The statement that the HLS-EU instrument is unsuitable for measuring health literacy is incorrect. Only the initially developed assessment instruments were based on a functional, paternalistic understanding of health literacy that aimed primarily to improve compliance (1, 2). The substantially further developed content of the definition of the HLS-EU considers that health-relevant information should not merely be understood but should be sought out, found, assessed, and applied, all of which requires specific skills. Accordingly, in addition to functional health literacy the HLS-EU-Q47 also take into account interactive and critical health literacy. The HLS-EU-Q47 does not only have high reliability but also good internal and external validity (3).
In contrast to what our correspondents state it is a strength of the instrument that it relies on the subjective assessments of those surveyed; this means it gives an insight into the difficulties that can arise when dealing with health-relevant information.
It is a questionable practice to extract single items from a coordinated catalogue of items. However, the selected examples in particular show how difficult dealing with health information is—even for topics that have been under discussion for many years, such as patient information leaflets in medication packets. The fact that even doctors do not understand package inserts is, furthermore, not an argument against collecting data from citizens‘ subjective perspectives.
On the contrary, the results of the survey (4) based on the HLS-EU-Q-47 showed how much of the information is still not appropriate for the target audience, nor is it user friendly. The results are important in terms of developing interventions. As they show that ultimately, much of the currently available health relevant information does not reach its target audience for the simple reason—among others—that it does not meet to an appropriate degree the prerequisites for information given and the challenges of information processing.
Footnotes
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
References
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