Functional health literacy and health-promoting behaviour in a national sample of British adults

Objectives: To measure the prevalence of limited functional health literacy in the UK, and examine associations with health behaviours and self-rated health. Design: Psychometric testing using a British version of the Test of Functional Health Literacy in Adults (TOFHLA) in a population sample of adults. Setting: UK-wide interview survey (excluding Northern Ireland and the Scottish Isles). Participants: 759 adults (439 women, 320 men) aged 18-90 years (mean age=47.6 years) selected using random location sampling. Main outcome measures: Functional health literacy, self-rated health, fruit and vegetable consumption, physical exercise and smoking. Results: We found that 11.4% of participants had either marginal or inadequate health literacy. Multivariable logistic regression analysis indicated that the risk of having limitations in health literacy increased with age (adjusted odds ratio 1.04; 95% confidence interval 1.02 to 1.06), being male ( odds ratio=2.04; 95% confidence interval 1.16 to 3.55), low educational attainment (odds ratio=7.46; 95% confidence interval 3.35 to 16.58) and low income (odds ratio = 5.94; 95% confidence interval 1.87 to 18.89). In a second multivariable logistic regression analysis, every point higher on the health literacy scale increased the likelihood of eating at least five portions of fruit and vegetables a day ( odds ratio = 1.02; 95% confidence interval 1.003 to 1.03), being a non-smoker (odds ratio = 1.02; 95% confidence interval 1.0003 to 1.03) and having good self-rated health (odds ratio = 1.02; 95% confidence interval 1.01 to 1.04), independently of age, education, gender, ethnicity and income. Conclusions: The results encourage efforts to monitor health literacy in the British population and examine associations with engagement with preventative health behaviours.