In the survey contains a systematic comparison between the results of the first population-based health literacy survey in Germany from 2014 and the follow-up survey from 2020 (HLS GER 1'). Both surveys were conducted according to the same methodology with an identical questionnaire. The comparison shows that the distribution of health literacy in the population has changed little, but overall there has been a deterioration in health literacy during the last six years.

• The findings of both studies show that the majority of the population faces great difficulties in dealing with health-related information. Compared to the 2014 results, in 2020 respondents report to have even more difficulties when dealing with and processing health and illness information. The 2020 survey data shows that 64.2% of the population have limited health literacy.
• Across age groups, health literacy has worsened over the past six years. In contrast to the 2014 survey, however, the younger age groups performed significantly worse in 2020.
• The social gradient identified in the 2014 survey increased: The correlation between the level of education and the level of health literacy has become stronger over time. There is a similar correlation between social status and health literacy.
• Respondents have severe difficulties appraising information on health issues. In 2020 people find it
  even more difficult to assess the trustworthiness of media health information and derive consequences for their own behavior than they did in 2014.
• There have been shifts in ranking the personal relevance of information sources. Family doctors and specialists are even more clearly at the top in 2020 than they were in 2014. However, there has been a noticeable increase in the importance of the Internet, which is becoming particularly important for people with one or more chronic illnesses
• The negative consequences of low health literacy for individual health outcome remain unchanged between both measurements. For example, people with low health literacy have poorer self-assessed health, exercise less and are more often physically inactive, and have an unhealthier diet than respondents with higher levels of health literacy. On average, people with low health literacy also use the health care system more often than people with higher levels of health literacy.

The results of both waves of HLS-GER 1 in 2014 and in 2020 highlight that developing and strengthening health literacy in populations and creating user-friendly health care services and information environments have to be considered critical public health targets. The National Health Literacy Action Plan, which was created in response to the results of the first survey in 2018, makes detailed proposals in this regard.

Hurrelmann, K., Klinger, J., Schaeffer, D. (2020): Health Literacy Survey Germany – Comparison of Results between 2014 and 2020. Short Summary. Bielefeld: Interdisciplinary Centre for Health Literacy Research (ICHL). Bielefeld University. DOI: https://doi.org/10.4119/unibi/2951269