Everyday health information literacy among young men compared with adults with high risk for metabolic syndrome

Abstract

This cross-sectional population-based study aims at identifying differences in the aspects of everyday health information literacy among young healthy men and adults with an increased risk for metabolic syndrome. Data were collected with a self-assessment-based 10-item screening tool administered at the Finnish Defence Force’s call-ups (n=2507, response rate 59%) and at health intervention study (n=571, response rate 98%). Adults with increased risk for metabolic syndrome seemed to value health information but had more difficulty in knowing who to believe in health issues and understanding the terminology used. The difficulties applied especially to respondents 35 years old or over. Men, and especially young men, had lower motivation than women to seek health information. Although the results are indicative, the everyday health information literacy screening tool seems to be useful in revealing areas that health communication should be focused on among different populations.

Keywords

Age Finland gender health information literacy health promotion motivation

1. Introduction

The competencies that people possess with regard to finding, evaluating and using health information may influence their information behaviour [1]. The concept of health information literacy (HIL) has been used to describe these competencies. It has been defined as ‘the set of abilities needed to recognize a health information need, identify likely information sources and use them to retrieve relevant information, assess the quality of the information and its applicability to a specific situation, and analyse, understand, and use the information to make good health decisions’ [2]. The concept of everyday health information literacy (EHIL) refers to competencies to find, evaluate and understand health-related information in everyday life situations, and is directed especially towards literate populations [3]. It can be considered as information literacy in a health context or as a combination of the concepts of health literacy (HL) and information literacy.

Research on HIL has focused on different population subgroups and these studies (further discussed in Section 1.1.) indicate that there are significant differences in HIL based on individuals’ age, education, economical situation and health status. However, research within this area is still scarce. It has been proposed that HIL should be studied among various populations and that different aspects of health information literacy (e.g. motivation, skills, confidence) should be investigated separately but in parallel [3]. This study responds to this demand by comparing the different aspects of HIL among two population subgroups: generally healthy young men and adults with an increased risk for metabolic syndrome. Both populations have characteristics that make health promotion important to them.

1.1. Theoretical background and literature review

If people lack knowledge about the health risks and benefits of a behaviour, they may be unmotivated to alter unhealthy habits. Hence, increased knowledge can be considered a precondition for change [4, 5] but increased knowledge alone does not necessarily lead to improvements in behaviour (e.g. [6 –8]). Moreover, those who are passive in seeking health information also tend to be passive in discovering information by chance [9] or may avoid heath information altogether (see [10 –12]). Thus, those individuals whom health promoters attempt to influence with health messages may be the most difficult to reach.

Health information literacy is complex to measure and many measures focus on some narrow aspect of the concept. Based on an operationalization of the Medical Library Association’s (2003) definition of HIL, Niemelä et al. [3] have designed a 10-item screening tool aiming at identifying differences in individuals’ EHIL. Their aim was to develop a simple and practical screening tool that could be used to detect individuals who would benefit from HIL counselling. The 10 statement items of the tool are presented in the Methods section. An addition to former (HL or) HIL screening tools is a question about a diagnosis of dyslexia [3].

Niemelä et al. [3] conducted a pilot study of the EHIL tool among Finnish upper secondary school students (n=217). Based on a factor analysis, they identified three independent factors of EHIL: motivation on finding health information, confidence in one’s ability to find, understand and use health information, and evaluation of health information. Furthermore, an item on the ability to understand terminology in health contexts was considered to be ‘a fundamental HIL statement’ and was therefore analysed separately [3]. The identified factors were assumed to encompass the most fundamental aspects of everyday health information literacy among the literate population [3]. From these factors, for instance, motivation has generally been regarded as an important factor of HL and HIL (e.g. [7, 13, 14]). Niemelä et al. propose that HIL should be studied among various populations and that different aspects of health information literacy, for example, motivation, skills and confidence, should be investigated separately but in parallel [3].

Research on HIL has mainly focused on health professionals and the roles of libraries and librarians in the promotion of HIL [15, 16]. In everyday life settings HIL has been studied among upper secondary school students [3], young men [1], adults attempting to manage their weight [17] and older adults [18 –21]. These studies indicate that there are significant differences in HIL based on individuals’ age, education, economical situation and health status. For example, high educational level (seniors [19], young men [10], university students [22]) and female gender (upper secondary school student [3]) have been found to be associated with higher HIL. HIL has also been positively associated with self-rated health among older people (aged 65–79) [19] and health-promoting behaviours and physical fitness among young men (aged 17–23) [23]. Moreover, among young men, low EHIL has been associated with avoidance of physical activity information [1] and non-preference of fear appeals [24]. These results indicate that individuals who are unconfident in their abilities to find, understand and use health-related information may be more prone to avoid this information.

In this study, we focus on comparing the different aspects of HIL among two population subgroups: generally healthy young men and adults with an increased risk for metabolic syndrome. The metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure [25].

Metabolic syndrome has been defined as a combination of abdominal obesity and two of the other listed risk factors: raised triglycerides, reduced HDL cholesterol, raised blood pressure and raised fasting plasma glucose or diagnosed type 2 diabetes. Individuals’ knowledge, attitudes and behaviour play a large role in preventing and managing the risk factors making up metabolic syndrome and many lifestyle interventions are based on this understanding [26]. Individuals with a high risk for metabolic syndrome should be aware of and informed about their situation as there are good possibilities to promote their wellbeing and prevent the onset of diseases such as type 2 diabetes.

Young men represent a generally healthy population but may engage in risky behaviours, physical inactivity and unhealthy dietary habits, placing them at risk of acute and chronic health conditions in the future (see e.g. [27]). Increased age is associated with more protective health behaviours [28]. Elderly people are generally regarded having higher health consciousness [29]. Young people, in turn, may be rather confident in their abilities to find and use health-related information but may lack motivation to seek for information on health [1]. Furthermore, women have been shown to be more proactive and engaged in seeking, gaining and discussing health-related issues (e.g. [30 –32]). Yet gender differences tend to decrease as age increases [28].

1.2. Objectives

The aim of this study is to increase our knowledge of EHIL among different kinds of individuals. The objective of this population-based study is to compare different aspects of EHIL (i.e. motivation, confidence, evaluation and terminology) between adults with increased risk for metabolic syndrome (aged 20–61) and healthy young men (aged 17–23). This knowledge can be utilized in tailoring health communication for these target groups. The association of gender and age are further investigated by comparing (a) men and women and (b) men who were under 35 years old with men who were 35 or older in the population subgroup of adults with increased risk for metabolic syndrome. The study also contributes to the validation of the EHIL screening tool.

The research questions were set as follows:

Are there significant differences between the two populations in the total scores or item-based scores of the EHIL screening tool?

Are there significant differences in the EHIL between genders or different age groups among adults with increased risk for metabolic syndrome?

2. Methods

2.1. Survey design

The EHIL screening tool by Niemelä et al. [3] includes 10 statements to which individuals are instructed to respond on a scale from 1 (strongly disagree) to 5 (strongly agree). The statements are:

It is important to be informed about health issues.

I know where to seek health information.

I like to get health information from a variety of sources.

It is difficult to find health information from printed sources (magazines and books).

It is difficult to find health information from the Internet.

It is easy to assess the reliability of health information in printed sources (magazines and books).

It is easy to assess the reliability of health information on the Internet.

Health-related terminology and statements are often difficult to understand.

I apply health-related information to my own life and/or that of people close to me.

It is difficult to know who to believe in health issues.

There are some limitations relating to this data collection methodology. When data is collected at a single point in time, changes in the population cannot be measured. Furthermore, surveys generally cannot provide strong evidence of cause and effect. Without this temporal association there is lack of proof about the causality.

2.2. Study populations and questionnaire distribution

To collect data on young men’s EHIL, the screening tool was administered at the Finnish Defence Forces call-ups in the city of Oulu, Finland, in September to December 2012 and 2013 within the MOPO study [1, 23, 24, 33]. The MOPO study (2009–2016) combines traditional health promotion, modern technology and measurements of physical activity in the activation of young men.

In Finland military or civilian (non-military) service is mandatory for all male citizens, and annually all 18-year-old men are called for service in call-ups. Thus the sampling methodology of MOPO study was a total population sampling and a large, representative, population-based sample of young men was reached. All 2507 men present at the call-ups in Oulu area in 2012 and 2013 were invited to participate in the study, and 1870 (66%) agreed to participate. The participants were given oral and written information about the study and its benefits and risks, including their right to refuse to take part or withdraw from the study without it affecting their future health care or military service. The local ethics committee granted approval (ETTM123/2009) to conduct the MOPO study [33]. All participants were asked to fill in a questionnaire including items about, for example, socio-demographic information (e.g. age and educational level), physical activity and EHIL. Of the men 1842 (73.5%) filled in the questionnaire and of them 1481 (59.1%) responded to each of the 10 EHIL statements.

Information on EHIL of individuals with high risk for metabolic syndrome was collected within the ongoing (from 2013 to 2016) multidisciplinary intervention study ‘Improved Methods of Life-style Modification for Patients at High Risk for Metabolic Syndrome (PrevMetSyn)’ (see [34, 35]). The PrevMetSyn study aims at revealing the effects of a web-based tailored lifestyle support system on weight loss, eating behaviour, self-efficacy and health. During the project a persuasive ICT application is developed to support making lifestyle and eating habit modifications.

The sampling methodology of PrevMetSyn study was a random sampling. A population-based sample of 571 participants living in the area of the city of Oulu (age 20–60 years) was collected using the address and information system of the Finnish Population Register Centre. In total, an invitation letter was sent to randomized 12,500 people and 1065 agreed to participate. Of them 423 individuals did not meet the inclusion criteria, which were both high body mass index (27–35 kg/m²) and possibility and ability to use a computer and the Internet. Some were also interrupted before the beginning of the intervention. In the end the study population consisted of 289 men and 282 women.

Body mass index 27 was set as the minimum inclusion criteria instead of 25, which is normally used as a minimum index for overweight, because 25 was considered too low for the purposes of the intervention study.

Some of the participants already had metabolic syndrome, defined as a waist circumference in males of >94 cm and in females >80 cm and at least two of the following criteria: high fasting glucose (impaired fasting glucose >5.6 or diagnosed with diabetes), high triglycerides (>1.7 mmol/l or medication), low HDL cholesterol (men <1.0, females <1.3 mmHg or medication) and high blood pressure (≥130/≥ 85 or medication) [25].

The data were collected through a questionnaire that received 571 (99%) responses at the beginning of the PrevMetSyn intervention study in February 2013 to February 2014. Of the participants, 37 answered a paper questionnaire on the occasion when physiological measurements and laboratory tests were conducted. The rest filled in an electronic questionnaire, for example, with their home computer. Furthermore, 530 electronic questionnaire answers were received, but some of the answers needed to be rejected owing to incorrect identification number. The final number of valid answers to the questionnaire was 563 (98%) and of them 559 (98%) had responded to all 10 EHIL statements (see Table 1).

Table 1.

The number and percentages of the population-based samples and EHIL respondents included in this study.

Study	Population-based sample	EHIL respondents from the population-based sample
MOPO – young generally healthy men	2507 (100%)	1481 (59.1%)
PrevMetSyn – men and women with high risk for metabolic syndrome	571 (100%)	559 (97.9%)

2.3. Data analysis

Statistical analyses were performed using the IBM SPSS Statistics for Windows, version 19.0 (IBM Corp, 2010). The individual statements of the EHIL screening tool were summed to form a sum variable with a minimum of 10 and a maximum of 50 points as suggested by Niemelä et al. [3]. Variables 4, 5, 8 and 10 were reversed. Cronbach’s alphas were calculated to assess the internal consistency of the EHIL sum variable. It was 0.70 in the population of young men, and 0.57 in the population of adults with high risk for metabolic syndrome. Furthermore item-based comparisons were presented according to different aspects of EHIL [3].

For comparison of adults at high risk for metabolic syndrome with healthy young men, the adults at risk were categorized into two groups according to age: (a) 20–35 years; and (b) 35–61 years.

Mean and standard deviation values were calculated for continuous variables and percentages for categorical variables. All continues variables were normally distributed and correlation analysis was used to examine the relationships between continuous variables. Associations between the categorical response and explanatory variables were analysed using cross-tabulation with Pearson’s chi-square test or its non-parametric alternative, Fisher’s exact test (two-sided). The non-parametric test was used when the expected cell counts were low (<5) because of unequally distributed data among the cells of the table. Student’s t-test was used to analyse the statistical significance of the differences between group sum variable means.

3. Results

3.1. Characteristics of the study participants

The mean age of the young men was 17.9 years (standard deviation 0.688) and the mean age of the adults with increased risk for metabolic syndrome was 45.8 (standard deviation 9.979, aged 20–61 years). Approximately half of respondents with increased risk for metabolic syndrome were men (n=283) and half were women (n=271). Information about the gender and age were missing from some of the respondents. Of the young men 8.2% (n=137) and of the high-risk individuals, 4.1% (n=23) reported an expert diagnosis of dyslexia.

3.2. Everyday health information literacy

First the sum variables of the EHIL screening tool were investigated and compared. For young men (participating MOPO study) the EHIL sum variable mean was 34.70 with a standard deviation of 4.998. For adults with increased risk (participating the PrevMetSyn study) mean EHIL was 36.57 with a standard deviation of 4.639. The difference was statistically significant (t-test, p < 0.000).

In the following section an item-based comparison of the 10 EHIL statements is presented. These results are organized based on the different aspects of EHIL identified in the study by Niemelä et al. [3].

3.2.1. Motivation

Of the young men 62.5% (n=926) and of the individuals with high risk for metabolic syndrome 96.1% (n=538) thought that it is important to be informed about health issues. Of the young men 38.4% (n=563) agreed that they like to get health information from a variety of sources and 35.5% (n=525) that they apply health information to their own lives and/or the lives of people close to them, whereas these proportions among the adults with increased risk were 86.8% (n=485) and 70.4% (n=396), respectively. Of the adults with increased risk 89.3% (n=500) and of the young men 70.4% (n=1042) were confident in their ability to know where to seek information (see Table 2).

Table 2.

An item-based comparison of EHIL statements among young generally healthy men (n=1481) and adults with increased risk for metabolic syndrome (n=559).

Statement	Young men who agreed, N (%)	High-risk individuals who agreed, N (%)
Motivation
It is important to be informed about health issues (EHIL 1)	926 (62.5)	538 (96.1)*
I know where to seek health information (EHIL 2)	1042 (70.4)	500 (89.3)*
I like to get health information from a variety of sources (EHIL 3)	563 (38.4)	485 (86.8)*
I apply health-related information to my own life and/or that of people close to me (EHIL 9)	525 (35.5)	396 (70.8)*
Confidence
It is difficult to find health information from printed sources (magazines and books) (EHIL 4)	251 (16.9)	103 (18.4)
It is difficult to find health information from the Internet (EHIL 5)	192 (13.0)	79 (14.1)
It is difficult to know who to believe on health issues (EHIL 10)	195 (13.2)	253 (45.2)*
Evaluation
It is easy to assess the reliability of health information in printed sources (magazines and books) (EHIL 6)	493 (33.5)	195 (34.8)
It is easy to assess the reliability of health information on the Internet (EHIL 7)	461 (31.3)	172 (30.7)
Terminology
Health-related terminology and statements are often difficult to understand (EHIL 8)	237 (16.0)	225 (40.2)*

Statistically significant difference between the young men and adults with increased risk for metabolic syndrome (Pearson’s chi-square or Fisher’s exact test p<0.05).

3.2.2. Confidence

Of the young men 16.9% (n=251) and of the adults with increased risk for metabolic syndrome 18.4% (n=103) agreed with the statement concerning the difficulty of finding health information from printed sources, and 13.0% (n=192) of young men and 14.1% (n=79) of high-risk individuals agreed with the statement relating the Internet. Of young men 13.2% (n=195) agreed with the statement ‘it is difficult to know who to believe in health issues’ while the proportion was 45.2% (n=253) for the adults with increased risk.

3.2.3. Evaluation

Over one-third of both young men (33.8%, n=493) and of adults with increased risk (34.8%, n=195) agreed that it is easy to assess the reliability of health information in printed sources. The percentages relating to the easiness of assessing the reliability of health information on the Internet were 31.3% (n=461) for young men and 30.7% (n=172) for the adults with increased risk.

3.2.4. Terminology

Of the young men 16.0% agreed that health-related terminology and statements are often difficult to understand, whereas 40.2% of the high-risk individuals had experienced these difficulties. We were interested in finding out whether there is a difference between genders. Therefore the women and men with increased risk for metabolic syndrome were further investigated. An EHIL item-based comparison of high-risk women and men is presented in Table 3.

Table 3.

EHIL item-based comparison of high-risk women (n=282) and men (n=289) of all ages with increased risk for metabolic syndrome.

Statement	High-risk women who agreed, N (%)	High-risk men who agreed, N (%)
Motivation
It is important to be informed about health issues (EHIL 1)	264 (97.3)	267 (94.7)
I know where to seek health information (EHIL 2)	255 (94.1)	238 (84.5)*
I like to get health information from a variety of sources (EHIL 3)	251 (92.6)	228 (81.2)*
I apply health-related information to my own life and/or that of people close to me (EHIL 9)	207 (76.7)	185 (65.4)*
Confidence
It is difficult to find health information from printed sources (magazines and books) (EHIL 4)	48 (17.7)	52 (18.4)
It is difficult to find health information from the Internet (EHIL 5)	40 (14.7)	34 (12.4)
It is difficult to know who to believe in health issues (EHIL 10)	134 (49.4)	117 (41.3)
Evaluation
It is easy to assess the reliability of health information in printed sources (magazines and books) (EHIL 6)	94 (34.7)	98 (34.6)
It is easy to assess the reliability of health information on the Internet (EHIL 7)	85 (31.4)	84 (29.7)
Terminology
Health-related terminology and statements are often difficult to understand (EHIL 8)	107 (39.5)	114 (40.3)

Statistically significant difference between women and men with increased risk for metabolic syndrome (Pearson’s chi-square or Fisher’s exact test p<0.05).

Of the adults with high risk for metabolic syndrome, both men and women aged from 35 to 61 years were more likely to find it difficult to know who to believe in health issues (p=0.027), to assess the reliability of health information in printed sources (p<0.001), and to understand health-related terminology (p<0.001) when compared with men and women from aged 20 to 34.

When high-risk men under the age of 35 were compared with men of the age of 35 or older statistically significant differences applied to the statements ‘it is easy to assess the reliability of health information in printed sources (magazines and books)’ (p=0.023) and to ‘health-related terminology and statements are often difficult to understand’ (p=0.003).

Of the women in the population of the adults with increased risk for metabolic syndrome, 94.1% (n=255) agreed that they know where to seek health information and 92.6 (n=251) preferred getting health information from a variety of sources. The percentages for men were 84.5 (n=238) (p<0.001) and 81.2 (n=228) (p<0.001), respectively. Of women, 76.7% (n=207) agreed with the statement ‘I apply health-related information to my own life and/or that of people close to me’ and of men 65.4% (n=185) (p=0.004). A comparison of EHIL item scores of high-risk men aged from 20 to 34 and from 35 to 61 is presented in Table 4.

Table 4.

EHIL item-based comparison of men under 35 years (n=51) and men 35 or older (n=230) with increased risk for metabolic syndrome.

Statement	High-risk men (20–35 years old) who agreed, N (%)	High-risk men (35–61 years old) who agreed, N (%)
Motivation
It is important to be informed about health issues (EHIL 1)	46 (90.2)	220 (95.7)
I know where to seek health information (EHIL 2)	42 (82.4)	195 (84.8)
I like to get health information from a variety of sources (EHIL 3)	38 (74.5)	189 (82.5)
I apply health-related information to my own life and/or that of people close to me (EHIL 9)	33 (64.7)	151 (65.7)
Confidence
It is difficult to find health information from printed sources (magazines and books) (EHIL 4)	7 (13.7)	45 (19.6)
It is difficult to find health information from the Internet (EHIL 5)	7 (13.7)	27 (11.7)
It is difficult to know who to believe in health issues (EHIL 10)	15 (29.4)	101 (43.9)
Evaluation
It is easy to assess the reliability of health information in printed sources (magazines and books) (EHIL 6)	25 (49.0)	73 (31.7)*
It is easy to assess the reliability of health information on the Internet (EHIL 7)	15 (29.4)	68 (29.6)
Terminology
Health-related terminology and statements are often difficult to understand (EHIL 8)	11 (21.6)	103 (44.8)*

Statistically significant difference between men under 35 years and men 35 or older participating PrevMetSyn study (Pearson’s chi-square or Fisher’s exact test p<0.05).

4. Discussion

This study focuses on comparing adults with an increased risk for metabolic syndrome (aged from 20 to 61 years) to healthy young men (aged from 17 to 23 years) in the total scores and item-based scores of the EHIL screening tool. The main results of the comparison are discussed in this section.

The sum variable mean of the EHIL screening tool for young men was lower than for adults with increased risk for metabolic syndrome. This finding is discussed later in this section.

4.1. Aspects of everyday health information literacy

Based on the results of this study, different aspects of EHIL stand out for different population subgroups. Adults with increased risk for metabolic syndrome seem to value health information but have more difficulty in knowing who to believe on health issues. Young men seem to be rather confident in their competencies but may lack motivation to seek health information.

These differences may be explained by the different health statuses and situations of life of the two population groups. Also, the young, healthy individuals may have a more confident attitude towards their abilities to find and evaluate health information [10, 23] when compared with individuals who already are at high risk of serious health conditions. It may be that the young men have not had experiences on serious health conditions or diseases that would have ‘forced’ them to seek information on complex health issues.

If only the sum variables of EHIL screening tool of young men and high-risk individuals were under scrutiny we would have concluded that the mean score for high-risk individuals is higher and thus it would seem that their EHIL is better. However, based on previous knowledge on the topic, the result is not very informative in its entirety and seems even unreliable. This is why it is important to investigate the different aspects of EHIL, as suggested by Niemelä et al. [3], separately. Moreover, especially for the PrevMetSyn study, the low values of Cronbach’s alpha support this finding.

4.2. Gender and age

With high-risk individuals we took a closer look into the responses related to different aspects of EHIL based on the respondents’ gender and age. According to the results men tended to have lower motivation than women to seek health information (according to three items out of four) (see Table 3). This finding is in line with previous research indicating that men are less likely to be motivated to seek health information than women [10, 31, 36 –39]. Moreover, high-risk men of the age 35–61 reported problems relating to evaluation of health information and understanding the terminology used when compared with younger high-risk men. This finding indicates that they need support with evaluating the reliability of printed sources and understanding the terminology used in health settings.

The EHIL of the high-risk men of the aged from 20 to 34 differed from those of the healthy young men. Young men in the MOPO study were more confident in their competencies to evaluate health information and understand the terminology used. This was an expected finding as gender differences in health behaviour tend to decrease as age increases [28]. Reasons for this can be that high-risk men were somewhat older and already aware that they have increased risks for several diseases. The number of the respondents in the younger subgroup of high-risk men in the PrevMetsyn study was moderately low. Therefore, scrutinizing the differences between young healthy men and young men with increased risk for metabolic syndrome can only be regarded as indicative in this comparative cross-sectional study.

According to the results of this study men, and especially younger men, have low motivation to seek health information. Thus gender seems to be associated with motivation as an EHIL factor. Previously, women have been shown to have better EHIL in the study by Niemelä et al. [3] and HL in the study by Sørensen et al. [14]. Women were observed to be more motivated [3]. Furthermore, in the study by Wellstead and Norriss [40] many men who were experiencing a major stressful life event were unfamiliar with likely sources of information or help. Moreover in the study by Johnson et al. [41] men, generally speaking, had limited motivation to promote and maintain good health.

The theoretical and practical lessons learned from this study relate to differences in EHIL among different population groups. Another important observation applies to the difference between utilizing the EHIL measure as a sum variable and as individual statements. In this case the latter alternative was considered as more informative and probably more accurate as well.

4.3. Practical applications, study limitations and future studies

The results of this cross-sectional population-based study show differences in EHIL of young healthy men and adults with increased risk for metabolic syndrome. The found differences should be taken into account when designing health information literacy promotion, targeted health communication strategies and intervention studies. The provided health information should be tailored according to individual’s personal preferences and life situation (see e.g. [42]). Tailored health communication is a means to increase the effectiveness of health information by providing more user-centred information. It aims to increase the possibility that the information content is received, processed and accepted by the receiver [43, 44].

Information on the aspects of the EHIL screening tool has already been utilized in intensive face-to-face group counselling on healthy eating and lifestyle in an intervention study [45]. One of the counselling visits was targeted on the perceived ability to assess the quality of health information. Applying the EHIL screening tool together with cognitive behavioural therapy built up a novel counselling approach [45].

We argue that men, and especially younger men, need motivational health communication. Another option would be to provide health information literacy assessment and feedback to reveal skill gaps [46] or help individuals evaluate their competencies [47] in relation to specific tasks. The results imply that young men have high confidence in their EHIL skills, but we could ponder whether this high confidence is actually connected with good skills. In fact, there is an ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also more broadly captures personal activation or motivation to manage health [48]. However, both aspects are important and they also make independent contributions to health [48]. In general, the EHIL screening tool may reflect confidence rather than actual skills [1, 23].

The study has some limitations. Data for this study were collected at a single point in time and we were not able to investigate changes in the populations or draw conclusions on cause and effect.The results indicate that the EHIL of ‘healthy’ and ‘unhealthy’ individuals’ differs, especially according to the different aspects of EHIL. This study provided comparison with large population-based samples, but the results can be considered as indicative. They are not necessarily generalizable to all ‘healthy’ and ‘unhealthy’ population groups. Therefore this difference should be further examined among different health subgroups and countries.

Moreover, future studies should focus on the further development and validation of the EHIL screening tool. Among the study populations of this cross-sectional study, different aspects of EHIL and on how they are associated with health behaviour and the physical health of individuals could be examined too. The EHIL screening tool should also be further developed to better suite different population groups and their changing health information environments. Another demand for developing the tool arises from the dramatic changes that have occurred in individuals’ information environment during recent years. The new challenges commenced by new technological tools and information practices have been taken into account in a recently published Framework for Information Literacy for Higher Education by the Association of College & Research Libraries [49]. This framework highlights the role of individuals’ understanding on authority and information creation as key elements for information literacy. These perspectives could be taken into account in studying EHIL as well.

In addition, the theoretical and practical development of the EHIL should take into account individuals’ personality and information behaviour and their preferences. Furthermore, an instrument such as the self-perceived health-related quality of life construct would be useful as support for the EHIL screening tool.

5. Conclusions

According to the results, different aspects of EHIL stand out for young healthy men and adults with increased risk for metabolic syndrome. Young men seem to be rather confident in their competencies but may lack motivation to seek health information. Adults with increased risk for metabolic syndrome seem to value health information but have more difficulty in knowing who to believe in health issues and understanding the used terminology. Among adults (both men and women) with increased risk for metabolic syndrome, those aged 35 years or older were more likely to find it difficult to know who to believe in health issues, assess the reliability of health information in printed sources and understand health-related terminology than those under 35 years old. Furthermore, the results indicate that men in general, and especially young men, have lower motivation than women to seek health information. Thus gender seems to be associated with motivation as an EHIL factor. This finding is in line with previous research.

Found differences should be taken into account when designing health information literacy promotion, targeted health communication strategies and intervention studies. The study also contributes to the validation of the EHIL screening tool.

Future studies should focus on the different aspects of EHIL and how they are associated with health behaviour and physical health of individuals. The EHIL screening tool seems to be useful in revealing areas on which health communication should be focused on among different populations. However, it could be further developed to better suit different population groups and their changing health information environments.

Footnotes

Funding

MOPO study was financially supported by the Finnish Cultural Foundation, the Juho Vainio Foundation, the Ministry of Education and Culture, the Centre for Military Medicine, the European Social Fund, the European Regional Development Fund, Tekes – The Finnish Funding Agency for Technology and Innovation, and the Northern Ostrobothnia Hospital District. PrevMetSyn study has received financial support from the Academy of Finland, Ministry of Social Affairs and Health, Finnish Foundation for Cardiovascular Research, Sigrid Juselius Foundation and City of Oulu.

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Everyday health information literacy among young men compared with adults with high risk for metabolic syndrome – a cross-sectional population-based study

Abstract

Keywords

1. Introduction

1.1. Theoretical background and literature review

1.2. Objectives

2. Methods

2.1. Survey design

2.2. Study populations and questionnaire distribution

2.3. Data analysis

3. Results

3.1. Characteristics of the study participants

3.2. Everyday health information literacy

3.2.1. Motivation

3.2.2. Confidence

3.2.3. Evaluation

3.2.4. Terminology

4. Discussion

4.1. Aspects of everyday health information literacy

4.2. Gender and age

4.3. Practical applications, study limitations and future studies

5. Conclusions

Footnotes

Funding

References