Malta Health Literacy Survey2014

The right of every person to maintain and improve the quality of life throughout the life-course

Health Literacy

Find

Understand

Judge

Apply

Health Promotion

Disease Prevention

Health Care The

comprehensive HLS-EU definitionof Health Literacy

The Tool - HLS-EU concept in practice (the HLS-EU-Q16 matrix)

Health Literacy

Finding information relevant to health (FHI)

Understand information relevant to

health (UHI)

Judgeinformation relevant to health (JHI)

Apply information relevant to

health (AHI)

Total statements

Health Care 1, 2 3, 4 5 6, 7 7

Disease Prevention 8 9, 10 11 12 5

Health Promotion 13 14, 15 16 - 4

Total statements 4 6 3 3 16

Survey Methodology• Conducted in July 2014 by the National Statistics

Office. • A stratified random sample of persons aged 18

years and over and living in private households, stratified by district, age group (18-32, 33-48, 49-64 and 65+) and gender.

• Quotas were applied on the strata in order to obtain a fully representative net sample of 1,500 persons.

• Information from 1,514 completed responses was gathered using the validated and standardised HLS-EU-Q16 questionnaire through the use of Computer Assisted Telephone Interviewing (CATI).

Findings

30

12

19

20

14

17

34

40

10

32

29

16

28

25

26

24

57

59

52

51

48

49

54

52

44

63

60

54

64

62

61

57

11

24

25

21

31

28

10

6

31

4

9

25

7

12

12

16

1

1

2

2

2

2

1

1

2

0

0

2

1

0

0

1

1

4

2

6

5

5

1

1

13

1

2

3

1

1

3

0 10 20 30 40 50 60 70 80 90 100

judge behaviour related to health

understand media information

understand advice of family/friends

find activities for mental well-being

using media info to protect yourself

judge reliability media info

understand health screenings

understand health warnings

find info mental health problems

follow professional instructions

use professional info for decisions

judge need of a second opinion

understand instructions on medicine

understand doctor info

find info to get professional help

find info on treating illnesses

Percentage Distribution of Survey Responses (n=1514)

Very Easy Fairly Easy Fairly Difficult Very Difficult Don't Know

Easy to…..

• Understand (87%)and follow (94.6%) professional instructions

• Understand health warnings (92.5%)

• Understand instructions on medicines (92.4%)

• Understand health screenings (88.3%)

• Judge behaviour related to health (87%)

• Find information on common mental health problems (45.7%)

• Use media information to protect oneself from illness (38%)

• Judge the reliability of health information from the media (35%)

• Judge need of second opinion (31.5%)

Don’t know or difficult to…..

HEALTH CARE

1 find information on treatments of

illnesses that concern you

80.5% 19.5%

2 find out where to get professional

help when you are ill

86.8% 13.2%

3 understand what your doctor tells

you

87.0% 13.0%

4 understand your doctor's or

pharmacist's instructions on how to

take a prescribed medicine

92.4% 7.8%

5 judge when you may need to get a

second opinion from another doctor

69.5% 30.5%

6 use information the doctor gives you

to make decisions about your illness

88.3% 11.7%

7 follow instructions from your doctor

or pharmacist

94.6% 5.3%

13 find out about activities that are

good for your mental well-being

70.6% 29.5%

14 understand advice on health from

family members or friends

70.4% 29.7%

15 understand information in the

media on how to get healthier

70.8% 29.2%

16 judge which everyday behaviour is

related to your health

87.0% 12.9%

HEALTH PROMOTION

8 find information on how

to manage mental health

problems like stress and

depression

54.3% 45.7%

9 understand health

warnings about

behaviour such as

smoking, low physical

activity and drinking too

much

92.5% 7.5%

10 understand why you

need health screenings

88.3% 11.7%

11 judge if the information

on health risks in the

media is reliable

65.0% 35.0%

12 decide how you can

protect yourself from

illness based on

information in the media

62.0% 38.0%

DISEASE PREVENTION

>80% EASY/FAIRLY EASY60-80% EASY/FAIRLY EASY<60% EASY/FAIRLY EASY

1

find information on

treatments of illnesses

that concern you 80.5% 19.5%

2

find out where to get

professional help when

you are ill 86.8% 13.2%

8

find information on how

to manage mental health

problems like stress and

depression 54.3% 45.7%

13

find out about activities

that are good for your

mental well-being 70.6% 29.5%

FIND INFORMATION

3understand what your doctor

tells you 87.0% 13.0%

4understand your doctor's or

pharmacist's instructions on how

to take a prescribed medicine 92.4% 7.8%

9

understand health warnings

about behaviour such as

smoking, low physical activity

and drinking too much 92.5% 7.5%

10understand why you need health

screenings 88.3% 11.7%

14understand advice on health

from family members or friends 70.4% 29.7%

15understand information in the

media on how to get healthier 70.8% 29.2%

UNDERSTAND INFORMATION

5

judge when you may

need to get a second

opinion from another

doctor 69.5% 30.5%

11judge if the information

on health risks in the

media is reliable 65.0% 35.0%

16judge which everyday

behaviour is related to

your health 87.0% 12.9%

JUDGE INFORMATION

6

use information the doctor

gives you to make decisions

about your illness 88.3% 11.7%

7 follow instructions from your

doctor or pharmacist 94.6% 5.3%

12

decide how you can protect

yourself from illness based on

information in the media 62.0% 38.0%

USE INFORMATION

Health Literacy

Find

Understand

Judge

Apply

Health Promotion

DiseasePrevention

Health Care

From Likert Scale to Literacy IndexEach statement in the national questionnaire was given a numeric value:– ‘very difficult’ as having a numeric value of ‘1’ and ‘very easy’ as having

a numeric value of ‘4’.– ‘Don’t know’ were not given any value in order not to bias results. For each respondent, the average value of all statements was worked out

and then converted to a metric score in order to obtain the relevant Health Literacy index. The following formula was applied:

Literacy Index = (Mean -1) * (50/3)

Where: • Mean…..is the mean of all participating items for each Individual • 1 …………is the minimal possible value of the mean (leads to a minimum

value of the index of 0) • 3 ………..is the range of the mean • 50…….is the chosen maximum value of the new metric.

Classification of anyHealth Literacy Index(0 minimum; 50 maximum)

Level Range

Excellent 42-50

Sufficient 33-41.99

Problematic 25-32.99

Inadequate 0-24.99

Source: HLS-EU Consortium

General Health Literacy IndexMean for Malta

Malta 34.01

Male 34.06

Female 33.94

Malta has a SUFFICIENT level of General Health Literacy

Comparative Distribution of Health Literacy Indices Malta & HLS-EU*

MeanGeneralHealthIndex

Healthcare Index

Disease Prevention

Index

Health promotion

Index

Malta 34.0 34.8 31.5 31.7

HLS-EU* 33.8 34.7 34.2 32.5

NL 37.1 38 37.7 35.7

*HLS-EU was carried out in Austria, Bulgaria, Germany (NR Westphalia), Greece, Ireland, Netherlands, Poland, Spain

Distribution of General Health Literacy for Malta and HLS-EU*

Level% Distribution

MT (n=1514)% Distribution

(HLS-EU*)

Excellent(42-50)

9.2 16.5

Sufficient(33-41.99)

45.0 36.0

Problematic(25-32.99)

42.5 35.2

Inadequate(0-24.99)

3.3 12.4

*HLS-EU was carried out in Austria, Bulgaria, Germany (NR Westphalia), Greece, Ireland, Netherlands, Poland, Spain

(45.8%) (47.6%)

6.0%

20.0%11.1%

28.3%

29.0%

33.1%

46.3%

40.3% 49.1%

19.4%10.7% 6.8%

Health Care Disease Prevention Health Promotion

Percentage Distribution of Literacy for Health Care, Disease Prevention and Health Promotion

Inadequate Problematic Sufficient Excellent

Levels of

Health Promotion Literacy and

Disease Prevention Literacy are not as good as levels relating

to

Health Care Literacy

0 10 20 30 40 50

Inadequate Malta

Inadequate EU

Problematic Malta

Probelmatic EU

Sufficient Malta

Sufficient EU

Excellent Malta

Excellent EU

Percent %

Percentage levels for Health Care Literacy

0 5 10 15 20 25 30 35 40 45

Inadequate Malta

Inadequate EU

Problematic Malta

Probelmatic EU

Sufficient Malta

Sufficient EU

Excellent Malta

Excellent EU

Percent %

Percentage levels for Disease Prevention Literacy

0 10 20 30 40 50 60

Inadequate Malta

Inadequate EU

Problematic Malta

Probelmatic EU

Sufficient Malta

Sufficient EU

Excellent Malta

Excellent EU

Percent %

Percentage levels for Health Promotion Literacy

45.8% of the Maltese Population have

problematic or inadequate Health Literacy

Health Literacy Level and Social Determinants

No statistically significant difference was observed for gender, marital status, types of households or persons residing in different districts

Social determinants found to influence on Health Literacy levels include:

Health Literacy

Education

Financial Status

Social Status

Age

Vulnerable Groups (1)

• 61.6% of persons with bad self-perceived health have a limited level of health literacy

Bad self-perceived health

• 60.6% of persons with low self-declared social status have a limited level of health literacy

Low social status

• 56.3% of persons with more than one long term illness have a limited level of health literacy

More than one long term illness

Vulnerable Groups (2)

• 56.1% of persons residing in Gozo have a limited level of health literacy

Gozo

• 54.4% of persons over 76 years of age have a limited level of health literacy

76+ years

• 48.9% of persons with Pre-primary and Primary Levels of Education have a limited health literacy

Low Education level

31

32

33

34

35

36

37

38

Less than €800

€800-under €1850

€1850-under €2400

€2400-under €2950

€2950-under €3600

€3600 and over

Me

an G

HL

Net Household Income

Net Household Income and Mean General Health Literacy level

Mean HL level

Health Behaviour as a predictor of Health Literacy Levels

31

32

33

34

35

36

37

38

Underweight Normal Overweight Obese Unknown

M

e

a

n

G

H

L

Body Mass Index

Body Mass Index and Mean General Health Literacy level

General HLMean level

31

32

33

34

35

36

37

38

No illness One illness More than OneIllness

M

e

a

n

G

H

L

Long Term Illnesses

Long Term Illnesses and Mean General Health Literacy level

General HLMean level

31

32

33

34

35

36

37

38

Very Good Good Fair Bad Very Bad

Me

an G

HL

Self Assessed Health

Distribution of Self Assessed Health by Mean General Health Literacy level

Mean HL level

Body Mass Index and the

presence of Long term Illnesses are inversely

correlated with Health Literacy

Self-assessed Health seems

to be the best proxy indicator of Health Literacy Level

Health Literacy Levels and Service Use

Emergency Service Use

Persons with low HL levels tend to be admitted to accident and emergency more often.

This increases costs!

31

32

33

34

35

36

37

38

No use ofemergency

services

1 to 2 times 3 or moretimes

Me

an H

L

Emergency Service Use

HL level by frequency of emergency service use

Persons who made use of other health professional services i.e. allied healthcare professionals, were significantly more health literate than the rest of the other subgroups for all dimensions of Health Literacy.

Conclusions (1)

• Malta has a SUFFICIENT level of Health Literacy with a Mean General Health Literacy of 34.0

• This is equivalent to the Mean General Health Literacy in Europe but is considerably less than of the best i.e. the Netherlands

Conclusions (2)

• Limited Health Literacy is a problem of nearly one in every two Maltese persons

• Levels of Disease Prevention Literacy and Health Promotion Literacy are not as good as Health Care Literacy levels

Conclusions (3)

• Respondents had difficulty or did not know how to: • find information on common mental

health problems

• use media information to protect themselves from illness

• judge the credibility of health information from the media

Conclusions (4)

• Persons at risk of limited Health Literacy include:–Bad self-perceived health

–Low self-assessed social status

–More than one long-term illness

–Gozo residents

–Age 76+ years

–Pre-primary or primary education

Conclusions (5)

• Body Mass Index and the presence of Long term Illnesses are inversely correlated with Health Literacy

• Level of Self-assessed Health seems to be the best proxy indicator of Health Literacy Level

Conclusions (6)

• Health Literacy is influencing:

– How persons behave

– How persons participate

– How persons use health services

therefore

Health Literacy matters

Recommendations (1)

• Support and advocate for better mental health and wellbeing

• Analyse deeper and act upon the interaction between health messages and media messages from a citizen information perspective

Recommendations (2)

• Address Health Literacy to:

– strengthen empowerment

– improve outcomes

– reduce inequalities

– save costs

– improve sustainability

Health Literacy - a strong policy tool

Recommendations (3)

• Identify and address Health Literacy gaps at the professional –patient interface because

Health Literacy is

the duty of every professional

& the right of every citizen

THANK YOU