[Comprehensibility of the HLS-EU-Q tool for assessing health literacy of long-term unemployed individuals: A...

Health literacy is associated with better health behavior and increased utilization of preventive measures. However, studies indicate that a significant proportion of the German population exhibits deficits in health literacy, particularly individuals with a low socio-economic status. Notably, the HLS-EU-Q questionnaire, a widely used instrument for measuring health literacy in this context, has not yet been evaluated for its comprehensibility within this population group, at least in German-speaking countries.This article is the first exploratory study to examine the comprehensibility of the HLS-EU-Q16 for people affected by long-term unemployment. To achieve this, the "think-aloud" method was employed, allowing participants to verbalize their understanding and thoughts while responding to selected questions from the HLS-EU-Q16. The data were analyzed using a topic-oriented content analysis. A total of 12 participants were included in this study.We observed comprehension difficulties on multiple levels, indicating that the demands of the HLS-EU-Q16 questionnaire on the level of abstraction were too high for the surveyed population. Additionally, language barriers made it difficult to interpret the answers of people with German as a second language and difficulties in understanding the differentiation of the response scale became apparent.The comprehension difficulties suggest that individuals with a low socio-economic status, such as long-term unemployed people, may benefit from health literacy assessment instruments that are less complex, use easy-to-understand language and are better tailored to the living environment and cognitive patterns of the target population.