• HLS₁₉ Instruments in different languages 

Publications on international HLS₁₉ results 

• HLS₁₉ Short Summary of the International Report
• HLS₁₉ Executive Summary of the International Report
• HLS₁₉ International Report on the methodology, results and recommendations
• Factsheets on HLS₁₉ instruments
• Articles on HLS₁₉

Publications on national HLS₁₉ results 

• Austria
• Bulgaria
• Czech Republic
• France
• Germany
• Hungary
• Israel
• Italy
• Norway
• Portugal
• Russian Federation
• Slovenia
• Switzerland

Publications on HLS-EU (using international data) 

Pelikan, J. M., Straßmayr, C., & Ganahl, K. (2020). Health Literacy Measurement in General and Other Populations: Further Initiatives and Lessons Learned in Europe (and Beyond). In G. D. Logan & E. R. Siegel (Eds.), Health Literacy in Clinical Practice and Public Health. New Initiatives and Lessons Learned at the Intersection with other Disciplines (pp. 170-191): IOS Press.

Pelikan, J.M., Ganahl, K, Van den Broucke, S. and Sørensen, K (2019). Measuring health literacy in Europe: Introducing the European Health Literacy Survey Questionnaire (HLS-EU-Q), in Okan, O, Bauer, U, Pinheiro, P, Levin-Zamir, D. and Sørensen, K (eds.) International Handbook of Health Literacy, Research, practice and policy across the life-span, Policy Press, pp. 115-138.

Pelikan, J. M.; Ganahl, K.; Roethlin, F. (2018): Health literacy as a determinant, mediator and/or moderator of health: empirical models using the European Health Literacy Survey dataset. In: Global Health Promotion 1757-9759; Vol 0(0): 1–10, DOI: 10.1177/1757975918788300 

Pelikan, J. M.; Ganahl, Kristin (2017): Die europäische Gesundheitskompetenz-Studie: Konzept, Instrument und ausgewählte Ergebnisse. In Doris Schaeffer, Jürgen M. Pelikan (Eds.), Health Literacy Forschungsstand und Perspektiven, pp. 93-126

Pelikan, J. M. and Ganahl, K. (2017). Measuring Health Literacy in General Populations: Primary Findings from the HLS-EU Consortium's Health Literacy Assessment Effort. Studies Health Technology Information, 240, pp. 34-59.

Sørensen K., et al. (2015). Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). The European Journal of Public Health, 25 (6), pp.1053-1058. 

Sørensen, K., et al. (2013). Measuring Health Literacy in Populations: Illuminating the Design and Development Process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health,13 (1), p. 948.

Sørensen, K., et al. (2012). Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models. BMC Public Health, 12 (1), p. 80.

HLS-EU Consortium (2012). Comparative report of health literacy in eight EU Member States. The European Health Literacy Survey HLS-EU.
    

Video and Infographics on HLS-EU

HLS-EU - Health Literacy – Motiongraphic

HLS-EU - Gesundheitskompetenz (German version)

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 

Partners from M-POHL member countries could join the HLS₁₉. They had to participate with one policy and one research representative so that both perspectives could work together in preparing and implementing the survey and in using results to improve health literacy. For fulfilling the research part, a National Study Center (NSC) was contracted for conducting the HLS₁₉ Project nationally, for providing a national report and representing the respective HLS₁₉ member country at the HLS₁₉ Research Assembly. For fulfilling the policy role in the HLS₁₉ Project, usually the national Ministry of Health sent a member of their own staff or nominate a representative of another suitable institution for the HLS₁₉ Policy Assembly. 

17 countries in the WHO European Region - Austria, Belgium, Bulgaria, Czech Republic, Denmark, France, Germany, Hungary, Ireland, Israel, Italy, Norway, Portugal, Russian Federation, Slovakia, Slovenia, and Switzerland - participated in the HLS₁₉ project in the period 2019-2021. 

The vision of M-POHL is to enhance health literacy in the WHO European Region by ensuring the availability of high-quality and internationally comparative data to support evidence-informed political decisions and targeted practice interventions. As described in its Concept Note and the Vienna Statement on the Measurement of Population and Organizational health literacy in Europe, M-POHL’s ambitious aims are to: 

• support health literacy by strengthening the collaboration between research and policy,
• address the personal health literacy among general population and patients,
• institutionalize regular, high-quality internationally comparative population health literacy surveys,
• address health literacy-friendliness of systems and organizations,
• support collection and analysis of data on organizational health literacy (health literacy-friendly structures and processes), and
• foster evidence-informed policy and practice.

The Health Literacy Population Survey Project 2019-2021 (HLS₁₉) is M-POHL’s first project aiming to collect comparative data on population health literacy in as many member states of the WHO-European region as possible. Building on the European Health Literacy Survey (HLS-EU, 2009-2012), M-POHL partners have further developed and piloted a methodology to assess personal health literacy in general populations. A joint study protocol is used to ensure comparability and reliability for the cross-national analysis and benchmarking between participating partner countries. Data is analysed on the European level for an internationally comparative report and by national teams for more specific country reports. These reports and the subsequent publications are intended to support evidence-based policy for improving health literacy, especially in participating HLS19 member states and WHO-Europe region. Furthermore, the HLS₁₉ Project shall pave the grounds towards regular European health literacy surveys.

Main activities of the HLS₁₉ Project

The main research- and development-related activities of the HLS19 Project are to

• develop a HLS₁₉ study protocol and a survey instrument for the scientific study of population health literacy at national and international levels,
• initiate and accomplish a cross-national comparative survey among the HLS₁₉ project partner countries,
• establish and update a HLS₁₉ database,
• provide comparative results across the HLS₁₉ project partner countries,
• publish and disseminate the findings in reports, scientific peer-reviewed journals, books, factsheets, policy briefing papers and through the M-POHL public website,
• define and manage a set of rules for access to and use of the HLS₁₉ database by all HLS₁₉ project partners, M-POHL members with observer status and external researchers who intend to conduct and publish second-order analyses.

The International Coordination Centre (ICC) of the HLS₁₉ Project

The WHO-CC for Health Promotion in Hospitals and Health Care at the department of Health and Society of the Austrian Public Health Institute (Gesundheit Österreich GmbH) is the International Coordination Centre (ICC) of the HLS₁₉ Project. 

Core team of the International Coordination Centre (ICC) and their roles/responsibilities: 

Jürgen Pelikan - Principal International Investigator
Christa Straßmayr - Project Coordination and Research
Thomas Link – Statistics and Research
Peter Nowak – Finance and Contracting
 

Christina Dietscher 

M-POHL policy co-chair
Austrian Federal Minister of Social Affairs, Health, Care and Consumer Protection
christina.dietscher@gesundheitsministerium.gv.at 

Jürgen Pelikan

M-POHL research co-chair 
Austrian Public Health Institute (Gesundheit Österreich GmbH)
juergen.pelikan@goeg.at

About M-POHL

M-POHL (2025): Governance and Work structure of the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL). International Coordination Center of M-POHL and its projects at the Austrian National Public Health Institute, Vienna

M-POHL (2023): Assessing Organizational Health Literacy. Factsheet. International Coordination Center of M-POHL and its projects at the Austrian National Public Health Institute, Vienna

M-POHL (2023): Evidence-based Policy and Practice (EVPOP). Factsheet. International Coordination Center of M-POHL and its projects at the Austrian National Public Health Institute, Vienna

M-POHL (2023): The Health Literacy Survey 2024-2026 (HLS24). Factsheet. International Coordination Center of M-POHL and its projects at the Austrian National Public Health Institute, Vienna

M-POHL (2023): The WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL). Factsheet. International Coordination Center of M-POHL and its projects at the Austrian National Public Health Institute, Vienna

Dietscher C. and Pelikan J.M. (2019) 'The action network for measuring population and organizational health literacy (M-POHL) and its Health Literacy Survey 2019 (HLS19)', European Journal of Public Health, 29 (4).

Dietscher, C., Pelikan, J.M., Bobek, J., Nowak P. and World Health Organization- Regional Office for Europe (‎2019)‎ 'The Action Network on Measuring Population and Organizational Health Literacy (‎M-POHL)‎: a network under the umbrella of the WHO European Health Information Initiative (‎EHII)‎’, Public Health Panorama, 5 (1), pp. 65-71

M-POHL (2018) Concept Note 'For a WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL Network) within the European Health Information Initiative (EHII)'. Vienna.

M-POHL (2018) The Vienna Statement on the measurement of population and organizational health literacy in Europe. Vienna.

WHO documents

World Health Organization (2016) 'Shanghai Declaration on promoting health in the 2030 Agenda for Sustainable Development', Geneva: World Health Organization. 

World Health Organization (2021) Geneva Charter for Well-Being, Geneva:  World Health Organization. World Health Organization.  

Kickbusch I., Pelikan, J. M., Apfel, F., and Tsouros, A. D. (2013) Health literacy. The solid facts. Copenhagen: WHO Regional Office for Europe. 

M-POHL structure

M-POHL is a network of member countries from the WHO-European Region under the auspices of WHO-Europe. Associated membership and observer status are possible. The network is represented by two co-chairs, one co-chair represents policy interests, and one represents research interests. An international coordination center (ICC) coordinates and administrates the activities of M-POHL in cooperation with the co-chairs and the Advisory Board. In the Governance and Work Structure of M-POHL roles, responsibilities and decision structures in M-POHL are outlined in detail. An organogram can be found here:

M-POHL chairs

M-POHL is currently co-chaired by Christina Dietscher (Austrian Federal Ministry of Labour, Social Affairs, Health, Care and Consumer Protection) and by Diane Levin-Zamir (University of Haifa, School of Public Health and Clalit Health Services).

Anastasia Koylyu is M-POHLs health literacy contact at the WHO/Europe.

M-POHL Advisory Board

M-POHL is supported by an Advisory Board consisting of excellent experts from research and policy. The Advisory Board advices the M-POHL co-chairs and the ICC regarding strategic, research and policy directions and on the development of theoretical and empirical aspects of its projects. The Advisory Board members are: 

• Altyn Aringazina (Kazakhstan)
• Henrik Bøggild (Denmark)
• Gerardine Doyle (Ireland))
• Christopher Le (Norway)
• Andreja Ljubič (Slovenia)
• Kristine Sørensen (Denmark)
• Tamara Štemberger Kolnik (Slovenia)
• Miguel Telo de Arriaga (Portugal)
• Stephan Van den Broucke (Belgium). 

International Coordination Centre (ICC)

The International Coordination Centre (ICC) of M-POHL is situated within the Competence Centre Health Promotion and Healthcare of the Austrian National Public Health Institute (Gesundheit Österreich GmbH). The ICC is elected by M-POHL General Assembly for a period of 5 years.

The main contact persons at the ICC are Christa Straßmayr for the coordination of M-POHL and its projects and Robert Griebler for the scientific coordination of the M-POHL projects.

M-POHL Partners 

M-POHL brings together health researchers, health policy makers, and health administrators. Member countries typically participate with two positions: 

• a representative from research
• a representative from health policy or health administration. 

This enables dialogue between these perspectives. These representatives are part of the M-POHL General Assembly, which convenes twice a year to discuss progress and to jointly decide on next steps. This continuous collaboration increases a broader understanding of health literacy, supports health literacy’s momentum, and assists the planning of specific health literacy activities and interventions in respective countries.

M-POHL is open to all member states of WHO-Europe. Associated membership for non-WHO European countries is possible. In the Governance and Work Structure of M-POHL details on becoming a member, associated member and observer are outlined. M-POHL has currently (as of 2024) 27 participating member countries, 2 observing countries from the WHO European Region, and in addition observers from Asian countries. 

M-POHL Countries

Austria	Belgium	Bulgaria
Czech Republic	Denmark	Estonia
France	Germany	Hungary
Ireland	Israel	Italy
Kazakhstan	Moldova	Netherlands
Norway	Portugal	Russian Federation
Serbia	Slovakia	Slovenia
Spain	Sweden	Switzerland
Turkey	Ukraine	United Kingdom

Background

M-POHL builds upon WHO´s Health Literacy: The solid facts and the first European Health Literacy Survey (HLS-EU) (2009-2012) which found that an average of 47% of the citizens in the 8 participating countries had limited health literacy. Subsequently, more and more countries set out to measure and improve health literacy. Recommendations called for regular comparative health literacy surveys in Europe in as many countries as possible.

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