[Navigational health literacy of the population in Germany]. / Navigationale Gesundheitskompetenz der Bevölkerung in Deutschland.

AIM: Many health care systems are characterized by their high complexity and intransparency. Finding one's way through the multitude of services and finding the right place requires high navigational health literacy (NHL). NHL is defined as the ability to manoeuvre through the health care system and deal with the information required to do so. However, so far, there has been a lack of data on the population's NHL. The objective of this article is to analyse empirically the NHL in Germany and its association with socio-demographic and economic factors. METHOD: NHL was surveyed with an instrument (HLS19-NAV) newly developed by an international working group, measuring the self-assessed difficulties in relation to 12 navigation-related information tasks. The HLS19-NAV has already been used in 8 countries, including Germany. In Germany, data on NHL was collected from 2,151 adult residents in a representative cross-sectional study. The relationship between socio-demographic and economic factors, and NHL was examined by using methods of analysis of variance and multivariate linear regression analysis. RESULTS: Approximately 80% of the respondents showed low NHL with a mean score of 41.5 out of a possible 100 points. Those with low socio-economic resources, people of advanced age, people who had migrated to Germany or who were limited by health issues had a particularly low NHL. However, even people with good resources had a relatively low NHL. In contrast, the mean score was significantly higher among health professionals. CONCLUSIONS: In recent years, numerous efforts have been made to reduce navigational difficulties and to better guide patients through the German health care system. However, according to the results of the study, there is still need for further action. Above all, structural measures are required: this includes the creation of sufficient, reliable information on the health care system and its organizations as well as the implementation of navigation aids, health care pathways and the creation of a health-literate health care system including organizations and health professionals that contribute to strengthening NHL in general.

Health literacy and the role of social support in different age groups: results of a German cross-sectional survey.

BACKGROUND: Scholars demand more focus on context-related factors of health literacy as the management of health information is seen as a social practice. One prominent factor is social support that is expected to be particularly relevant for persons vulnerable for low health literacy. It was shown that health literacy can differ across the life span and especially older people have been demonstrated to be vulnerable for low health literacy. Therefore, health literacy and the relation of social support on health literacy in different age groups should be investigated. METHODS: In a German nationwide survey 2,151 adults were interviewed face-to-face. General comprehensive health literacy was measured with the HLS19-Q47 which differentiates single steps of health information management - access, understand, appraise, and apply. Social support was measured with the Oslo 3 Social Support Scale. Bivariate and multivariate analyses were performed for all respondents and for five age groups. RESULTS: Health literacy is relatively low in all age groups but particularly low among old-old people (76 + years). Also, the youngest adults (18-29 years) have slightly lower health literacy than middle-aged adults. On average, health literacy is higher among people with higher social support but this association varies between age groups. It tends to be quite strong among younger adults (18-45 years) and young-old persons (65-75 years) but is weak among older middle-aged (46-64 years) and old-old persons. The association also differs between steps of information management. It is stronger for accessing and applying information but there are differences in age groups as well. CONCLUSIONS: Social support is a relevant aspect to improve individuals' health literacy and therefore should be addressed in interventions. However, it is necessary to differentiate between age groups. While both young adults and particularly old-old persons are challenged by health information management, young adults can strongly profit from social support whereas it can barely compensate the low health literacy of old-old persons. In addition, different challenges in information management steps in different age groups need to be considered when designing health literacy interventions. Thus, target group specific services and programs are needed.

[Health Literacy of People with Former Soviet Union and Turkish Migration Background in Germany]. / Gesundheitskompetenz von Personen mit ex-sowjetischem und türkischem Migrationshintergrund in Deutschland.

AIM: So far, there are hardly any data on the health literacy of persons with a migration background in Germany. The aim of the article was to analyse the health literacy of this population group - particularly persons who originate in Turkey and the former Soviet Union (FSU). METHODOLOGY: In summer 2020, face-to-face interviews with 525 persons with FSU and 512 persons with Turkish migration background above the age of 18 were carried out across Germany. The interviews were conducted in German, Russian or Turkish. Health literacy was assessed using the internationally developed HLS19-Q47 instrument. Bivariate and multivariate analyses were carried out for each immigration group separately considering demographic, socioeconomic, linguistic and migration-specific variables. RESULTS: Overall, around half of the respondents had low health literacy, with no differences between the immigration groups. In both groups, low educational levels, socioeconomic disadvantages, limited German literacy skills, older age, multiple chronic illnesses and personal experience of immigration were linked with lower health literacy. In multivariate analyses, associations between health literacy and literacy skills, social status, financial deprivation, and chronic illness remained; however, after adjustment, no significant difference persisted by immigration generation. CONCLUSION: While a significant proportion of persons with Turkish or FSU migration background in Germany have difficulty dealing with health information, compared with existing studies, they do not have a lower health literacy than the population without a migration background. People with a migration background are therefore not to be regarded as vulnerable to low health literacy in general. Particularly socioeconomically disadvantaged subgroups display low health literacy. Interventions should therefore target these subgroups specifically and consider their living conditions. In addition, people with low literacy skills and German proficiency have greater difficulties in processing health information. This highlights the need for multilingual information, but also for multimedia materials in plain language. Structural measures are necessary for a health-literate health system and for reducing health inequalities.

[Digital Health Literacy of the Population in Germany: Results of the HLS-GER 2]. / Digitale Gesundheitskompetenz der Bevölkerung in Deutschland: Ergebnisse des HLS-GER 2.

AIM: While the availability and variety of digital information on health offers a range of opportunities, they also pose a number of challenges, because the need for digital health literacy (DHL) is increasing along with the growing range of information possibilities. The aim of this study was to analyze the extent of DHL in the German population, key determinants, and consequences for the use of digital health information resources. METHODOLOGY: The analysis was based on data from the Second Health Literacy Survey Germany (HLS-GER 2), consisting of a representative sample of n=2,151. A questionnaire developed as part of the international comparative study HLS19 was used to measure DHL, its determinants, and the use of digital health information resources. Bivariate and multivariate analyses were conducted. RESULTS: Overall, 75.8% of the population had low DHL. In particular, low literacy skills, older age, a lower level of education and social status were associated with low DHL. Multivariate analysis also indicated a strong association between DHL and general health literacy (HL). Low DHL led to lower use of digital health information resources. CONCLUSION: The results underscore the importance of promoting DHL in the general population and especially among groups with low DHL. Efforts in this area should include general HL, as it is closely related to DHL. Strengthening DHL is also a socially important task in order to increase the still low use of digital health information resources in Germany and, in general, to meet the increasing digitalization of the health care system.

[Comparison of Health Literacy of the Population in Germany between 2014 and 2020]. / Gesundheitskompetenz der Bevölkerung in Deutschland im Zeitvergleich der Jahre 2014 und 2020.

AIM: This article compares the results of two health literacy (HL) surveys of the population in Germany over time. The first survey was conducted in 2014, the second in 2020. The changes in GK, measured by the degree of subjectively assessed difficulties in individual information tasks in the three areas of health care, prevention, health promotion, in the total population and in subgroups are examined. METHODOLOGY: The analyses were based on population-representative cross-sectional data collected in 2014 and 2020. An internationally coordinated questionnaire (HLS-EU-Q47) was used to measure GK. Changes in the population groups were analysed uni- and bivariately as well as multivariately in a trend analysis. RESULTS: The HL of the German population has worsened statistically significantly within six years. This can be observed in all three overall domains. This effect was particularly evident among people with low social status and financial deprivation. CONCLUSION: Over time, dealing with health and disease-related information has become more difficult. As this development is mainly driven by socioeconomically disadvantaged population groups, it has apparently increased social inequality in the health sector. Promoting HL - as this and other studies show - is more important for the society than ever and should be given special attention in relation to the above-mentioned population groups.

Differences in health literacy domains among migrants and their descendants in Germany.

Background: Health literacy (HL) is considered to be an important precondition for health. HL research often identifies migrants as vulnerable for low HL. However, in-depth data on HL among migrants especially in its domains of health care, disease prevention and health promotion and its determinants are still scarce. Objective: The aim of this study was therefore to analyse the current status of HL among migrants and their descendants from Turkey and from the former Soviet Union (FSU) in Germany and factors associated with it. This has not been studied using large-scale data and bilingual interviews. We differentiate between dimensions of HL, namely the domains of health care, disease prevention and health promotion which goes beyond many previous studies. In addition, we explore new mechanisms by testing the explanatory power of self-efficacy and interethnic contacts for migrants' HL. Methods: The study includes 825 first- and second-generation adult migrants from two of the largest immigration groups in Germany, from Turkey and FSU, who were interviewed face-to-face in German, Turkish or Russian in late summer 2020. HL was measured using the HLS19-Q47 instrument. Age, gender, educational level, social status and financial deprivation, chronic illness, health-related literacy skills, self-efficacy, interethnic contacts, migration generation, duration of stay and region of origin were considered as possible determinants. Ordinary least square regressions were estimated. Results: The average general HL score was 65.5. HL in health promotion and disease prevention was lower than in health care. Low financial deprivation, health-related literacy skills, and self-efficacy were positively correlated with each HL domain. Educational level, social status, age, gender, duration of stay and interethnic contacts were positively correlated with HL in some domains. Region of origin was only correlated with the domain of disease prevention until interethnic contact was accounted for. Conclusion: Our study contributes to the existing knowledge by analyzing different domains of HL and testing its correlations with self-efficacy and interethnic contact among migrants. We reveal that migrants cannot generally be considered as vulnerable for low HL, as oftentimes outlined. There is a need for interventions e.g. to enhance the understanding of health information among subgroups with lower HL.

Health literacy in former Soviet Union immigrants in the US: A mixed methods study.

BACKGROUND: People with limited health literacy may have trouble finding, understanding, and using health-related information and services and navigating the healthcare system. PURPOSE: The purpose of this study was to assess the health literacy of immigrants from the former Soviet Union (FSU) using the Health Literacy Survey (HLS19-Q12 in Russian) and explore associated socio-demographic factors. METHOD: This mixed methods study recruited adult immigrants through social networks and social media and included data from online survey and follow-up interviews. Variance in health literacy was explained using multiple linear regression. Qualitative data were analyzed through modified Grounded Theory approach. FINDINGS: Survey respondents (n = 318) were primarily female college-educated FSU immigrants aged 20-74 from 14 of the 15 FSU countries and distributed across 33 US states. Forty percent scored at or below predefined cut-offs for inadequate or problematic health literacy levels. Social status, social support, and English proficiency were significant variables in explaining variance in health literacy scores while controlling for age, gender, and education. Interviews (n = 24) identified eight themes: English proficiency, social support, health insurance, experience with health care, complexity of the US healthcare system, relevant health information, health beliefs/practices, and trust. DISCUSSION: There is a need to distribute health-related information in the native language (e.g., Russian), potentially through social media and immigrants' social networks. Health providers should be aware of the prevalence of inadequate and problematic health literacy among FSU immigrants and consider associated social factors.

Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations-International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA.

The Russian language is the eighth most spoken language in the world. Russian speakers reside in Russia, across the former Soviet Union republics, and comprise one of the largest populations of international migrants. However, little is known about their health literacy (HL) and there is limited research on HL instruments in the Russian language. The purpose of this study was to adapt the Health Literacy Questionnaire (HLS19-Q) developed within the Health Literacy Survey 2019-2021 (HLS19) to the Russian language to study HL in Russian-speaking populations in Germany, Israel, Kazakhstan, Russia, and the USA. The HLS19-Q was translated either from English or from a national language to Russian in four countries first and then critically reviewed by three Russian-speaking experts for consensus. The HLS19 protocol and "team approach" method were used for linguistic and cultural adaptation. The most challenging was the adaptation of HLS19-Q questions to each country's healthcare system while general HL questions were flexible and adaptable to specific contexts across all countries. This study provides recommendations for the linguistic and cultural adaptation of HLS19-Q into different languages and can serve as an example of international collaboration towards this end.

[Health Literacy in Germany before and during the COVID-19 Pandemic]. / Gesundheitskompetenz in Deutschland vor und während der Corona-Pandemie.

AIM: The aim of this study was to compare the general and digital health literacy (HL) of the German population before the outbreak of the COVID-19 pandemic and during its persistence and to investigate different changes in population groups. METHODOLOGY: The analyses are based on population representative cross-sectional data collected in 2019/2020 before and 2020 during the pandemic. An internationally coordinated questionnaire (HLS19) was used. Changes in groups were analyzed bivariate. RESULTS: The results showed that the HL of the population in Germany tended to improve during the pandemic. This effect was especially evident with regard to the evaluation of health information and in the area of digital HL. Women, people with low or medium education, younger people and those with a migration background appeared to have benefited to a more than average extent. For older people, there was no change, and for those with multiple chronic conditions, the results even indicated a worsening. CONCLUSION: The systematic exposure to clearly structured and continuously repeated health information during the COVID-19 pandemic seems to have improved the ability to process health-related information in the German population. In particular, there has been an increase in competence in dealing with digital information media, which are being increasingly used to communicate health information. However, there are some large differences between different population groups.

Health Literacy in Germany - Findings of a Representative Follow-up Survey.

BACKGROUND: Studies have shown that the health literacy of the German population is low. The aim of this article is to analyze current developments in health literacy on the basis of recent data. METHODS: The Health Literacy Survey Germany 2 (HLS-GER 2) is a representative quantitative survey of the German-speaking resident population of Germany aged 18 and above. It was carried out in December 2019 and January 2020 by paper- assisted personal oral interview (PAPI). Data on health literacy and socio - demographic characteristics were acquired with an internationally coordinated questionnaire. The instrument for measuring general health literacy consisted of 47 questions that reflect an individual's ability to access, understand, appraise, and apply health-related information. The associations between general health literacy and sociodemographic factors were analyzed using bivariate and multivariate statistical tests. RESULTS: 58.8% of the participants had low health literacy, characterized by rating at least one-third of the questions as "difficult" or "very difficult." Many respondents stated that they had difficulties accessing (48.3%), understanding (47.7%), and applying (53.5%) information, and even more of them (74.7%) reported difficulties appraising information. The correlation coefficients reveal that health literacy is weakly associated with the following variables: age, sex, social status, literacy, level of education, financial deprivation, migration background, and the presence of one or more chronic diseases. CONCLUSION: The findings of the HLS-GER 2 highlight the need for action in pro - moting health literacy in the healthcare system. As the explanation of variance is low, there are presumably other important determinants of health literacy that were not taken into account. Further studies should be performed to investigate societal conditions of supplying health information, for example, or social and personal characteristics.