HLS19
The Health Literacy Survey 2019-2021 (HLS19) was M-POHL’s first project. Its aim was to measure population health literacy in as many member countries of the WHO European Region as possible.
To plan and carry out this project, a consortium of participating countries was set up to make decisions, and working groups were formed to develop the study design as well as new survey instruments to measure navigational health literacy, communicative health literacy, digital health literacy, vaccination health literacy and the costs and economics of health literacy in addition to general health literacy.
Overview:
Partners from M-POHL member countries were eligible to participate in HLS19. They had to participate with a policy and a research representative so that both perspectives could work together in preparing and implementing the survey and using the results to improve population health literacy. To fulfill the research role, a National Study Center (NSC) was contracted to conduct the HLS19 nationally, provide a national report the results, and represent the HLS19 member country at the HLS19 Research Assembly. For the policy role in the HLS19, the national Ministry of Health usually sent a member of its own staff or nominated a representative from another suitable institution to the HLS19 Policy Assembly.
17 countries in the WHO European Region participated in the HLS19 in the period 2019-2021:
Austria Belgium Bulgaria Czech Republic Denmark France Germany Hungary Ireland
Israel Italy Norway Portugal Russian Federation Slovakia Slovenia Switzerland
The HLS19 was coordinated by an International Coordination Centre (ICC) located at the Austrian National Public Health Institute (Gesundheit Österreich GmbH).
Core team of the International Coordination Centre (ICC) and their roles/responsibilities:
- Jürgen M. Pelikan – Scientific Coordinator
- Christa Straßmayr - Project Coordination and Research
- Robert Griebler – Research
- Thomas Link – Statistics and Research
- Dominika Mikšová - Statistics and Research
- Peter Nowak – Finance and Contracting
Study Design
The HLS19 applied a multi-center cross-sectional 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/regions. Data were collected through face-to-face, telephone, or web-based interviews, or a combination of these. The timeframe for data collection was, due to the COVID-19 pandemic, from November 2019 to June 2021.
HLS19 instruments
To measure general health literacy, 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-Q47 instrument to collect data. Instruments were developed to measure:
- Digital health literacy (HLS19-DIGI),
- Communicative health literacy with physicians in healthcare HLS19-COM-P-Q11 and HLS19-COM-P-Q6, a short form),
- Navigational health literacy (HLS19-NAV),
- Vaccination health literacy (HLS19-VAC)
- Factsheets on the HLS19 instruments including information on psychometric properties can be found here.
In addition, 31 core and 18 optional correlates were 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 by 16 of the 17 countries into their national language(s) (Ireland used the original English version), resulting in a wide range 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. In addition, some countries have translated the instruments also into migrant languages. As only the HLS19-Q12 was mandatory, not all instruments are available in all these languages.
- A detailed overview of the available translations of the different HLS19 instruments can be found here.
Are you interested in using the HLS19 instruments? An agreement for the use of the HLS19 instruments will be granted, if the following conditions are fulfilled:
- The use of the tool is non-commercial and in public interest.
- Any licensing by third parties is prohibited.
- 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 “The European Health Literacy Population Survey 2019-2021 (HLS19)” of M-POHL’.
- The instruments have to be cited – citation suggestions are provided with the instruments.
- A PDF copy of publications resulting from the use of the HLS19 instrument must be provided to the ICC after publication.
- 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. Any use of these versions is subject to the same rights and rules apply as to the original HLS19 instruments according to point 1 to 5. Furthermore, the instruments can only be shared with others by a joint agreement between the ICC and the applicant.
The HLS19 instruments are owned by the HLS19 Consortium. Any use of the HLS19 instruments requires a contractual agreement between the applicant and the HLS19 Consortium. For permission to use the English version of the instruments, the ICC will evaluate the application and decide whether to grant permission. For granting permission for translated versions the respective National Study Centre and the ICC will jointly evaluate the application and decide on giving permission. The use of the instruments is free of charge:
- A detailed overview of the available translations of the different HLS19 instruments can be found here.
- An application including a contractual agreement with the conditions for using the HLS19 instruments must be submitted. A template for the application and agreement can be found here.
- Factsheets on the HLS19 instruments including information on psychometric properties can be found here.