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.