OBJECTIVE—Health literacy (HL), the capacity of individuals to access, understand, and use health information to make informed and appropriate health-related decisions, has been recognized as an important concept in patient education and disease management. This study examined the psychometric properties of newly developed scales for measuring three different levels of HL (i.e., functional, communicative, and critical) in patients with diabetes. RESEARCH DESIGN AND METHODS—The reliability and validity of the three HL scales were evaluated in a sample of 138 outpatients with type 2 diabetes. In addition, sociodemographic and clinical characteristics, knowledge of diabetes, information-seeking behaviors, and self-efficacy were assessed for each patient through a self-report questionnaire and review of electronic medical records. RESULTS—Scale items were constructed to directly reflect the definition of HL. Internal consistency of functional, communicative, and critical HL scales was adequately high (α = 0.84, α = 0.77, and α = 0.65, respectively). Three interpretable factors were identified in exploratory factor analysis. Correlations between HL scales and other measures supported the construct validity of the scales. The three HL scales were only moderately correlated with each other, suggesting that each represents a different domain of HL abilities and skills. CONCLUSIONS—Our newly developed HL scales are reliable and valid measures of three types of HL in diabetic patients. Exploring a patient's HL levels may provide a better understanding of the patient's potential barriers to self-management of disease and health-promoting behaviors.

With the increase in media reports and rapid diffusion of the Internet, the skills in finding and utilizing health information (health literacy; HL) are becoming important in maintaining and promoting health. This study aimed to examine the psychometric properties of a brief measure to assess major components of communicative and critical HL among Japanese office workers, in order to consider its applicability to health promotion at workplace. The participants were 190 male office workers at a Japanese company. A self-administered questionnaire was distributed at the annual health checkup, in which HL, health-related behaviors and coping with job stress were asked. Also, the number of somatic symptoms reported by the worker was counted out of the eight symptoms in the health checkup questionnaire. The higher HL group was more likely to have regular eating patterns and exercise weekly, and tended to be a never smoker. In coping with job stress, those with higher HL were more likely to actively solve the problems or seek support from others, whereas those with lower HL were more likely to be resigned to the situation. Further, lower HL group reported significantly greater number of somatic symptoms than higher HL group. These findings were generally as hypothesized, supporting the validity of the HL scale among office workers. Further research on HL is needed to explore the extent and impact of HL on health outcomes.

Health 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. A 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. Internal 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. This 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.

Objectives  Health information is an important resource for patients to understand and engage in the management of their health conditions. We discuss the role of health literacy (HL) in improving patient participation and propose future research in this field.Methods  Literature searches were conducted to review existing definitions and measures of HL and identify empirical findings of its impact on patient health/illness‐related behaviours. We searched MEDLINE using ‘health literacy’ as a keyword and retrieved 371 articles published in English between 1985 and 2006. We also hand‐searched publications of leading researchers and related institutes and followed the reference lists of relevant articles.Results  The World Health Organization has defined HL as ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.’ Based on this definition, three levels of HL have been described: functional, communicative and critical. Studies of HL have increased dramatically over the past few years, but there is a gap between the conceptual definition of HL and its application. Thus, empirical evidence of its impact on patient health/illness‐related behaviours is still limited.Conclusions  The prevalence and consequence of inadequate HL as fully defined have not been determined. Further research is needed to develop measures of HL beyond the functional level and that consider the interaction of the individual patient HL with the health and social contexts in which the patient lives.

Health communication consists of interpersonal or mass communication activities focused on improving the health of individuals and populations. Skills in understanding and applying information about health issues are critical to this process and may have a substantial impact on health behaviors and health outcomes. These skills have recently been conceptualized in terms of health literacy (HL). This article introduces current concepts and measurements of HL, and discusses the role of HL in health communication, as well as future research directions in this domain. Studies of HL have increased dramatically during the past few years, but a gap between the conceptual definition of HL and its application remains. None of the existing instruments appears to completely measure the concept of HL. In particular, studies on communication/interaction and HL remain limited. Furthermore, HL should be considered not only in terms of the characteristics of individuals, but also in terms of the interactional processes between individuals and their health and social environments. Improved HL may enhance the ability and motivation of individuals to find solutions to both personal and public health problems, and these skills could be used to address various health problems throughout life. The process underpinning HL involves empowerment, one of the major goals of health communication.