The Antecedents and Consequences of Health Literacy in an Ecological Perspective: Results from an Experimental Analysis

Int J Environ Res Public Health. 2018 Apr 19;15(4):798. doi: 10.3390/ijerph15040798.


This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was measured using the 47-item HLS-EU questionnaire (HLS-EUQ47) and the Newest Vital Sign (NVS). The two measures stood in significant correlation to the outcomes of the sub-discipline of the Euro Health Consumer Index (r = 0.790 for HLS-EUQ47; r = 0.789 for NVS). The HLS-EUQ47 also stood in correlation to the percentage of population with post-secondary education (r = 0.810), the reading performance for 15-year-old students (r = 0.905), the presence of a national screening program for breast (r = 0.732) or cervical cancer (r = 0.873). The NVS stood in correlation with the unemployment rate (r = −0.778), the Gross Domestic Product (r = 0.719), the Gini coefficient (r = −0.743), the rank of the Euro Patient Empowerment Index (r = −0.826), the expenditure on social protection (r = 0.814), the Consumer Empowerment Index (r = 0.898), the percentage of adults using the internet for seeking health information (r = 0.759), the prevalence of overweight individuals (r = −0.843), the health expenditure (r = 0.766), as well as the percentage of individuals using the internet for interacting with public authorities (r = 0.755). This study provides some preliminary considerations regarding alternative means by which to study HL and proposes new methods for experimentation. The methods and the results could offer a means by which the relationship between society and overall healthcare protection could be strengthened.

Keywords: antecedents; consequences; determinants of health; ecological study; health literacy.

MeSH terms

  • Adolescent
  • Adult
  • Consumer Health Information / methods
  • Early Detection of Cancer / statistics & numerical data
  • Europe
  • Female
  • Gross Domestic Product / statistics & numerical data
  • Health Expenditures / statistics & numerical data
  • Health Literacy / statistics & numerical data*
  • Health Promotion / statistics & numerical data
  • Health Status
  • Health Surveys
  • Humans
  • Internet
  • Literacy
  • Male
  • Middle Aged
  • Research Design*
  • Unemployment / statistics & numerical data