Communicative health literacy and associated variables in nine European countries: results from the HLS19 survey

Abstract

Our study aimed to report on variables associated with communicative health literacy (COM-HL) in European adults. The HLS₁₉ survey was conducted in 2019-2021 including nine countries which measured COM-HL by using a validated questionnaire (HLS₁₉-COM-P-Q6 with a score ranging from 0 to 100). Linear regression models were used to study variables associated with COM-HL globally (multilevel model with random intercepts and slopes and at country level) and in each country. Additional models studied each of the HLS₁₉-COM-P-Q6 items separately. The mean COM-HL score ranged between 62.5 and 76.6 across countries. Among the 18,137 pooled participants, COM-HL was positively associated with age, a higher self-perceived social status, previous training in healthcare, an increasing number of general practitioner visits; and negatively associated with female sex, reported financial difficulties, having a chronic condition and an increasing number of specialist visits. These effects were heterogeneous from one country to another, and from one item to another when analysing the different COM-HL items separately. However, there was a consistent statistically significant association between COM-HL (score and each item) and financial difficulties as well as self-perceived social status in all countries. Interventions to improve communication between patients and physicians should be a high priority to limit communication disparities.

Keywords: Communicative health literacy; HLS19; Health disparities; Physician–patient communication; Socio-economic status.

Fig. 1

shows the percentage of “difficult” responses for each item by country. Difficult" and “very difficult” have been grouped together. Items are represented by crosses with the corresponding colour in the legend. The mean value for each item is presented after all countries. Item COM1 (expressing health concerns…) was the least difficult in all countries; item COM2 (finding time…) was the most difficult in all countries except the Czech Republic (CZ) and France (FR), where the most difficult items were COM5 (being involved in decisions…) and COM3 (expressing preferences…) respectively.