Challenges in Navigating the Health Care System: Development of an Instrument Measuring Navigation Health Literacy

• Main Authors: Lennert Griese, Eva-Maria Berens, Peter Nowak, Jürgen M. Pelikan, Doris Schaeffer
• Format: Article
• Language: English
• Published: MDPI AG 2020-08-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: health literacy; hls-eu; navigation; orientation; health care system; instrument development
• Online Access: https://www.mdpi.com/1660-4601/17/16/5731

Due to their rapid expansion and complexity, it is increasingly difficult for patients to orient themselves in health care systems. Therefore, patients require a high degree of health literacy, or more precisely, navigation health literacy (HL-NAV). The actual extent of HL-NAV of patients and citizens is still largely unknown due to the lack of adequate measurement instruments. Thus, within the new international Health Literacy Population Survey 2019 (HLS₁₉), one aim was to develop a suitable instrument for measuring HL-NAV in the HLS₁₉ the HL-NAV-HLS19. The item development was conducted by an international working group within the HLS₁₉ Consortium led by the first and last authors. Methodologically, it is based on a scoping literature review, development of a conceptual framework for HL-NAV, and first item formation, as well as an evaluation by experts, stakeholders, focus groups, pre-test interviews, and continuously feedback from the HLS₁₉ Consortium. HL-NAV was defined as the ability to access, understand, appraise, and apply information on navigational issues, drawing on ten selected publications and the health literacy definition of the HLS-EU Consortium. Main tasks of HL-NAV at the system, organization, and interaction level were identified, to which first related items were assigned. Based on the feedback from experts, the focus group discussions, and the HLS₁₉ Consortium, the instrument was slightly revised. Finally, twelve items proved to be feasible in the pre-test. The instrument will be used for the first time in the HLS₁₉ survey and will provide first data on HL-NAV in general populations for the countries participating in HLS₁₉. It is suited for cross-country comparisons and monitoring, as well as for intervention development. However, the instrument should be translated into and validated in further languages and countries for population samples.