Background
Methods
Participants
Measurements
Japanese version of the HLS-EU-Q47
Confirmation of scale validity
Demographic and socioeconomic characteristics
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Gender (men, women)
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Age groups (20–29, 30–39, 40–49, 50–59, 60–69)
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Highest level of education (junior high school, high school, 2-year college, college/university, graduate school)
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Annual pre-tax household income in millions of yen (<2.5, 2.5–3.5, 3.5–4.5, 4.5–6.0, 6.0–8.5, 8.5–12.5, ≥ 12.5, unknown)
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Self-assessed living conditions (very hard, a little hard, common, a little well, very well) [17]
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Occupation (self-employed, managerial and administrative, professional and technical, other regular staff [routine and manual], part-time, homemaker, student, unemployed)
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Municipality size (very large [population of 500,000≤], large [100,000–499,999], moderate [<100,000], small)
Health status
Statistical analysis
Reliability and validity
Comparison between Japan and Europe
Results
Participant characteristics
Total (n = 1054) | GEN-HL (n = 927) | One-way ANOVA | ||||
---|---|---|---|---|---|---|
Variables | n | % | mean | SD | F |
P
|
Gender | ||||||
Men | 509 | 48.3 | 24.4 | 8.3 | 12.17 | <.001 |
Women | 545 | 51.7 | 26.2 | 8.1 | ||
Age group | ||||||
20 − 29 | 154 | 14.6 | 22.8 | 7.8 | 13.06 | <.001 |
30 − 39 | 228 | 21.6 | 23.7 | 7.6 | ||
40 − 49 | 211 | 20.0 | 24.6 | 7.3 | ||
50 − 59 | 213 | 20.2 | 26.0 | 8.4 | ||
60 − 69 | 248 | 23.5 | 28.2 | 8.8 | ||
Age (mean ± SD) | 46.1 | 13.5 | ||||
Highest level of education | ||||||
Junior high school | 25 | 2.4 | 25.7 | 8.1 | 0.21 | .93 |
High school | 432 | 41.0 | 25.4 | 8.6 | ||
2-year college | 142 | 13.5 | 25.1 | 7.2 | ||
College/university | 417 | 39.6 | 25.2 | 8.3 | ||
Graduate | 38 | 3.6 | 26.4 | 7.7 | ||
Annual pre-tax household income (million yena) | ||||||
<2.5 | 146 | 13.9 | 24.2 | 8.2 | 0.99 | .44 |
2.5 − 3.5 | 126 | 12.0 | 25.1 | 9.0 | ||
3.5 − 4.5 | 119 | 11.3 | 25.0 | 8.6 | ||
4.5 − 6.0 | 183 | 17.4 | 26.3 | 8.0 | ||
6.0 − 8.5 | 181 | 17.2 | 25.2 | 7.6 | ||
8.5 − 12.5 | 92 | 8.7 | 25.3 | 7.8 | ||
12.5 or > | 44 | 4.2 | 25.9 | 8.6 | ||
Unknown | 163 | 15.5 | 27.3 | 8.6 | ||
Self-assessed living conditions | ||||||
Very hard | 132 | 12.5 | 24.0 | 9.1 | 4.81 | <.001 |
A little hard | 324 | 30.7 | 24.6 | 8.4 | ||
Common | 501 | 47.5 | 25.9 | 8.1 | ||
A little well | 87 | 8.3 | 26.7 | 7.3 | ||
Very well | 10 | .9 | 32.8 | 6.6 | ||
Occupation | ||||||
Self-employed | 61 | 5.8 | 25.9 | 9.8 | 1.98 | .056 |
Managerial and administrative | 38 | 3.6 | 23.5 | 7.0 | ||
Professional and technical | 142 | 13.5 | 26.4 | 8.2 | ||
Other (routine and manual) | 288 | 27.3 | 24.4 | 8.2 | ||
Part-time | 123 | 11.7 | 25.7 | 7.5 | ||
Homemaker | 217 | 20.6 | 26.5 | 7.7 | ||
Student | 26 | 2.5 | 23.5 | 6.9 | ||
Unemployed | 159 | 15.1 | 24.7 | 9.2 | ||
Municipality size | ||||||
Very large (population of 500,000 or more) | 340 | 32.3 | 26.1 | 8.9 | 2.09 | .10 |
Large (population of 100,000 − 499,999) | 388 | 36.8 | 25.3 | 7.6 | ||
Moderate (population of <100,000) | 247 | 23.4 | 24.9 | 8.3 | ||
Small | 79 | 7.5 | 23.6 | 8.1 |
Response to questionnaire
Health domain/Competence | Items | Very easy | Fairly easy | Fairly difficult | Very difficult | Don’t know/Not applicable | Total difficult (“Very difficult” and “Fairly difficult”) | |||
---|---|---|---|---|---|---|---|---|---|---|
Japan | Europea | Differences | ||||||||
Q1 | Health care/Accessing | Finding information on symptoms of illnesses that concern you | 7.7 | 41.4 | 37.8 | 8.3 | 4.8 | 46.1 | 22.8 | 23.3 |
Q2 | Finding information on treatments of illnesses that concern you | 6.0 | 36.0 | 41.3 | 12.0 | 4.7 | 53.3 | 26.9 | 26.4 | |
Q3 | Finding out what to do in case of a medical emergency | 3.5 | 30.5 | 42.6 | 18.3 | 5.1 | 60.9 | 21.8 | 39.1 | |
Q4 | Finding out where to get professional help when you are ill | 4.7 | 27.4 | 42.9 | 20.5 | 4.5 | 63.4 | 11.9 | 51.5 | |
Q5 | Health care/Understanding | Understanding what your doctor says to you | 8.3 | 45.5 | 37.8 | 6.3 | 2.1 | 44.0 | 15.3 | 28.7 |
Q6 | Understanding the leaflets that come with your medicine | 11.4 | 46.1 | 31.8 | 9.0 | 1.7 | 40.8 | 28.0 | 12.8 | |
Q7 | Understanding what to do in a medical emergency | 3.7 | 28.5 | 46.3 | 17.2 | 4.4 | 63.5 | 21.7 | 41.8 | |
Q8 | Understanding your doctor’s or pharmacist’s instructions on how to take a prescribed medicine | 18.3 | 54.5 | 20.6 | 5.0 | 1.6 | 25.6 | 6.5 | 19.1 | |
Q9 | Health care/Appraising | Judging how information from your doctor applies to you | 7.4 | 43.1 | 39.8 | 6.8 | 2.8 | 46.7 | 18.0 | 28.7 |
Q10 | Judging the advantages and disadvantages of different treatment options | 3.4 | 21.6 | 48.4 | 22.2 | 4.4 | 70.6 | 42.6 | 28.0 | |
Q11 | Judging when you may need to get a second opinion from another doctor | 2.9 | 16.2 | 45.1 | 27.9 | 7.9 | 73.0 | 38.6 | 34.4 | |
Q12 | Judging if the information about illness in the media is reliable | 2.8 | 17.6 | 51.4 | 21.8 | 6.5 | 73.2 | 49.7 | 23.5 | |
Q13 | Health care/Applying | Using information the doctor gives you to make decisions about your illness | 5.4 | 39.8 | 40.5 | 8.8 | 5.5 | 49.3 | 23.1 | 26.2 |
Q14 | Following the instructions on medication | 27.8 | 54.0 | 13.6 | 3.2 | 1.4 | 16.8 | 6.8 | 10.0 | |
Q15 | Calling an ambulance in an emergency | 19.9 | 38.4 | 26.8 | 10.1 | 4.8 | 36.8 | 8.8 | 28.0 | |
Q16 | Following instructions from your doctor or pharmacist | 25.1 | 57.6 | 12.3 | 3.1 | 1.8 | 15.5 | 5.6 | 9.9 | |
Q17 | Disease Prevention/Accessing | Finding information about how to manage unhealthy behavior such as smoking, low physical activity and excessive drinking | 17.2 | 52.1 | 22.4 | 5.9 | 2.5 | 28.3 | 14.7 | 13.6 |
Q18 | Finding information on how to manage mental health problems such as stress or depression | 6.4 | 36.1 | 39.1 | 13.9 | 4.6 | 52.9 | 33.5 | 19.4 | |
Q19 | Finding information about vaccinations and health screenings that you should have | 10.5 | 45.3 | 32.8 | 7.3 | 4.1 | 40.1 | 24.0 | 16.1 | |
Q20 | Finding information on how to prevent or manage conditions such as being overweight, high blood pressure or high cholesterol | 12.0 | 49.8 | 29.2 | 5.5 | 3.5 | 34.7 | 18.1 | 16.6 | |
Q21 | Disease Prevention/ Understanding | Understanding health warnings about behavior such as smoking, low physical activity and excessive drinking | 36.9 | 45.9 | 12.3 | 3.6 | 1.2 | 15.9 | 10.3 | 5.6 |
Q22 | Understanding why you need vaccinations | 22.5 | 53.1 | 17.5 | 4.3 | 2.7 | 21.7 | 16.6 | 5.1 | |
Q23 | Understanding why you need health screenings | 24.5 | 54.6 | 15.8 | 3.3 | 1.8 | 19.2 | 10.4 | 8.8 | |
Q24 | Disease Prevention/Appraising | Judging how reliable health warnings are, such as smoking, low physical activity and excessive drinking | 22.1 | 49.0 | 21.9 | 3.9 | 3.1 | 25.8 | 14.4 | 11.4 |
Q25 | Judging when you need to go to a doctor for a check-up | 9.4 | 33.6 | 43.6 | 9.6 | 3.8 | 53.2 | 16.3 | 36.9 | |
Q26 | Judging which vaccinations you may need | 7.3 | 30.2 | 44.9 | 12.1 | 5.5 | 57.0 | 32.7 | 24.3 | |
Q27 | Judging which health screenings you should have | 9.4 | 34.2 | 40.5 | 12.2 | 3.7 | 52.8 | 25.1 | 27.7 | |
Q28 | Judging if the information on health risks in the media is reliable | 5.0 | 25.1 | 49.1 | 15.1 | 5.6 | 64.2 | 42.1 | 22.1 | |
Q29 | Disease Prevention/ Applying | Deciding if you should have a flu vaccination | 16.9 | 43.5 | 27.7 | 8.2 | 3.7 | 35.9 | 26.2 | 9.7 |
Q30 | Deciding how you can protect yourself from illness based on advice from family and friends | 7.5 | 38.4 | 39.1 | 9.4 | 5.6 | 48.5 | 22.2 | 26.3 | |
Q31 | Deciding how you can protect yourself from illness based on information in the media | 6.4 | 36.5 | 42.5 | 9.6 | 5.0 | 52.1 | 36.9 | 15.2 | |
Q32 | Health Promotion/ Accessing | Finding information on healthy activities such as exercise, healthy food and nutrition | 12.7 | 54.1 | 24.6 | 5.3 | 3.3 | 29.9 | 14.3 | 15.6 |
Q33 | Finding out about activities that are good for your mental well-being | 14.2 | 53.9 | 22.5 | 4.8 | 4.6 | 27.3 | 22.6 | 4.7 | |
Q34 | Finding information on how your neighborhood could be more health-friendly | 7.9 | 38.3 | 39.8 | 8.2 | 5.9 | 47.9 | 40.3 | 7.6 | |
Q35 | Finding out about political changes that may affect health | 5.2 | 25.8 | 44.6 | 18.5 | 5.9 | 63.1 | 53.2 | 9.9 | |
Q36 | Finding out about efforts to promote your health at work | 7.9 | 35.7 | 30.6 | 7.3 | 18.5 | 38.0 | 34.8 | 3.2 | |
Q37 | Health Promotion/ Understanding | Understanding advice on health from family members or friends | 12.0 | 52.0 | 25.9 | 4.6 | 5.6 | 30.5 | 13.0 | 17.5 |
Q38 | Understanding information on food packaging | 11.0 | 43.8 | 32.8 | 9.0 | 3.3 | 41.8 | 36.2 | 5.6 | |
Q39 | Understanding information in the media on how to get healthier | 11.7 | 51.5 | 28.6 | 5.0 | 3.2 | 33.6 | 23.3 | 10.3 | |
Q40 | Understanding information on how to keep your mind healthy | 6.9 | 39.4 | 39.9 | 9.4 | 4.4 | 49.3 | 26.1 | 23.2 | |
Q41 | Health Promotion/ Appraising | Judging how where you live affects your health and well-being | 5.4 | 24.7 | 46.9 | 14.9 | 8.2 | 61.8 | 24.6 | 37.2 |
Q42 | Judging how your housing conditions help you to stay healthy | 6.4 | 27.4 | 46.2 | 12.7 | 7.3 | 58.9 | 19.5 | 39.4 | |
Q43 | Judging which everyday behavior is related to your health | 10.3 | 41.2 | 36.1 | 9.5 | 2.9 | 45.5 | 12.6 | 32.9 | |
Q44 | Health Promotion/ Applying | Making decisions to improve your health | 10.2 | 36.8 | 36.9 | 13.8 | 2.3 | 50.7 | 21.7 | 29.0 |
Q45 | Joining a sports club or exercise class if you want to | 9.1 | 29.4 | 36.8 | 19.5 | 5.1 | 56.4 | 24.1 | 32.3 | |
Q46 | Influencing your living conditions that affect your health and well-being | 6.5 | 26.9 | 43.6 | 19.9 | 2.9 | 63.6 | 25.5 | 38.1 | |
Q47 | Taking part in activities that improve health and well-being in your community | 4.8 | 23.3 | 44.7 | 19.9 | 7.2 | 64.6 | 38.9 | 25.7 |
Reliability and validity
Cronbach’s alpha | Pearson’s correlation coefficients | ||||
---|---|---|---|---|---|
CCHL | J-eHEALS | SRHa | MHI-5 | ||
Health literacy indices | |||||
GEN-HL | .97 | .62 | .51 | .18 | .26 |
HC-HL | .92 | .57 | .47 | .12 | .21 |
DP-HL | .93 | .55 | .44 | .17 | .24 |
HP-HL | .94 | .57 | .49 | .22 | .26 |
CCHL | .17 | .16 | |||
J-eHEALS | .13 | .10b |
Comparison between Japan and Europe
Health literacy indices | Japan | Europe | ||
---|---|---|---|---|
GEN-HL | Mean | 25.3 | 33.8 | |
SD | 8.2 | 8.0 | ||
Categorized index (%) | Excellent | 4.2 | 16.5 | |
Sufficient | 10.4 | 36.0 | ||
Problematic | 35.5 | 35.2 | ||
Inadequate | 49.9 | 12.4 | ||
Limiteda | 85.4 | 47.6 | ||
HC-HL | Mean | 25.7 | 34.7 | |
SD | 8.6 | 8.3 | ||
Categorized index (%) | Excellent | 2.4 | 19.9 | |
Sufficient | 18.1 | 39.1 | ||
Problematic | 30.5 | 28.8 | ||
Inadequate | 40.9 | 12.1 | ||
Limiteda | 71.4 | 40.9 | ||
DP-HL | Mean | 22.7 | 34.2 | |
SD | 9.2 | 8.8 | ||
Categorized index (%) | Excellent | 2.0 | 21.3 | |
Sufficient | 10.2 | 35.9 | ||
Problematic | 27.6 | 21.9 | ||
Inadequate | 60.1 | 13.7 | ||
Limiteda | 87.7 | 35.6 | ||
HP-HL | Mean | 25.5 | 32.5 | |
SD | 9.2 | 9.1 | ||
Categorized index (%) | Excellent | 2.6 | 15.6 | |
Sufficient | 18.3 | 33.5 | ||
Problematic | 33.0 | 30.8 | ||
Inadequate | 46.1 | 20.1 | ||
Limiteda | 79.1 | 50.9 |