Health literacy measures

For more than two decades, our health literacy tools have helped health services and governments measure and understand health literacy at scale.

For over twenty years we have been developing and refining our Health Literacy measurement tools and processes. Our expertise in developing health literacy measures, including the Health Literacy Questionnaire (HLQ) and eHealth Literacy Questionnaire (eHLQ), enables people to gain insights into the many facets of health literacy.

Administered in over 1500 studies in over 100 countries, these questionnaires are the most robustly developed and extensively psychometrically evaluated health literacy questionnaires available.

With these measures, health providers and governments can identify and understand the health literacy profiles of individuals and/or populations.

Health Literacy Questionnaire (HLQ)

“Thinking broadly about your experiences in trying to look after your health, what abilities does a person need to have in order to get, understand, and use health information to make informed decisions about their health?”

This is the seeding statement that led to the development of the Health Literacy Questionnaire (HLQ). We consulted community members, patients, health professionals, and policymakers both locally in Australia and internationally through interviews and workshops to identify the many facets of health literacy; the core mechanisms underpinning people’s health experiences. Based on the voice of people, the HLQ was developed as a comprehensive measure of health literacy that can be used to assess the strengths and challenges of a wide range of people and organisations.

The HLQ measures nine areas of health literacy:

Feeling understood and supported by healthcare providers
Having sufficient information to manage my health
Actively managing my health
Social support for health
Appraisal of health information
Ability to actively engage with healthcare providers
Navigating the healthcare system
Ability to find good health information
Understand health information well enough to know what to do

These 9 areas of health literacy make up the 9 scales of the HLQ, represented by 44 items. Using a rigorous validity testing procedure, the HLQ was found to have strong to very strong psychometric properties, providing unique insights into 9 different areas of health literacy.

With the 9 HLQ scale scores, a health literacy profile of the population (or profiles of subgroups using methods from the Ophelia process) can be established. The population or groups may demonstrate strengths (indicated by higher scores) in certain areas while challenges (indicated by lower scores) in other areas. This health literacy profile(s) allows for a strengths-based approach to tackle people’s health literacy challenges. It will also reflect on an organisation’s needs or competencies, providing valuable insights into what interventions can be used to optimise health outcomes.

Through our consultation with people in other countries and cultures during the development phase, we ensured that the HLQ could also be translated and culturally adapted into a language other than English. As of today, the HLQ has been translated into 24 languages across nearly 100 countries. We continue to seek inputs from community members throughout the translation and cultural adaptation process. Each translated version of the HLQ has demonstrated strong psychometric properties, indicating that it is the health literacy measure that can be used across languages and cultures.

HLQ Validity testing papers in European languages:

Dutch

Spanish and Catalan

Swedish

Use of the HLQ in Spain

Obtaining a licence for a Health Literacy Questionnaire (HLQ)

You must register (apply) to use the questionnaires and will be issued with a Licence that enables us to track usage and ensure that it is properly administered.

Please note that without a licence you will not be able to publish and refer to the questionnaire.

They are freely available for government, not for profit, and community/civil society organisations.

An administration and service fee is levied on for profit and commercial organisation - please see the fee scale on the registration form.

To obtain a registration form for a licence please email: HL-info@latrobe.edu.au

eHealth Literacy Questionnaire (eHLQ)

“Thinking about citizens’ experiences in trying to look after their health (or the health of their family), what does a person need to be able to do in order to use digital health services?”

Like the development of the HLQ, the eHealth Literacy Questionnaire (eHLQ) also started with a seeding statement to uncover the core mechanisms behind people’s use of digital technology for health. Eight concept mapping workshops were held in London, United Kingdom and Capital Region of Denmark, followed by an online survey to international stakeholders. Participants included IT users and non-users, people living with chronic illness(es), healthcare providers, health informatics professionals, public health researchers, and computer scientists. Based on the workshop findings, people identify 7 areas of digital health literacy that represent their use of digital technology for health. The eHealth Literacy Framework was first established, followed by the simultaneous development of the eHLQ in Danish and English.

Instead of measuring digital health literacy simply as a personal skill and capacity, the eHLQ also considers the digital health systems people can use and interaction between the individual and the system. The 7 areas measured by the eHLQ includes:

Using technology to process health information
Understanding of health concepts and language
Ability to actively engage with digital services
Feel safe and in control
Motivated to engage with digital services
Access to digital services that work
Digital services that suit individual needs

Based on the workshop statements, 35 items were developed to represent the 7 areas/scales of the eHLQ. Advanced statistical methods were used in the validity testing of both the Danish and English eHLQ. Again, strong psychometric properties were demonstrated in both versions. Like the HLQ, the eHLQ produces a digital health literacy profile of the population. In addition to personal capacity, the profile sheds light on the maturity of an organisation or country’s digital health services. This supports a strength-based approach to optimise people’s digital health literacy and ultimately improve health outcomes and equity.

While the first development paper of the eHLQ (Danish) was published in 2018, the eHLQ has already been translated into 13 languages. Validity testing studies of other language versions of the eHLQ continue to demonstrate its robustness across cultures.

Validity testing of the HLQ in European languages