As health information and services become increasingly digital, it is more important than ever that people can find, understand, evaluate and use health information in everyday life. A new study from the University of Eastern Finland shows that a brief 12-item questionnaire, known as HLS-Q12, can be used to assess health literacy in Finnish adults and to support reliable comparisons across key population groups. This can help identify where communication and support are most needed.

Published in International Journal of Public Health, the study was carried out by researchers at the University of Eastern Finland and partners in North Savo as part of the broader health and well-being research project PREWELL in Finland.

Health literacy affects how people manage information, services and decisions related to their health in everyday life. Reliable monitoring is important because health literacy is closely linked to health outcomes and health equity.

“There has been limited large-scale evidence on whether a brief international health literacy instrument works well enough for monitoring of the adult population in Finland,” says Postdoctoral Researcher Jing Zhou from the University of Eastern Finland. “Our study shows that HLS-Q12 provides a useful basis for this purpose.”

In the study, the researchers analysed survey data from 7,077 adults living in Finland, including both a nationally recruited sample and a regional sample from North Savo. The results showed that HLS-Q12 had high reliability and a clear overall structure. The questionnaire also performed consistently enough across key sociodemographic groups to support meaningful subgroup comparisons.

Clear differences across population groups

The study found that women reported higher health literacy than men, that people with higher education scored higher than those with lower education, and that younger adults showed higher levels than older adults.

“A brief questionnaire that works well across different groups can help identify where communication and support are most needed,” Zhou says. “As health and social services continue to digitalise, it becomes increasingly important to ensure that no population groups are left behind.”

The findings provide a stronger basis for monitoring health literacy in Finland and support more targeted health communication and more accessible services. The researchers used two complementary analytic approaches to examine whether the tool worked in a sufficiently similar way across different population groups.

Research article:

Zhou J, Rekola H, Sormunen M, Mäki-Opas T. Structural Validation and Measurement Invariance of the HLS-Q12 Health Literacy Instrument in Finnish Adults: Comparing Traditional and Alignment Methods. International Journal of Public Health. 2026. DOI: 10.3389/ijph.2026.1609337