What Do We Measure and What Do We Perceive? Health Literacy – A Profile Analysis Among First-Year University Students
Keywords:
health literacy; higher education; first-year university students; functional health literacy; health promotion
Abstract
Background: Health literacy has become a key concept in health promotion and health behavior research, referring to individuals’ abilities to access, understand, evaluate, and apply health-related information. The literature emphasizes the multidimensional nature of health literacy, highlighting differences between functional and self-perceived components. Examining these dimensions jointly is particularly relevant among first-year university students, who face increased autonomy and new health-related decision-making contexts upon entering higher education.
Methodology: A quantitative cross-sectional study was conducted among 314 first-year full-time university students. Functional health literacy was assessed using the Newest Vital Sign (NVS), while subjective health literacy was measured with the BRIEF Health Literacy Screening Tool. Based on the combined assessment of these dimensions, distinct health literacy profiles were identified. Data analysis relied on descriptive statistics and chi-square tests, with effect sizes estimated using Cramer’s V.
Results: Overall, functional health literacy levels were relatively favorable, whereas subjective health literacy showed a less advantageous distribution. No statistically significant association was found between the functional and subjective dimensions. Profile-based analysis revealed four distinct health literacy patterns, with the overestimating profile being the most prevalent. Among sociodemographic factors, place of residence and mothers’ educational attainment were significantly associated with health literacy profiles.
Conclusions: The findings indicate that health literacy among first-year university students is heterogeneous, and adequate functional skills do not necessarily coincide with realistic self-assessment. The profile-based approach proved useful in identifying student groups with different needs and may support the development of more targeted, health literacy–sensitive health promotion interventions in higher education settings.
References
1. Beauchamp, A., Buchbinder, R., Dodson, S., Batterham, R. W., Elsworth, G. R., McPhee, C., … Osborne, R. H. (2015). Distribution of health literacy strengths and weaknesses across socio-demographic groups: A cross-sectional survey using the Health Literacy Questionnaire (HLQ). BMC Public Health, 15, 678. https://doi.org/10.1186/s12889-015-2056-z
2. Berkman ND, Davis TC, McCormack L. (2010). Health literacy: what is it? Journal of Health Communication 15(2):9–19.
3. Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
4. Bíró, É., Szabó, P., & Kósa, K. (2022). A magyar felnőtt lakosság egészségműveltsége. Egészségfejlesztés, 63(3), 3–15.
5. Chew, L. D., Bradley, K. A., & Boyko, E. J. (2004). Brief questions to identify patients with inadequate health literacy. Family Medicine, 36(8), 588–594.
6. Cutler, D. M., & Lleras-Muney, A. (2010). Understanding differences in health behaviors by education. Journal of Health Economics, 29(1), 1–28. https://doi.org/10.1016/j.jhealeco.2009.10.003
7. Dehal A, Garrett T, Tedders SH, Arroyo C, Afriyie-Gyawu E, Zhang J. (2011). Body mass index and death rate of colorectal cancer among a national cohort of US adults. Nutrition and Cancer. 63(8):1218–25.
8. Deliens, T., Deforche, B., De Bourdeaudhuij, I., & Clarys, P. (2014). Determinants of eating behaviour in university students: A qualitative study using focus group discussions. BMC Public Health, 14, 53. https://doi.org/10.1186/1471-2458-14-53
9. Dunlosky, J., & Metcalfe, J. (2009). Metacognition. Sage Publications.
10. Franze M, Fendrich K, Schmidt CO, Fahland RA, Thyrian JR, Plachta-Danielzik S, et al. (2011). Implementation and evaluation of the population-based programme “health literacy in school-aged children” (GeKo KidS). Public Health Journal. 19(4):339–47.
11. Frisch A-L, Camerini L, Diviani N, Schulz PJ. (2011). Defining and measuring health literacy: how can we profit from other literacy domains? Health Promotion International. 27(1):117–26.
12. Haun, J. N., Valerio, M. A., McCormack, L. A., Sørensen, K., & Paasche-Orlow, M. K. (2014). Health literacy measurement: An inventory and descriptive summary of 51 instruments. Journal of Health Communication, 19(2), 302–333. https://doi.org/10.1080/10810730.2014.936571
13. Haun, J., Luther, S., Dodd, V., & Donaldson, P. (2012). Measurement variation across health literacy assessments: implications for assessment selection in research and practice. Journal of health communication, 17 (3), 141–159. https://doi.org/10.1080/10810730.2012.712615
14. Horváth, C., Csányi, T., & Révész, L. (2021). A serdülők egészségműveltségének mérése: A HELMA kérdőív hazai adaptációja. Egészségfejlesztés, 62(4), 4–15.
15. Jordan, J. E., Buchbinder, R., & Osborne, R. H. (2010). Conceptualising health literacy from the patient perspective. Patient education and counseling, 79(1), 36–42. https://doi.org/10.1016/j.pec.2009.10.001
16. Khajouei R, Salehi F. (2017). Health literacy among Iranian high school students. American Journal of Health Behavior. 41(2):215–22.
17. Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77(6), 1121–1134. https://doi.org/10.1037/0022-3514.77.6.1121
18. Kühn, L., Bachert, P., Hildebrand, C., Kunkel, J., Reitermayer, J., Wäsche, H., & Woll, A. (2022). Health literacy among university students: A systematic review of cross-sectional studies. Frontiers in Public Health, 9, 680999. https://doi.org/10.3389/fpubh.2021.680999
19. Lamanauskas V, Augienė D. (2019). Identifying primary school teachers’ health literacy. Journal of Turkish Science Education 16(4):451–66.
20. Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, et al. (2020). What is the meaning of health literacy? A systematic review and qualitative synthesis. Family Medicine and Community Health. 8(2):e000351.
21. Mátyás G, Vincze F, Bíró É. (2021): Validation of health literacy questionnaires in Hungarian adult sample. Orvosi Hetilap. 162(39): 1579–1588.
22. McQueen DV, Kickbusch I, Potvin L, Pelikan JM, Balbo L, Abel T. (2007). Health and modernity: the role of theory in health promotion. New York: Springer; 2007.
23. Nielsen-Bohlman L, Panzer AM, Kindig DA (2004). Health literacy: a prescription to end confusion. Washington (DC): National Academies Press (US)
24. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. https://doi.org/10.1093/heapro/15.3.259
25. Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual Review of Public Health, 42, 159–173. https://doi.org/10.1146/annurev-publhealth-090419-102529
26. Okan, O., Bauer, U., Levin-Zamir, D., Pinheiro, P., & Sørensen, K. (Eds.). (2019). International handbook of health literacy. Policy Press.
27. Paakkari, L., & Okan, O. (2019). Health literacy – Talking the language of (school) education. HLRP: Health Literacy Research and Practice, 3(3), e161–e164. https://doi.org/10.3928/24748307-20190502-01
28. Park A, Eckert TL, Zaso MJ, Scott-Sheldon LA, Vanable PA, Carey KB, et al. Associations between health literacy and health behaviors among urban high school students. Journal of School Health. 2017;87(12):885–93.
29. Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. (2015). Health literacy impact on national healthcare utilization and expenditure. International Journal of Health Policy and Management. 4(11):747–55.
30. Sørensen, K., Pelikan, J. M., Röthlin, F., Ganahl, K., Slonska, Z., Doyle, G., … Brand, H. (2015). Health literacy in Europe: Comparative results of the European Health Literacy Survey (HLS-EU). European Journal of Public Health, 25(6), 1053–1058. https://doi.org/10.1093/eurpub/ckv043
31. Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12, 80. https://doi.org/10.1186/1471-2458-12-80
32. Stormacq, C., Van den Broucke, S., & Wosinski, J. (2019). Does health literacy mediate the relationship between socioeconomic status and health disparities? Health Promotion International, 34(5), e1–e17. https://doi.org/10.1093/heapro/day062
33. Sukys, S., Česnaitiene, V. J., & Ossowski, Z. M. (2017). Is health education at university associated with students’ health literacy? BioMed Research International, 2017, 8516843. https://doi.org/10.1155/2017/8516843
34. Tehrani Banihashemi SA, Amirkhani MA, Haghdoost AA, Alavian SM, Asgharifard H, Baradaran H, et al. (2007). Health literacy and the influencing factors: a study in five provinces of Iran. Strides in Development of Medical Education Journal. 4:1–9.
35. Vamos, S., Yeung, P., Bruckermann, T., Moselen, E. F., Dixon, R., Osborne, R. H., & Stringer, D. (2016). Exploring health literacy profiles of Texas university students. Health Behavior and Policy Review, 3(3), 209–225. https://doi.org/10.14485/HBPR.3.3.3
36. van der Heide, I., Wang, J., Droomers, M., Spreeuwenberg, P., Rademakers, J., & Uiters, E. (2013). The relationship between health, education, and health literacy: Results from the Dutch adult literacy and life skills survey. Journal of Health Communication, 18(Suppl. 1), 172–184. https://doi.org/10.1080/10810730.2013.825668
37. van der Vaart, R., & Drossaert, C. H. C. (2017). Development of the Digital Health Literacy Instrument. Journal of Medical Internet Research, 19(1), e27. https://doi.org/10.2196/jmir.6709
38. Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: The Newest Vital Sign. Annals of Family Medicine, 3(6), 514–522. https://doi.org/10.1370/afm.405
39. Wharf Higgins J, Begoray D, MacDonald M. (2009). A social-ecological conceptual framework for understanding adolescent health literacy in the health education classroom. American Journal of Community Psychology. 44(3–4):350–62.
40. Williams M, Parker R, Baker D, Coates W, Nurss J. (1995). The impact of inadequate functional health literacy on patients’ understanding of diagnosis, prescribed medications, and compliance. Academic Emergency Medicine. 2(5):386.
41. World Health Organization. (2016). Health literacy: The solid facts. WHO Regional Office for Europe.
42. World Health Organization. (2021). Health literacy development for the prevention and control of noncommunicable diseases. WHO.
43. Zarcadoolas C, Pleasant A, Greer DS. (2009). Advancing health literacy: a framework for understanding and action. San Francisco: John Wiley & Sons
2. Berkman ND, Davis TC, McCormack L. (2010). Health literacy: what is it? Journal of Health Communication 15(2):9–19.
3. Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005
4. Bíró, É., Szabó, P., & Kósa, K. (2022). A magyar felnőtt lakosság egészségműveltsége. Egészségfejlesztés, 63(3), 3–15.
5. Chew, L. D., Bradley, K. A., & Boyko, E. J. (2004). Brief questions to identify patients with inadequate health literacy. Family Medicine, 36(8), 588–594.
6. Cutler, D. M., & Lleras-Muney, A. (2010). Understanding differences in health behaviors by education. Journal of Health Economics, 29(1), 1–28. https://doi.org/10.1016/j.jhealeco.2009.10.003
7. Dehal A, Garrett T, Tedders SH, Arroyo C, Afriyie-Gyawu E, Zhang J. (2011). Body mass index and death rate of colorectal cancer among a national cohort of US adults. Nutrition and Cancer. 63(8):1218–25.
8. Deliens, T., Deforche, B., De Bourdeaudhuij, I., & Clarys, P. (2014). Determinants of eating behaviour in university students: A qualitative study using focus group discussions. BMC Public Health, 14, 53. https://doi.org/10.1186/1471-2458-14-53
9. Dunlosky, J., & Metcalfe, J. (2009). Metacognition. Sage Publications.
10. Franze M, Fendrich K, Schmidt CO, Fahland RA, Thyrian JR, Plachta-Danielzik S, et al. (2011). Implementation and evaluation of the population-based programme “health literacy in school-aged children” (GeKo KidS). Public Health Journal. 19(4):339–47.
11. Frisch A-L, Camerini L, Diviani N, Schulz PJ. (2011). Defining and measuring health literacy: how can we profit from other literacy domains? Health Promotion International. 27(1):117–26.
12. Haun, J. N., Valerio, M. A., McCormack, L. A., Sørensen, K., & Paasche-Orlow, M. K. (2014). Health literacy measurement: An inventory and descriptive summary of 51 instruments. Journal of Health Communication, 19(2), 302–333. https://doi.org/10.1080/10810730.2014.936571
13. Haun, J., Luther, S., Dodd, V., & Donaldson, P. (2012). Measurement variation across health literacy assessments: implications for assessment selection in research and practice. Journal of health communication, 17 (3), 141–159. https://doi.org/10.1080/10810730.2012.712615
14. Horváth, C., Csányi, T., & Révész, L. (2021). A serdülők egészségműveltségének mérése: A HELMA kérdőív hazai adaptációja. Egészségfejlesztés, 62(4), 4–15.
15. Jordan, J. E., Buchbinder, R., & Osborne, R. H. (2010). Conceptualising health literacy from the patient perspective. Patient education and counseling, 79(1), 36–42. https://doi.org/10.1016/j.pec.2009.10.001
16. Khajouei R, Salehi F. (2017). Health literacy among Iranian high school students. American Journal of Health Behavior. 41(2):215–22.
17. Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77(6), 1121–1134. https://doi.org/10.1037/0022-3514.77.6.1121
18. Kühn, L., Bachert, P., Hildebrand, C., Kunkel, J., Reitermayer, J., Wäsche, H., & Woll, A. (2022). Health literacy among university students: A systematic review of cross-sectional studies. Frontiers in Public Health, 9, 680999. https://doi.org/10.3389/fpubh.2021.680999
19. Lamanauskas V, Augienė D. (2019). Identifying primary school teachers’ health literacy. Journal of Turkish Science Education 16(4):451–66.
20. Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, et al. (2020). What is the meaning of health literacy? A systematic review and qualitative synthesis. Family Medicine and Community Health. 8(2):e000351.
21. Mátyás G, Vincze F, Bíró É. (2021): Validation of health literacy questionnaires in Hungarian adult sample. Orvosi Hetilap. 162(39): 1579–1588.
22. McQueen DV, Kickbusch I, Potvin L, Pelikan JM, Balbo L, Abel T. (2007). Health and modernity: the role of theory in health promotion. New York: Springer; 2007.
23. Nielsen-Bohlman L, Panzer AM, Kindig DA (2004). Health literacy: a prescription to end confusion. Washington (DC): National Academies Press (US)
24. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. https://doi.org/10.1093/heapro/15.3.259
25. Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual Review of Public Health, 42, 159–173. https://doi.org/10.1146/annurev-publhealth-090419-102529
26. Okan, O., Bauer, U., Levin-Zamir, D., Pinheiro, P., & Sørensen, K. (Eds.). (2019). International handbook of health literacy. Policy Press.
27. Paakkari, L., & Okan, O. (2019). Health literacy – Talking the language of (school) education. HLRP: Health Literacy Research and Practice, 3(3), e161–e164. https://doi.org/10.3928/24748307-20190502-01
28. Park A, Eckert TL, Zaso MJ, Scott-Sheldon LA, Vanable PA, Carey KB, et al. Associations between health literacy and health behaviors among urban high school students. Journal of School Health. 2017;87(12):885–93.
29. Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. (2015). Health literacy impact on national healthcare utilization and expenditure. International Journal of Health Policy and Management. 4(11):747–55.
30. Sørensen, K., Pelikan, J. M., Röthlin, F., Ganahl, K., Slonska, Z., Doyle, G., … Brand, H. (2015). Health literacy in Europe: Comparative results of the European Health Literacy Survey (HLS-EU). European Journal of Public Health, 25(6), 1053–1058. https://doi.org/10.1093/eurpub/ckv043
31. Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12, 80. https://doi.org/10.1186/1471-2458-12-80
32. Stormacq, C., Van den Broucke, S., & Wosinski, J. (2019). Does health literacy mediate the relationship between socioeconomic status and health disparities? Health Promotion International, 34(5), e1–e17. https://doi.org/10.1093/heapro/day062
33. Sukys, S., Česnaitiene, V. J., & Ossowski, Z. M. (2017). Is health education at university associated with students’ health literacy? BioMed Research International, 2017, 8516843. https://doi.org/10.1155/2017/8516843
34. Tehrani Banihashemi SA, Amirkhani MA, Haghdoost AA, Alavian SM, Asgharifard H, Baradaran H, et al. (2007). Health literacy and the influencing factors: a study in five provinces of Iran. Strides in Development of Medical Education Journal. 4:1–9.
35. Vamos, S., Yeung, P., Bruckermann, T., Moselen, E. F., Dixon, R., Osborne, R. H., & Stringer, D. (2016). Exploring health literacy profiles of Texas university students. Health Behavior and Policy Review, 3(3), 209–225. https://doi.org/10.14485/HBPR.3.3.3
36. van der Heide, I., Wang, J., Droomers, M., Spreeuwenberg, P., Rademakers, J., & Uiters, E. (2013). The relationship between health, education, and health literacy: Results from the Dutch adult literacy and life skills survey. Journal of Health Communication, 18(Suppl. 1), 172–184. https://doi.org/10.1080/10810730.2013.825668
37. van der Vaart, R., & Drossaert, C. H. C. (2017). Development of the Digital Health Literacy Instrument. Journal of Medical Internet Research, 19(1), e27. https://doi.org/10.2196/jmir.6709
38. Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: The Newest Vital Sign. Annals of Family Medicine, 3(6), 514–522. https://doi.org/10.1370/afm.405
39. Wharf Higgins J, Begoray D, MacDonald M. (2009). A social-ecological conceptual framework for understanding adolescent health literacy in the health education classroom. American Journal of Community Psychology. 44(3–4):350–62.
40. Williams M, Parker R, Baker D, Coates W, Nurss J. (1995). The impact of inadequate functional health literacy on patients’ understanding of diagnosis, prescribed medications, and compliance. Academic Emergency Medicine. 2(5):386.
41. World Health Organization. (2016). Health literacy: The solid facts. WHO Regional Office for Europe.
42. World Health Organization. (2021). Health literacy development for the prevention and control of noncommunicable diseases. WHO.
43. Zarcadoolas C, Pleasant A, Greer DS. (2009). Advancing health literacy: a framework for understanding and action. San Francisco: John Wiley & Sons
Published
2026-05-29
How to Cite
HorváthC. (2026). What Do We Measure and What Do We Perceive? Health Literacy – A Profile Analysis Among First-Year University Students. Egészségfejlesztés, 67(1), 31-44. https://doi.org/10.24365/ef.21908
Issue
Section
Original Article - Research
Copyright (c) 2026 Cintia Horváth
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
.png)
