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Functional health literacy and health-promoting behaviour in a national sample of British adults
  1. Christian von Wagner,
  2. Katherine Knight,
  3. Andrew Steptoe,
  4. Jane Wardle
  1. Cancer Research UK Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
  1. Professor Jane Wardle, Department of Epidemiology and Public Health, University College London, 2–16 Torrington Place, London WC1E 6BT, UK;


Objectives: To measure the prevalence of limited functional health literacy in the UK, and examine associations with health behaviours and self-rated health.

Design: Psychometric testing using a British version of the Test of Functional Health Literacy in Adults (TOFHLA) in a population sample of adults.

Setting: UK-wide interview survey (excluding Northern Ireland and the Scottish Isles).

Participants: 759 adults (439 women, 320 men) aged 18–90 years (mean age _ 47.6 years) selected using random location sampling.

Main outcome measures: Functional health literacy, self-rated health, fruit and vegetable consumption, physical exercise and smoking.

Results: We found that 11.4% of participants had either marginal or inadequate health literacy. Multivariable logistic regression analysis indicated that the risk of having limitations in health literacy increased with age (adjusted odds ratio 1.04; 95% confidence interval 1.02 to 1.06), being male (odds ratio _ 2.04; 95% confidence interval 1.16 to 3.55), low educational attainment (odds ratio _ 7.46; 95% confidence interval 3.35 to 16.58) and low income (odds ratio _ 5.94; 95% confidence interval 1.87 to 18.89). In a second multivariable logistic regression analysis, every point higher on the health literacy scale increased the likelihood of eating at least five portions of fruit and vegetables a day (odds ratio _ 1.02; 95% confidence interval 1.003 to 1.03), being a non-smoker (odds ratio _ 1.02; 95% confidence interval 1.0003 to 1.03) and having good self-rated health (odds ratio _ 1.02; 95% confidence interval 1.01 to 1.04), independently of age, education, gender, ethnicity and income.

Conclusions: The results encourage efforts to monitor health literacy in the British population and examine associations with engagement with preventative health behaviours.

  • health literacy
  • health communication
  • health behaviour
  • self-rated health

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  • Funding: This work was supported by Cancer Research UK and the British Heart Foundation. Researchers are independent from funding organisations.

  • Competing interests: None.

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