Subjective Estimation of Health Literacy — What Is Measured by the HLS-EU Scale and How Is It Linked to Empowerment?

A recently published study introduced a new instrument (HLS-EU) for the measurement of health literacy (HL) and comparative data at population level for this measure across eight EU countries, which revealed significant differences in HL at population level. The HLS-EU instrument consists of items that aim to assess respondents’ estimation of difficulties regarding different health-related tasks, and it is therefore a measure of subjective HL. With help of a two-step approach, the present study, which was conducted in Austria, aimed to investigate individual experiences and factors that are associated with high or low values of subjective HL as measured by the HLS-EU scale. In a first step, qualitative data of 20 cognitive interviews for the short version of the HLS-EU scale were analyzed. In a second step, the preliminary results of the qualitative analysis were validated with the help of a standardized survey (n=800). Results show that subjective HL may either be grounded in high empowerment, including high personal and social skills and resources, or in a lack of health-related experience and reduced critical contemplation, but high trust in the health system, which is paired with paternalistic preferences. As a conclusion, it is recommended that research should acknowledge the heterogeneous and multidimensional nature of subjective HL.