Health literacy

Health literacy (HLS-EU-Q16)

LASA filenames:
to be determined

Contact: Almar Kok


Health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health-related decisions” (Sørensen et al., 2012, p. 3). Health literacy is particularly important in today’s society, which demands a proactive attitude towards health and health care, and requires understanding and acting on health-related information. Individual differences in health literacy partly explain health inequalities (Stormacq et al., 2019), and are an important predictor of health care use (Vandenbosch et al., 2018). Health literacy tends to decrease with age, partly due to cognitive decline (Geboers et al., 2018; Kobayashi et al., 2015). At the same time, having high health literacy may be particularly important for older compared to younger adults, as the former tend to have more health problems and need more care (Timmermans et al., 2019).

Measurement instrument in LASA

Health literacy is measured by the 16-item version of the Health Literacy Questionnaire (HLS-EU-Q16), which originally has 47 items (HLS-EU Consortium, 2012). Items cover three themes: Health Care, Disease Prevention, and Health Promotion. For each theme, four different skills are assessed: obtaining/accessing information; understanding information; processing/appraising information; and applying/using information.

The 16-item version was developed using Rasch modelling and validated by Pelikan et al. (2014), and the Dutch version first appeared in Fransen et al. (2014). For 16 situations, it is asked how easy or difficult the participants perceives them to be for him or herself. Response options range from “very easy” (1) to “very difficult” (4). Examples are: “understanding what your doctor tells you”; “finding information about how to cope with psychiatric problems such as stress or depression”; “deciding how to protect yourself against disease based on information from the media”; and “judging how your daily life is affecting your health”. Except for applying/using information within the Health Promotion theme, each combination of theme*skill is covered by at least one item from the original 47-item questionnaire (Pelikan et al., 2014).

The questionnaire is available from wave K onwards, and included in the Medical interview.


HLS-EU-Q16_NL (in Dutch)

Variable information

not yet available

Availability of information per wave


Health literacy


¹ More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort;
K=not available yet

Me=data collected in medical interview

Previous use in LASA

Health literacy has not been used in LASA publications yet.


  1. Fransen, M.P., Leenaars, K.E.F., Rowlands, G., Weiss, B.D., Maat, H.P., & Essink-Bot, M-L. (2014). International application of health literacy measures: Adaptation and validation of the newest vital sign in The Netherlands. Patient Education and Counseling, 97. 403-309.
  2. Geboers, B., Uiters, E., Reijneveld, S. A., Jansen, C. J. M., Almansa, J., Nooyens, A. C. J., Verschuren, W. M. M., de Winter, A. F., & Picavet, H. S. J. (2018). Health literacy among older adults is associated with their 10-years’ cognitive functioning and decline – the Doetinchem Cohort Study. BMC Geriatrics, 18(1), 77.
  3. HLS-EU Consortium (2012). Comparative report of health literacy in eight EU member states. The European Health Literacy Survey HLS-EU (second revised and extended version, date July 22, 2014).
  4. Kobayashi, L. C., Wardle, J., Wolf, M. S., & von Wagner, C. (2015). Cognitive function and health literacy decline in a cohort of aging English adults. Journal of General Internal Medicine, 30(7), 958–964.
  5. Pelikan, J.M. (2014). Measuring comprehensive health literacy in general populations: validation of instrument, indices and scales of the HLS-EU study. 6th Annual Health Literacy Research Conference. Bethesda.
  6. Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., Brand, H., & the HLS-EU Consortium Health Literacy Project European. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 80.
  7. Stormacq, C., Van den Broucke, S., & Wosinski, J. (2019). Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review. Health Promotion International, 34(5), e1–e17.
  8. Timmermans, E. J., Hoogendijk, E. O., Broese van Groenou, M. I., Comijs, H. C., van Schoor, N. M., Thomése, F. C. F., Visser, M., Deeg, D. J. H., & Huisman, M. (2019). Trends across 20 years in multiple indicators of functioning among older adults in the Netherlands. European Journal of Public Health, 29(6), 1096–1102.
  9. Vandenbosch, J., Van den Broucke, S., Vancorenland, S., Avalosse, H., Verniest, R., & Callens, M. (2016). Health literacy and the use of healthcare services in Belgium. Journal of Epidemiology & Community Health, 70. 1032-1038

    Date of last update (new): August, 2023