Health literacy in Europe: Comparative results of the european health literacy survey (HLS-EU)
Open accessAbstract
BACKGROUND: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. M ETHODS: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. R ESULTS: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. DISCUSSION: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.
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Previous international collaborative research indicated that the proportion of the population with inadequate level of health literacy varied by country.
“Previous international collaborative research explored the differences and similarities in general health literacy of adults in European countries (Sorensen et al., 2015) and in Asian countries (Duong et al., 2017), indicating that the proportion of the population with inadequate level of health literacy varied by country.”
From Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India (2025) · cites this paper as Sorensen et al., 2015
Previous research has demonstrated associations between general health literacy and socioeconomic status.
“Subjective social status was positively associated with DHLI scores, which was consistent with previous research that has demonstrated associations between general health literacy and socioeconomic status (Duong et al., 2017; Ishikawa et al., 2023; Sorensen et al., 2015), as well as between socioeconomic status and digital health literacy (Estrela et al., 2023; Jiang et al., 2025).”
From Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India (2025) · cites this paper as Sorensen et al., 2015
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- Authors
- Sørensen, K., Pelikan, J. M., Röthlin, F., Ganahl, K., Slonska, Z., Doyle, G., Fullam, J., Kondilis, B., Agrafiotis, D., Uiters, E., Falcon, M., Mensing, M., Tchamov, K., Broucke, S. V. D., & Brand, H.
- Affiliations
- Maastricht University (NL)
- Ludwig Boltzmann Institut Health Promotion Research (AT)
- University College Dublin (IE)
- Hellenic American University (US)
- National School of Public Health (GR)
- National Institute for Public Health and the Environment (NL)
- Medical University of Sofia (BG)
- UCLouvain (BE)
- Corresponding author
- Sørensen, Kristine
- ORCID
- Venue
- The European Journal of Public Health
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-04-05
- Volume
- 25
- Issue
- 6
- Pages
- 1053-1058
- ISSN
- 1101-1262 (ISSN-L)
- 1464-360X
- PMC
- PMC4668324
- OpenAlex
- W2137800079
- Cited by
- 2,651
- References
- 0
- Citations by year
- 2026: 302 · 2025: 325 · 2024: 355 · 2023: 297 · 2022: 362 · 2021: 311 · 2020: 255 · 2019: 179 · 2018: 131 · 2017: 74 · 2016: 43 · 2015: 15 · 2014: 2
- FWCI
- 148.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- European Journal of Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Digital Access to Libraries (submittedVersion)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
- Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- health literacy, European Health Literacy Survey, cross-national comparison, social gradient, health equity, socioeconomic status, educational attainment, financial deprivation, older adults, health policy
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Europe, Female, Health Status, Humans, Male, Middle Aged, Surveys and Questionnaires, Sex Factors, Socioeconomic Factors, Young Adult, Health Literacy
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