Design & Methods

National samples of health literacy data are collected based on a joint study protocol to ensure reliability of data-collection and comparability of data for the cross-national analysis and benchmarking between participating member countries. The underlying model, definition and instrument of measuring and analysing health literacy builds on the integrated, comprehensive, multidimensional HLS-EU model and definition. 

HLS19 tools 

Measurement tools for assessing personal health literacy (HLS19 tools) - were developed jointly in English and later translated into languages of participating countries and into some languages of migrant groups in some participating countries. While the focus of the HLS19 Project is on general, comprehensive population health literacy, the structure and type of questions, which follow the pattern developed for the HLS-EU survey (“how easy / difficult is it for you to …”), enable the identification and measurement of specific aspects of health literacy where improvements in systems health literacy or organizational health literacy responsiveness are needed. Besides describing distributions of different health literacy measures and levels, specific research questions on determinants and consequences of health literacy are addressed. By that, the HLS19 Project will contribute to further developing the health literacy knowledge base in Europe. 
To ensure international comparability while also allowing for some leeway to cover specific interests of participating countries, the HLS19 tools were structured into three components: 

1. HLS19 core consisting of mandatory questions that each participating country must include:

  • Measurement of health literacy (12, 22 or 47 items)
  • Correlates: determinants and consequences of health literacy (31 core items and additional optional items)

2. HLS19 optional packages including questions on specific topic areas from which participating countries can choose:

  • Digital health literacy
  • Communication in healthcare
  • Navigation health literacy
  • Cost and Health Economics of health literacy
  • Vaccination health literacy
  • New Vital Sign Test (NVS).

3. National add-ons: country-specific questions on topics of importance for national policy, research and practice.

The HLS19 tools are translated into the national languages of the participating countries and into some languages of migrant groups in some participating countries, implemented and validated in national surveys to ensure broad applicability in Europe and beyond.  

Translations of the HLS19 tools are available in:

  • Arabic
  • Bulgarian
  • Danish
  • Dutch 
  • French 
  • German 
  • Hebrew 
  • Italian 
  • Norwegian 
  • Pakistani
  • Polish
  • Portuguese 
  • Russian 
  • Slovak
  • Slovenian 
  • Somali
  • Turkish
  • Vietnamese