Editorial

Bridging the International Divide for Health Literacy Research

Concept mapping served as the starting point for the aim of capturing the comprehensive structure of the construct of ‘health literacy.’ Ideas about health literacy were generated by 99 experts and resulted in 105 statements that were subsequently organized by 27 experts in an unstructured card sorting. Multidimensional scaling was applied to the sorting data and a two and three-dimensional solution was computed. The three dimensional solution was used in subsequent cluster analysis and resulted in a concept map of nine “clusters”: (1) self-regulation, (2) self-perception, (3) proactive approach to health, (4) basic literacy and numeracy skills, (5) information appraisal, (6) information search, (7) health care system knowledge and acting, (8) communication and cooperation, and (9) beneficial personality traits. Subsequently, this concept map served as a starting point for developing a “qualitative” structural model of health literacy and a questionnaire for the measurement of health literacy. On the basis of questionnaire data, a “quantitative” structural model was created by first applying exploratory factor analyses (EFA) and then cross-validating the model with confirmatory factor analyses (CFA). Concept mapping proved to be a highly valuable tool for the process of model building up to translational research in the “real world”.

Nos últimos anos, diferentes estudos têm demonstrado que um nível inadequado de literacia em saúde pode ter implicações significativas nos resultados em saúde, na utilização dos serviços de saúde e, consequentemente, nos gastos em saúde. O conceito de literacia em saúde evoluiu de uma definição meramente cognitiva para uma definição que engloba as componentes pessoal e social do indivíduo, assumindo‐se como a capacidade de tomar decisões fundamentadas no seu dia‐a‐dia.

O presente estudo transversal analítico teve como objetivo traduzir e validar para a população portuguesa o European Health Literacy Survey (HLS‐EU).

O HLS‐EU‐PT foi aplicado em todo o território nacional, incluindo as regiões autónomas, através de investigadores de uma rede académica. A recolha de dados foi realizada por entrevista presencial. A amostra final ficou constituída por 1.004 indivíduos com idades ≥ 16 anos.

Este estudo disponibilizou o instrumento de avaliação do nível de literacia para a saúde em Portugal, tão importante na gestão da saúde.

O HLS‐EU‐PT apresenta‐se como um instrumento adequado para aferir o nível de literacia em saúde da população portuguesa e evidencia propriedades psicométricas comparáveis às versões utilizadas nos outros países.

Em Portugal, 61% da população inquirida apresenta um nível de literacia geral em saúde problemático ou inadequado, situando‐se a média dos 9 países em 49,2%.

Relativamente à dimensão cuidados de saúde, apenas 44,2% apresenta um nível suficiente ou excelente de literacia em saúde. No que respeita à prevenção da doença, cerca de 45% dos inquiridos revela ter um nível suficiente ou excelente de literacia em saúde, comparativamente com a média dos 9 países, que nesta dimensão apresenta o valor de 54,5%. Na dimensão promoção da saúde, 60,2% da população auscultada apresenta um nível de literacia em saúde problemático ou inadequado, sendo que a média se situa nos 52,1%.

Assim, considera‐se fundamental e urgente a conceção e implementação de uma estratégia nacional de literacia em saúde.

In the last few years, several studies have shown that inadequate health literacy levels can have significant implications in health outcomes, in the use of health care services and, consequently, in health costs. The concept of health literacy has changed from a purely cognitive definition to a definition that includes the personal and social components of the individual, assuming the ability to make informed decisions in their everyday life.

This analytical cross‐sectional study aimed to translate and validate the European Health Literacy Survey (HLS‐EU) to the Portuguese population.

The HLS‐EU‐PT has been applied throughout the country, including the autonomous regions, through research of an academic network. Data collection was conducted by personal interview. The final sample was composed of 1004 individuals aged ≥ 16 years.

This study provided the assessment tool of literacy level for health in Portugal, so important in health management.

The HLS‐EU‐PT is an adequate instrument to measure the health literacy levels of Portuguese population and shows comparable psychometric properties to versions used in the other countries.

In Portugal, 61% of the surveyed population has general health literacy level problematic or inadequate, reaching the average of the nine countries in 49.2%.

Concerning the Healthcare dimension, only 44.2% have a sufficient or excellent level of health literacy. In terms of disease prevention, about 45% of respondents reveal a sufficient or excellent level of health literacy, and the average stands at 54.5%. In Health Promotion dimension about 60.2% of the auscultated population has an health literacy level problematic or inappropriate, and the average stands at 52.1%.

Therefore, it is fundamental and urgent to design and implement a National Strategy for Health Literacy.

Though there has been a considerable expansion of interest in the health literacy concept worldwide, there has also been criticism that this concept has been poorly defined, that it stretches the idea of “literacy” to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion. This paper takes as a starting point the expanded model of health literacy advanced by Nutbeam (2000) and addresses these concerns by interrogating the concept of “critical health literacy” in order to draw conclusions about its utility for advancing the health of individuals and communities. The constituent domains of critical health literacy are identified; namely information appraisal, understanding the social determinants of health, and collective action, and as far as possible each are clearly delineated, with links to related concepts made explicit. The paper concludes that an appreciation of work undertaken in a range of different disciplines, such as media studies, medical sociology, and evidence-based medicine can enhance our understanding of the critical health literacy construct and help us understand its usefulness as a social asset which helps individuals towards a critical engagement with health information. There is some evidence that aspects of critical health literacy have indeed been found to be a resource for better health outcomes, but more research is needed in this area, both to develop quantitative and qualitative approaches to evaluating health literacy skills, and to offer convincing evidence that investment in programmes designed to enhance critical health literacy are worthwhile.