Design & Methods HLS19

Study Design

The HLS19 applied a cross-sectional multi-center survey study design. The study population was defined as all permanent residents aged 18 and above living in private households in the 17 participating countries. A total of 42,445 interviews were included in the study. National sample sizes were expected to be at least 1,000 but varied from 865 to 5,660 respondents. The participating countries used a multi-stage random sampling procedure or quota sampling, and most countries stratified samples by gender, age group, population density, and geographical areas/units. Data were collected in personal, telephone, or web-based interviews, or by using a mix of these. The timeframe for data collection was from November 2019 to June 2021. 

HLS19 instruments

To measure General health literacy (HL) an adapted 47-item instrument, the HLS19-Q47, and two adapted short forms, the HLS19-Q12 and the HLS19-Q16, were developed based on the HLS-EU instruments, to collect data. New instruments were developed to measure 

  • Digital HL (instrument: HLS19-DIGI), 
  • Communicative HL with physicians in healthcare (instruments: HLS19-COM-P-Q11 (long form) and HLS19-COM-P-Q6 (short form), 
  • Navigational HL (instrument: HLS19-NAV), 
  • Vaccination HL (instrument HLS19-VAC)

Additionally, 31 core correlates, and 18 optional correlates were also included in the HLS19 questionnaires. Participating countries had to implement at least the HLS19-Q12 and the 31 core correlates; all other parts were optional.

The HLS19 instruments were developed in English and translated into their national language(s) by 16 out of the 17 countries (Ireland used the original English version), thereby creating a rich spectrum of languages in which the instruments are now available:  Arabic, Bulgarian, Czech, Danish, Dutch, French, German, Hebrew, Hungarian, Italian, Norwegian, Portuguese, Russian, Slovenian, and Slovak. Additionally, some countries translated the instruments into migrant languages. As only the HLS19-Q12 was mandatory to be implemented, not all instruments are available in all of these languages.

A detailed overview of available translations of the different HLS19 instruments can be found HERE 

Interested in using the HLS19 Instruments? 

Agreement for the use of the HLS19 instruments will only be granted, if the following conditions are fulfilled:

  1. The applicant is a non-profit academic and public research actor.
  2. The planned study is carried out in public interest.
  3. The HLS19 Project must be acknowledged in any publication resulting from the use of the HLS19 instrument as ‘The HLS19 instrument used in this research was developed within “HLS19 – the International Health Literacy Population Survey 2019-2021” of M-POHL’.
  4. A PDF copy of publications resulting from the use of the HLS19 instrument must be provided to the ICC after publication.
  5. Any further translations of the instruments have to be provided to the ICC. The ICC and the HLS19 Consortium can use these translated versions for its further research. For any use of these versions the same rights and rules apply as to the original HLS19 instruments according to point 1 to 4. Furthermore, the new instruments can only be shared with others by a joint agreement with the ICC and the applicant. 

The HLS19 instruments belong to the HLS19 Consortium. Any use of the HLS19 instruments needs contractual agreement between the applicant and the HLS19 Consortium. For granting permission to the English version of the instruments the ICC will evaluate the application and decide on giving permission. For granting permission to translated versions the respective National Study Centre and the ICC both together will evaluate the application and decide on giving permission. The use of the instruments is free of charge.

An application including a contractual agreement with the conditions for using the HLS19 instruments has to be provided. A template for the application and agreement can be found HERE