Health literacy

1. Key messages

One third of the population aged 15 years and over (33%) has a low level of health literacy, meaning they do not have sufficient skills to make decisions about their health.

Low levels of health literacy are more prevalent among women (35%) than men (32%), and in Brussels and Wallonia (38% and 36%, resp.) than in Flanders (29%).

People in poor health, older people, and lower educated people have a lower level of health literacy; in other words, people who have higher needs for healthcare and health promotion, are those who benefit the least from such interventions.

Attention is therefore needed to detect people with low health literacy and adapt the communication; it is however also important to improve the health literacy levels in the population.

2. Background

Health literacy is defined as “people’s knowledge, motivation and competencies to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course” [1]. Limited health literacy is associated with adverse health outcomes, inadequate health-related behavior, health service use, treatment and medication adherence, self-care management, and higher mortality rates [2-4]. A Belgian study showed that low health literacy is associated with greater use of health care services, particularly the more specialized services [5]. It has also been hypothesized that health literacy has a mediating role between socioeconomic status and health disparities and can be a tool against health inequalities [6]. Health literacy is today recognized as an important health determinant and attracts more and more attention at international, national, and regional levels [7,8]. More information on health literacy actions in Belgium is available in the report of the KCE [9].

Health literacy was measured in Belgium in 2014 and 2016 using online surveys and a convenience sample from the members of a Belgian health insurance fund. In 2018, health literacy was included in the HIS 2018 and therefore measured for the first time using a nationally representative sample. The HIS 2018 used the HLS-EU-Q6 questionnaire, a generic and subjective instrument adapted to the European context. With this instrument a score of health literacy is first computed, then the scores are grouped into three categories: 

  • Sufficient health literacy
  • Limited health literacy
  • Insufficient health literacy

First, the distribution of health literacy levels by region is presented, then the proportion of people with a poor level of health literacy is further analyzed in the population aged 15 years and over. A poor health literacy category is constructed by pooling the groups having “limited” and “insufficient” health literacy.

3. Distribution of health literacy levels

In 2018, 66.6% of the population aged 15 years and over had a sufficient level of health literacy, 27.8% a limited level, and 5.6% an insufficient level. Thus, one third of the population (33.4%) had a poor level of health literacy.

More people have a sufficient level of health literacy in Flanders (69.3%) than in Wallonia (62.7%) and Brussels (63.2%). The difference comes mainly from people with limited health literacy, as the proportion of people with insufficient health literacy is the same in the 3 regions.

Distribution of health literacy levels among the population aged 15 years and over, by region, Belgium, 2018
Source: Health Interview Survey, Sciensano [12]

4. Poor level of health literacy

Situation in 2018

Belgium

In Belgium, in 2018, 33.4% of the population had a poor level of health literacy. This proportion was lower for men (31.7%) than for women (35.0%). Poor health literacy was more prevalent among people aged 75 years and older (38.7% for men and 50.4% for women) and the younger people aged 15 to 24 (32.8% for men and 44.6% for women).

Prevalence of poor health literacy level among the population aged 15 years and over, by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [12]
Regional differences

Among men, the prevalence of poor health literacy was higher in Brussels and Wallonia (37.7% and 36.0%, resp.) than in Flanders (28.8%).

Among women, the differences between regions were smaller; yet Wallonia still had a higher prevalence of poor health literacy.

Prevalence of low health literacy level among the population aged 15 years and over, by sex and region, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [12]

Socio-economic disparities

The level of health literacy is strongly linked to educational level. People with the lowest educational level were nearly two times more likely to have low health literacy than people with the highest educational level. However, it is noteworthy that among people with tertiary education, 28.1% still have a low level of health literacy.

Prevalence of poor health literacy level among the population aged 15 years and over, by educational level, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [12]

5. Read more

View the metadata for this indicator

HISIA: Interactive Analysis of the Belgian Health Interview Survey

Definitions

Age-adjusted prevalence
Most indicators are linked to age. Since the Belgian population is ageing over time and that differences in age-composition are observed between regions and between educational groups, the prevalence rates are standardized by age with the European standard population 2010 to allow for comparability.
HLS-EU-Q6 questionnaire
The European Health Literacy Survey (HLS-EU) was developed by the HLS-EU Consortium to measure and compare health literacy in European countries based on the definition and conception model proposed by Sorensen et al. [10]. The original version is compounded of 47 items; a shorter version of 6 items was constructed to facilitate the inclusion of the questionnaire in population surveys. The correlation of results between the 47 items-questionnaire and the 6 items-questionnaire was 0.896 [11]. The questionnaire evaluates the three domains of health literacy, i.e. healthcare, prevention, and health promotion, and the 4 dimensions of health literacy, i.e. acquiring and obtaining consistent health information, understanding the information, evaluating, and judging the information, and the actual application and use of the information.

References

  1. Sorensen K, Pelikan JM, Röthlin F, Ganahl K, Slonska Z, Doyle G, et al. Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU). Eur J Public Health. 2015;25(6):1053-8.
  2. Okan O, Bauer U, Levin-Zamir D, Pinheiro P, Sørensen K. International Handbook of Health Literacy: Research, practice and policy across the lifespan. Policy Press; 2019. pp. 766.
  3. Nutbeam D. Defining and measuring health literacy: what can we learn from literacy studies? Int J Public Health. 2009;54(5):303–5.
  4. Van den Broucke S. Health literacy: a critical concept for public health. Arch Public Health. 2014;72(1):10.
  5. Vandenbosch J, Broucke SV den, Vancorenland S, Avalosse H, Verniest R, Callens M. Health literacy and the use of healthcare services in Belgium. J Epidemiol Community Health. 2016;70(10):1032-8.
  6. Stormacq C, Van den Broucke S, Wosinski J. Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promot Int. 2019;34(5):e1-17.
  7. Quaglio G, Sørensen K, Rübig P, Bertinato L, Brand H, Karapiperis T, et al. Accelerating the health literacy agenda in Europe. Health Promot Int. 2017;32(6):1074-80.
  8. Kickbusch I, Pelikan JM, Apfel F, Tsouros AD, World Health Organization, editors. Health literacy: the solid facts. Copenhagen: World Health Organization Regional Office for Europe; 2013. pp. 73.
  9. Rondia K, Adriaenssens J, Van Den Broucke S, Kohn L. Health literacy: what lessons can be learned from the experiences of other countries? Health Services Research (HSR) Brussels: Belgian Health Care Knowledge Centre (KCE); 2019. KCE Reports 322. D/2019/10.273/63.
  10. Sorensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.
  11. Sorensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:948.
  12. Charafeddine R, Demarest S, Berete F. Enquête de santé 2018: Littératie en santé [Internet]. Brussels, Belgium: Sciensano; 2020. Report No.: D/2019/14.440.72. Available from: https://his.wiv-isp.be/fr/Documents%20partages/HL_FR_2018.pdf