Social disparities, navigational health literacy, and unmet needs in Germany: results of a population survey

Objectives Navigational health literacy is increasingly important in the German health system. While social disparities have been reported, less is known about its association with unmet needs and whether it attenuates the associations between social characteristics and unmet needs. Methods This cross-sectional online survey in Germany included a random sample of 2,201 adults. Participants completed the validated HLS19-NAV instrument and reported unmet needs during the past 12 months. Associations were examined using descriptive and multiple Poisson regression analyses. Results Overall, 70% of participants showed inadequate navigational health literacy. Lower navigational health literacy was associated with lower income, lower education, statutory health insurance, and age 41–59 years. Unmet needs were more common among younger adults, women, and lower-income or statutorily insured participants. Better navigational health literacy was associated with lower prevalence of unmet needs. After adding navigational health literacy to the model, associations between social characteristics and unmet needs remained largely unchanged. Conclusion Navigational health literacy was unequally distributed across groups and strongly associated with unmet needs but did not reduce the observed social disparities in access to care.