Health literacy is linked to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgment and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain quality of life.
The concept of health literacy (HL) was originally limited to functional skills such as reading, writing, and numeracy. It has been increasingly expanded to cover broader competences that are needed to communicate, navigate, and actively participate within health care systems (Van den Broucke, 2014). Also, the idea of empowered and engaged patients and communities has increasingly become a subject of discussion in health policies (Kick busch & Maag,2008;Sørensenetal.,2015). Poor HL is seen as a risk factor that is associated with poor health outcomes, and high HL is seen as an asset that supports health-related empowerment (Nutbeam, 2008).
A new instrument to measure HL was developed by a research group in 2012 (HLS-EU Consortium, 2012; Sørensen et al., 2015, 2013). Unlike other HL concepts and instruments that have primarily focused on functional HL (that is, basic cognitive skills), the concept of HL covered by the HLS-EU (Health Literacy Survey Europe) inventory leaned toward the broader definition linked to empowerment (Sørensen et al., 2015). Empowerment, which is a key dimension of Kickbusch and Maag’s(2008) definition of HL, emphasizes not only the understanding of advice and instructions but also the active participation in decision processes regarding treatments (Kickbusch & Maag, 2008, ).