Measuring Global Alcohol Health Literacy: A Narrative Review

Studies assessing awareness and knowledge of alcohol-attributable causes of death and disease have been conducted across the globe to develop and evaluate public information campaigns to increase alcohol health literacy. Because of variation in measurement, the results of these studies cannot be easily compared to determine relative rates of high versus low alcohol health literacy across countries or regions. This review catalogs the samples and survey items that have been used and presents recommendations for how to improve alcohol health literacy survey research.

Searches for studies surveying general populations for knowledge of the associations between alcohol and nine alcohol-related health harms--fetal alcohol syndrome, liver cirrhosis, cancer, pancreatitis, tuberculosis, epilepsy, cardiovascular disease, lower respiratory infections, and conduction disorders--were conducted in PubMed and Embase. Survey results published between January 2007 and April 2018 were reviewed for eligibility. Of 791 studies initially identified, 76 were included in the final analysis.

Survey items varied substantially in the types of response options used (e.g., yes/no, agree/disagree, Likert scales, multiple choice); terminology for drinking behavior (e.g., alcohol consumption vs. alcohol abuse), risk-factor framing (e.g., cause vs. association), and health harms (e.g., cardiovascular disease vs. stroke); and how their results were presented (e.g., numbers and/or percentages of respondents vs. odds ratios). Very few studies used probability samples.

The current state of the research literature makes it impossible to identify patterns of alcohol health literacy globally or even to compare intra-country studies across time. We recommend that a database of standard, validated questions for assessing knowledge about the relationship between alcohol and several key health outcomes be assembled and made available to the research community.