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A mismatch between population health literacy and the complexity of health information: an observational study

Lookup NU author(s): Professor Gill Rowlands



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Royal College of General Practitioners, 2015.

For re-use rights please refer to the publisher's terms and conditions.


Background Low health literacy is associated with poorer health and higher mortality. Complex health materials are a barrier to health.Aim To assess the literacy and numeracy skills required to understand and use commonly used English health information materials, and to describe population skills in relation to these.Design and setting An English observational study comparing health materials with national working-age population skills.Method Health materials were sampled using a health literacy framework. Competency thresholds to understand and use the materials were identified. The proportion of the population above and below these thresholds, and the sociodemographic variables associated with a greater risk of being below the thresholds, were described.Results Sixty-four health materials were sampled. Two competency thresholds were identified: text (literacy) only, and text + numeracy; 2515/5795 participants (43%) were below the text-only threshold, while 2905/4767 (61%) were below the text + numeracy threshold. Univariable analyses of social determinants of health showed that those groups more at risk of socioeconomic deprivation had higher odds of being below the health literacy competency threshold than those at lower risk of deprivation. Multivariable analysis resulted in some variables becoming non-significant or reduced in effect.Conclusion Levels of low health literacy mirror those found in other industrialised countries, with a mismatch between the complexity of health materials and the skills of the English adult working-age population. Those most in need of health information have the least access to it. Efficacious strategies are building population skills, improving health professionals’ communication, and improving written health information.

Publication metadata

Author(s): Rowlands G, Protheroe J, Winkley J, Richardson M, Seed PT, Rudd R

Publication type: Article

Publication status: Published

Journal: British Journal of General Practice

Year: 2015

Volume: 65

Issue: 635

Pages: e351-e356

Print publication date: 01/06/2015

Online publication date: 25/05/2015

Acceptance date: 11/11/2014

Date deposited: 11/01/2018

ISSN (print): 0960-1643

ISSN (electronic): 1478-5242

Publisher: Royal College of General Practitioners


DOI: 10.3399/bjgp15X685285


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