National Health Survey: Health literacy

Health literacy is “the ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” [1,2].

Understanding health literacy from a population health perspective, including the various strengths and weaknesses individuals and groups may have, is a recognised information gap[3]. Reporting data in this area will allow policymakers to understand the diversity of health literacy within Australia and identify relationships between health literacy and access, equity and outcomes[4].

A better understanding of health literacy can inform the development of appropriate public health strategies to improve access to health services and health information. Health literacy should not be interpreted as a deficit of knowledge or understanding at the individual-level, but as a tool for policymakers and health providers to use to improve services for individuals, families and communities.

The Health Literacy Survey (HLS) was conducted by the ABS in 2018. The sample for the HLS was respondents aged 18 years and over who had already participated in the National Health Survey (NHS 2017-18). These respondents agreed to be contacted for further ABS surveys and had provided their contact details. The HLS was conducted from January 2018 to August 2018 with 5,790 fully responding adults.

The data in the HLS can be analysed along with the data collected in the NHS 2017-18.

The HLS uses the Health Literacy Questionnaire (HLQ) which was developed and extensively tested in Australia by a team led by Professor Richard Osborne in Victoria, Australia. The HLQ is a widely used multi-dimensional health literacy assessment tool for surveys, evaluation and service improvement. It collects information on how people find, understand and use health information, and how they manage their health and interact with healthcare providers.

The HLS was conducted with the assistance of an advisory group comprising experts in health literacy. Members of this advisory group were drawn from Commonwealth, New Zealand and State/Territory government agencies, and non-government organisations. The contributions made by members of the advisory group are greatly appreciated.

More information about the HLS can be found in the National Health Survey Users Guide.

The Health Literacy Questionnaire (HLQ) consists of 44 questions (or ‘items’) which form nine domains of health literacy[5]. Data was collected for each item and domain based on the level of agreement with a set of health literacy statements (‘strongly agree’, ‘agree’, ‘disagree’ or ‘strongly disagree’) or the perceived difficulty of a health literacy characteristic (‘always easy’, ‘usually easy’, ‘sometimes difficult’, ‘usually difficult’ or ‘cannot do or always difficult’).

The nine domains are:

1. Feeling understood and supported by healthcare providers (Domain 1)
2. Having sufficient information to manage my health (Domain 2)
3. Actively managing my health (Domain 3)
4. Social support for health (Domain 4)
5. Appraisal of health information (Domain 5)
6. Ability to actively engage with healthcare providers (Domain 6)
7. Navigating the healthcare system (Domain 7)
8. Ability to find good health information (Domain 8)
9. Understand health information well enough to know what to do (Domain 9)

All nine domains derived from the HLQ are considered separate and results should not be combined across domains. Summary results from a selection of four of the nine domains (3, 4, 6 and 7) are provided in the subsequent sections. The remaining five domains are discussed briefly in the ‘Other health literacy domains’ section.

In 2006, the ABS released a publication called the Adult Literacy and Life Skills Survey (ALLS), Summary Results. The ALLS provided information about whether Australians' literacy skills were adequate for the challenges they face in work and daily life.

The ALLS data included a derived domain to measure health literacy. Health literacy was defined as “the knowledge and skills required to understand and use information relating to health issues such as; drugs and alcohol, disease prevention and treatment, safety and accident prevention, first aid, emergencies, and staying healthy”. The ALLS assessed functional aspects of literacy, such as understanding text, finding information in documents, and problem-solving capabilities.

The HLS, which underpins the data in this release, moves beyond the functional approach and was developed from a “conceptual model … grounded in the daily lives of citizens, practitioners and policymakers”[6]. As such, the information about health literacy provided in this release is not comparable to the ALLS data.

The benefits of the HLS data are that it reports a larger range of health literacy characteristics and can therefore be used to improve health service provision.

This health literacy domain looks at how proactively people engage in their own care and make their own decisions about their health. It seeks to measure whether people feel they are able to take responsibility for managing their own health.

• I spend quite a lot of time actively managing my health.
• I make plans for what I need to do to be healthy.
• Despite other things in my life I make time to be healthy.
• I set my own goals about health and fitness.
• There are things that I do regularly to make myself more healthy.
   

• Overall 18% of people strongly agreed that they could actively manage their health, and 73% agreed. 9% of people disagreed or strongly disagreed that they could actively manage their health.
• People who considered themselves to be in excellent health were more likely to strongly agree that they could actively manage their health (34%), compared with 11% who considered their health to be good and 9% of people who considered their health to be fair or poor.
   

• People who did not report a long-term health condition were more likely to strongly agree that they could actively manage their health (21%), compared with 12% of people who had three or more long-term health conditions.
• 21% of people with a non-school qualification strongly agreed that they could actively manage their health, compared with 15% of people without a non-school qualification.
• Couple-only families were more likely to strongly agree (20%) that they could actively manage their health, than people living alone (15%).
• 21% of people who had never smoked strongly agreed that they could actively manage their health compared with 9% of those who smoked daily.
   

This health literacy domain looks at whether a person’s social system provides them with the support they require in managing their health.

• I can get access to several people who understand and support me.
• When I feel ill, the people around me really understand what I am going through.
• If I need help, I have plenty of people I can rely on.
• I have at least one person that can come to medical appointments with me.
• I have strong support from family or friends.
   

• Overall, 25% of people strongly agreed that they had social support for health, and 70% agreed while only 6% of people disagreed or strongly disagreed that they had social support for health.
• In general, younger people were more likely to strongly agree that they had social support for health than older people. For example, 39% of 18-24 year olds strongly agreed that they had social support for health, compared with 20% of those aged 65 years and over.
• Households with a higher household income (fifth quintile) were more likely to strongly agree that they have the social support they require in managing their health (29%) than those with lower household income (first quintile – 18%).
   

• People who lived alone were less likely (15%) than couple only households (26%) and couples with dependent children (27%) to strongly agree that they had social support for health.
• People who spoke English at home were more likely (26%) than those who spoke a language other than English at home (19%) to strongly agree that they had social support for health.
• People with a profound or severe core activity limitation (15%), as well as people with another disability (19%) were less likely to strongly agree that they had social support for health than people who did not have a disability (27%).
• Those without a long term health condition were more likely to strongly agree that they had social support for health (29%) than people with 3 or more long-term health conditions (17%).
   

This health literacy domain looks at whether people are proactive about their health, feel in control of relationships with healthcare providers and are able to seek advice from additional healthcare providers when necessary.

• Make sure that healthcare providers understand your problems properly.
• Feel able to discuss your health concerns with a healthcare provider.
• Have good discussions about your health with doctors.
• Discuss things with healthcare providers until you understand all you need to.
• Ask healthcare providers questions to get the health information you need.
   

• Overall, 33% of people always found it easy to actively engage with healthcare providers, 56% usually easy while 12% found it difficult.
• Older people aged 65 years and over were more likely to always find it easy to actively engage with healthcare providers (39%), compared with younger people aged 18-24 years (28%).
• Of those who assessed their health as excellent or very good, 36% always found it easy to actively engage with healthcare providers compared with 28% of those who assessed their health as fair or poor.
• People without a disability or a restrictive long-term health condition were less likely (10%) to find it difficult to actively engage with healthcare providers compared to those with a profound or severe core activity limitation (22%).
• Those without a long term health condition were less likely to have difficulty in actively engaging with healthcare providers (10%), compared with those with 3 or more long-term health conditions (17%).
   

This health literacy domain looks at whether people are able to find out about services and support to meet their needs, and are able to advocate on their own behalf when using health services.

• Find the right health care.
• Get to see the healthcare providers you need to.
• Decide which healthcare provider you need to see.
• Make sure you find the right place to get the health care you need.
• Find out which healthcare services you are entitled to.
• Work out what the best care is for you.
   

• Overall 26% of people reported finding it always easy to navigate the healthcare system, and 60% reported finding it usually easy, while 14% of people reported finding it difficult to navigate the healthcare system.
• Older people reported finding it easier to navigate the healthcare system than younger people. For example, 34% of people aged 65 years and older reported finding it always easy to navigate the healthcare system compared with 19% of people aged 35-44 years. 19% of people aged 18-24 years reported finding it difficult to navigate the healthcare system, with only 8% of people aged 65 years and over reporting finding it difficult.
   

• People with lower self-reported psychological distress levels were more likely (31%) to find it always easy to navigate the healthcare system compared with people reporting moderate (18%) or very high (17%) levels of psychological distress.
• The perceived difficulty of navigating the healthcare system between people without a long-term health condition and people with multiple long-term health conditions was similar for this domain.
   

The following items were used to assess this domain[1]:

• I have at least one healthcare provider who knows me well.
• I have at least one healthcare provider I can discuss my health problems with.
• I have the healthcare providers I need to help me work out what I need to do.
• I can rely on at least one healthcare provider.
   

Nearly one in three (32%) people strongly agreed that they felt understood and supported by healthcare providers, and 64% agreed. Only 4% of people disagreed or strongly disagreed that they felt understood and supported by healthcare providers.

The following items were used to assess this domain[1]:

• I feel I have good information about health.
• I have enough information to help me deal with my health problems.
• I am sure I have all the information I need to manage my health effectively.
• I have all the information I need to look after my health.
   

Nearly one in four (23%) people strongly agreed that they had sufficient information to manage their health, and 74% agreed. Only 3% of people disagreed or strongly disagreed that they had sufficient information to manage their health.

The following items were used to assess this domain[1]:

• I compare health information from different sources.
• When I see new information about health, I check up on whether it is true or not.
• I always compare health information from different sources and decide what is best for me.
• I know how to find out if the health information I receive is right or not.
• I ask healthcare providers about the quality of the health information I find.
   

Just over one in ten (11%) people strongly agreed that they could appraise health information (such as being able to identify reliable sources of information), and 72% agreed. 17% of people disagreed or strongly disagreed that they could appraise health information.

The following items were used to assess this domain[1]:

• Find information about health problems.
• Find health information from several different places.
• Get information about health so you are up to date with the best information.
• Get health information in words you understand.
• Get health information by yourself.
   

One in four (25%) people found it always easy to find good health information (such as using a diverse range of sources to find information that is up to date), and 63% found it usually easy. 12% of people reported finding it difficult to find good health information.

The following items were used to assess this domain[1]:

• Confidently fill medical forms in the correct way.
• Accurately follow the instructions from healthcare providers.
• Read and understand written health information.
• Read and understand all the information on medical labels.
• Understand what healthcare providers are asking you to do.
   

Over one in three (39%) people found it always easy to understand health information well enough to know what to do (such as being able to understand all written information in relation to their health and able to write appropriately on forms where required), and 54% found it usually easy. 8% of people reported finding it difficult to understand health information..

This release previously used catalogue number 4364.0.55.014.