Comprehensive health literacy in Japan is lower than in Europe: A validated japanese-language assessment of health literacy
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BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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The health literacy of the Japanese general population was lower than that of European countries.
“Also, it has been reported that the health literacy of the Japanese general population was lower than that of European countries (Nakayama et al., 2015).”
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 Nakayama et al., 2015
Trust in news websites and social media was lower in Japan partly because trustworthy online sources of health information were less available in the Japanese language due to the lack of reliable health information websites from public agencies.
“This may be partly because trustworthy online sources of health information were less available in the Japanese language due to the lack of reliable health information websites from public agencies (Nakayama et al., 2015).”
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 Nakayama et al., 2015
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- Authors
- Nakayama, K., Osaka, W., Togari, T., Ishikawa, H., Yonekura, Y., Sekido, A., & Matsumoto, M.
- Affiliations
- St. Luke's International University (JP)
- The Open University of Japan (JP)
- The University of Tokyo (JP)
- Iwate Medical University (JP)
- Corresponding author
- Nakayama, Kazuhiro
- ORCID
- Venue
- BMC Public Health
- Published
- 2015-05-23
- Volume
- 15
- Issue
- 1
- Pages
- 505-505
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4491868
- OpenAlex
- W1553187970
- Cited by
- 338
- References
- 2
- Citations by year
- 2026: 21 · 2025: 34 · 2024: 54 · 2023: 46 · 2022: 42 · 2021: 38 · 2020: 33 · 2019: 23 · 2018: 26 · 2017: 13 · 2016: 6 · 2015: 2
- FWCI
- 26.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Funders
- Japan Society for the Promotion of Science (23390497)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Social Sciences › Education › Health Education and Validation
- Keywords
- health literacy, HLS-EU-Q47, cross-national comparison, questionnaire validation, health decision-making, primary care, health information access, Japan, Europe
- MeSH terms
- Adult, Aged, Decision Making, Europe, Factor Analysis, Statistical, Female, Health Surveys, Humans, Japan, Language, Male, Middle Aged, Surveys and Questionnaires, Translating, Reproducibility of Results, Health Literacy
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