-18). These respondents agreed to be contacted for further ABS surveys and had provided their contact details. The HLS was conducted from January 2018 to August 2018 with 5,790 fully responding adults.
The data in the HLS can be analysed along with the data collected in the NHS 2017-18.
The HLS uses the Health Literacy Questionnaire (HLQ) which was developed and extensively tested in Australia by a team led by Professor Richard Osborne in Victoria, Australia. The HLQ is a widely used multi-dimensional health literacy assessment tool for surveys, evaluation and service improvement. It collects information on how people find, understand and use health information, and how they manage their health and interact with healthcare providers.
The HLS was conducted with the assistance of an advisory group comprising experts in health literacy. Members of this advisory group were drawn from Commonwealth, New Zealand and State/Territory government agencies, and non-government organisations. The contributions made by members of the advisory group are greatly appreciated.
More information about the HLS can be found in the National Health Survey Users Guide.
Health literacy domains
The Health Literacy Questionnaire (HLQ) consists of 44 questions (or ‘items’) which form nine domains of health literacy. Data was collected for each item and domain based on the level of agreement with a set of health literacy statements (‘strongly agree’, ‘agree’, ‘disagree’ or ‘strongly disagree’) or the perceived difficulty of a health literacy characteristic (‘always easy’, ‘usually easy’, ‘sometimes difficult’, ‘usually difficult’ or ‘cannot do or always difficult’).
The nine domains are:
1. Feeling understood and supported by healthcare providers (Domain 1)
2. Having sufficient information to manage my health (Domain 2)
3. Actively managing my health (Domain 3)
4. Social support for health (Domain 4)
5. Appraisal of health information (Domain 5)
6. Ability to actively engage with healthcare providers (Domain 6)
7. Navigating the healthcare system (Domain 7)
8. Ability to find good health information (Domain 8)
9. Understand health information well enough to know what to do (Domain 9)
All nine domains derived from the HLQ are considered separate and results should not be combined across domains. Summary results from a selection of four of the nine domains (3, 4, 6 and 7) are provided in the subsequent sections. The remaining five domains are discussed briefly in the ‘Other health literacy domains’ section.
Difference between the Health Literacy Survey and previous releases
In 2006, the ABS released a publication called the Adult Literacy and Life Skills Survey (ALLS), Summary Results. The ALLS provided information about whether Australians' literacy skills were adequate for the challenges they face in work and daily life.
The ALLS data included a derived domain to measure health literacy. Health literacy was defined as “the knowledge and skills required to understand and use information relating to health issues such as; drugs and alcohol, disease prevention and treatment, safety and accident prevention, first aid, emergencies, and staying healthy”. The ALLS assessed functional aspects of literacy, such as understanding text, finding information in documents, and problem-solving capabilities.
The HLS, which underpins the data in this release, moves beyond the functional approach and was developed from a “conceptual model … grounded in the daily lives of citizens, practitioners and policymakers”. As such, the information about health literacy provided in this release is not comparable to the ALLS data.
The benefits of the HLS data are that it reports a larger range of health literacy characteristics and can therefore be used to improve health service provision.
1 World Health Organisation (WHO), 2016. Health Literacy. Available from https://www.who.int/healthpromotion/conferences/9gchp/health-literacy/en/
2 Nutbeam D. “Health promotion glossary.” Health Promot. Int., 1998 13 (4): 349-364.
3 Bo, A et al. “National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults” BMC Public Health 2014 14:1095.
4 Batterham RW, Hawkins M, Collins PA, Buchbinder R, Osborne RH. Health literacy: applying current concepts to improve health services and reduce health inequalities. Public Health 2016; 132: 3-12.
5 The Health Literacy Questionnaire (HLQ).© Copyright 2014 Deakin University. Authors: Richard H Osborne, Rachelle Buchbinder, Roy Batterham, Gerald R Elsworth. No part of the HLQ can be reproduced, copied, altered or translated without the permission of the authors. Further information: email@example.com.
6 Osborne, R et al. “The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ)” BMC Public Health, 2013, 13:658.