Open Access Research article

Health literacy of Dutch adults: a cross sectional survey

Iris van der Heide12*, Jany Rademakers2, Maarten Schipper3, Mariël Droomers4, Kristine Sørensen5 and Ellen Uiters1

Author Affiliations

1 Centre for Nutrition, Prevention and health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands

2 NIVEL, Netherlands Institute for Health Services Research, Utrecht, Netherlands

3 Department of Statistics, Mathematical Modelling and Data Logistics, National Institute for Public Health and the Environment, Bilthoven, Netherlands

4 Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands

5 Department of International Health, Research School of Primary Care and Public Health, Maastricht University, Maastricht, Netherlands

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BMC Public Health 2013, 13:179  doi:10.1186/1471-2458-13-179

Published: 27 February 2013



Relatively little knowledge is available to date about health literacy among the general population in Europe. It is important to gain insights into health literacy competences among the general population, as this might contribute to more effective health promotion and help clarify socio-economic disparities in health. This paper is part of the European Health Literacy Survey (HLS-EU). It aims to add to the body of theoretical knowledge about health literacy by measuring perceived difficulties with health information in various domains of health, looking at a number of competences. The definition and measure of health literacy is still topic of debate and hardly any instruments are available that are applicable for the general population. The objectives were to obtain an initial measure of health literacy in a sample of the general population in the Netherlands and to relate this measure to education, income, perceived social status, age, and sex.


The HLS-EU questionnaire was administered face-to-face in a sample of 925 Dutch adults, during July 2011. Perceived difficulties with the health literacy competences for accessing, understanding, appraising and applying information were measured within the domains of healthcare, disease prevention and health promotion. Multiple linear regression analyses were applied to explore the associations between health literacy competences and education, income, perceived social status, age, and sex.


Perceived difficulties with health information and their association with demographic and socio-economic variables vary according to the competence and health domain addressed. Having a low level of education or a low perceived social status or being male were consistently found to be significantly related to relatively low health literacy scores, mainly for accessing and understanding health information.


Perceived difficulties with health information vary between competences and domains of health. Health literacy competences are associated with indicators of socio-economic position and with the domain in which health information is provided.

Health literacy; Socio-economic position; General population; Netherlands