Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy

Abstract

BackgroundHealth literacy, or the ability to access, understand, appraise and apply health information, is central to individuals’ health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe.MethodsA total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy.ResultsInternal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill.ConclusionsThis study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan.Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1835-x) contains supplementary material, which is available to authorized users.

Validating the European Health Literacy Survey Questionnaire in people with type 2 diabetes: Latent trait analyses applying multidimensional Rasch modelling and confirmatory factor analysis

“…(, ) and Nakayama et al. (), we found that a 12‐dimensional model, reflecting the hypothesis of the four cognitive domains being integrated in the three health domains, fit the data better than the 1‐ and 3‐dimensional models. Despite the theoretically funded 12‐dimensional structure described in the conceptual framework (HLS‐EU Consortium, ) and the absence of empirical evidence supporting a unidimensional scale, researchers continually add up the scores to one general index (e.g., Palumbo et al., ; Sørensen et al., , ; Toçi, Burazeri, Sørensen, Kamberi, & Brand, ).…”

“…This article seeks to evaluate the plausibility of the interpretations and uses of the European Health Literacy Survey Questionnaire (HLS‐EU‐Q47) sum score found in peer‐reviewed publications (Nakayama et al., ; Palumbo, Annarumma, Adinolfi, Musella, & Piscopo, ; Sørensen et al., , ). More specifically, we aim to evaluate the plausibility of the claims, assumptions and inferences that have been made based on the HLS‐EU‐Q47 score(s) because these might influence health policies.…”

Development of the health literacy on social determinants of health questionnaire in Japanese adults

“…Generally, similar results are obtained from studies reporting health literacy and self-rated health [30]. According to the WHO [33], to reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment.…”

“…HL-SDHQ referred the definition of health literacy for the domain of health promotion; we, therefore, used the HP-HL index of the Japanese version of the HLS-EU-Q47 [30] to confirm scale validity. We expected it to better recognize health literacy which needs to realize health promotion than HP-HL index because HL-SDHQ clearly focuses on the social determinants of health.…”

Associations of health literacy and information sources with health-risk anxiety and protective behaviors

“…A recent study reported that Japanese people had more difficulty in obtaining reliable and understandable health information compared to those in European countries, partly because of the absence of a reliable and comprehensive health information website comparable to MedlinePlus (US National Library of Medicine). 28 Health literacy is determined by the interaction of individual skills and abilities with the demands of society and the contexts within which people act. 4 Developing a reliable portal site of health information for general public may reduce the difference in the utilization of health information on the Internet by level of health literacy.…”