Next Article in Journal
Water Reclamation Using a Ceramic Nanofiltration Membrane and Surface Flushing with Ozonated Water
Next Article in Special Issue
Do Low Income Youth of Color See “The Bigger Picture” When Discussing Type 2 Diabetes: A Qualitative Evaluation of a Public Health Literacy Campaign
Previous Article in Journal
Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard
Previous Article in Special Issue
Effective Partnership in Community-Based Health Promotion: Lessons from the Health Literacy Partnership
Article Menu
Issue 4 (April) cover image

Export Article

Open AccessArticle
Int. J. Environ. Res. Public Health 2018, 15(4), 798;

The Antecedents and Consequences of Health Literacy in an Ecological Perspective: Results from an Experimental Analysis

Department of Health Science, University of Florence, Viale GB Morgagni 48, 50134 Firenze, Italy
Quality and Equity Unit, Regional Health Agency of Tuscany, 50141 Florence, Italy
School of Specialization in Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
Author to whom correspondence should be addressed.
Received: 13 March 2018 / Revised: 8 April 2018 / Accepted: 16 April 2018 / Published: 19 April 2018
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
Full-Text   |   PDF [518 KB, uploaded 3 May 2018]


This study analyses the relationship between the antecedents and consequences of health literacy (HL) at the ecological level among the nations involved in the European Health Literacy Survey (HLS-EU). The antecedents and consequences were investigated by means of proxy indicators. The HL was measured using the 47-item HLS-EU questionnaire (HLS-EUQ47) and the Newest Vital Sign (NVS). The two measures stood in significant correlation to the outcomes of the sub-discipline of the Euro Health Consumer Index (r = 0.790 for HLS-EUQ47; r = 0.789 for NVS). The HLS-EUQ47 also stood in correlation to the percentage of population with post-secondary education (r = 0.810), the reading performance for 15-year-old students (r = 0.905), the presence of a national screening program for breast (r = 0.732) or cervical cancer (r = 0.873). The NVS stood in correlation with the unemployment rate (r = −0.778), the Gross Domestic Product (r = 0.719), the Gini coefficient (r = −0.743), the rank of the Euro Patient Empowerment Index (r = −0.826), the expenditure on social protection (r = 0.814), the Consumer Empowerment Index (r = 0.898), the percentage of adults using the internet for seeking health information (r = 0.759), the prevalence of overweight individuals (r = −0.843), the health expenditure (r = 0.766), as well as the percentage of individuals using the internet for interacting with public authorities (r = 0.755). This study provides some preliminary considerations regarding alternative means by which to study HL and proposes new methods for experimentation. The methods and the results could offer a means by which the relationship between society and overall healthcare protection could be strengthened. View Full-Text
Keywords: health literacy; ecological study; antecedents; consequences; determinants of health health literacy; ecological study; antecedents; consequences; determinants of health
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

Supplementary material

Printed Edition Available!
A printed edition of this Special Issue is available here.

Share & Cite This Article

MDPI and ACS Style

Lorini, C.; Ierardi, F.; Bachini, L.; Donzellini, M.; Gemmi, F.; Bonaccorsi, G. The Antecedents and Consequences of Health Literacy in an Ecological Perspective: Results from an Experimental Analysis. Int. J. Environ. Res. Public Health 2018, 15, 798.

Show more citation formats Show less citations formats

Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Related Articles

Article Metrics

Article Access Statistics



[Return to top]
Int. J. Environ. Res. Public Health EISSN 1660-4601 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top