Key findings

In 2018, of young people aged 18–24:

  • almost all (98%) agreed or strongly agreed that they have sufficient information to manage their own health
  • around 1 in 5 (19%) found it difficult navigating the healthcare system
  • around 1 in 5 (21%) strongly disagreed or disagreed that they can appraise health information.

Health literacy is both an individual and a system-wide concept. It describes the accessibility of health information and how well it is communicated, understood, interpreted and acted on.

Health literacy is seen to have 2 parts:

  • individual health literacy, which includes the cognitive and social skills that enable and motivate an individual to seek out, understand and use information to benefit their health and engage with healthcare services
  • the health literacy environment, which includes the design and accessibility of infrastructure, policies, processes and materials that affect how an individual engages with the health system (ACSQHC 2014).

Increasing the health literacy of Australia can better equip and empower people to be actively involved in their health and the healthcare system, resulting in better health outcomes (ACSQHC 2014). Low levels of health literacy:

  • have been associated with lower engagement with health services, non‑adherence and improper usage of medication, and higher hospital re‑admission rates (Choudhry et al. 2019)
  • can form barriers to accessing health services. This compounds the disadvantage already experienced by marginalised groups and increases health inequalities (DoH 2019a). An interim report by the National Youth Taskforce found that difficulty in navigating the support system and finding programs/services for support was a recurring concern for marginalised young people (DoH 2019b).

The importance of health literacy has been widely acknowledged and efforts to measure and improve it have increased in recent years (ACSQHC 2014):

  • A key action of the National Action Plan for the Health of Children and Young People: 2020–2030 is improving health literacy to better health outcomes for young people (DoH 2019a).
  • The PDF DownloadAddendum to the National Health Reform Agreement 2020–21 to 2024–25 includes ‘Empowering people through health literacy’ as one of its guiding principles (CFFR 2020a, 2020b). The Agreement includes actions to increase the accessibility, quality and effectiveness of health information, support and services (CFFR 2020a).
  • In 2017, the Organisation for Economic Co-operation and Development (OECD) Health ministers agreed on the importance of removing barriers to health literacy and increasing the role individuals play in managing their health (OECD 2017). However, international comparisons of health literacy are still difficult as not all countries measure it and, for those that do, the methods vary (Moreira 2018). 

Box 1: Data sources on health literacy

ABS Health Literacy Survey

The ABS Health Literacy Survey (HLS) was conducted for the first time in 2018 (ABS 2019a). Respondents aged 18 and over were drawn from the ABS National Health Survey 2017–18. The HLS uses the Health Literacy Questionnaire (HLQ), a widely used and validated health literacy assessment tool (ABS 2019b).

The HLQ consists of 44 questions that combine to inform 9 domains of health literacy. Each domain covers different aspects of individual, environmental and/or institutional health literacy, providing a broad picture of the functional, social and systemic factors that influence the health literacy of the population (ABS 2019b; Osborne 2013). Each domain is independent and measures either the level of agreement with individual aspects of health literacy or the perceived difficulty of health literacy characteristics.

The HLQ does not provide a combined ‘total’ measure of health literacy, nor does it directly state whether, more broadly, health literacy levels are high or low. Health literacy has previously been measured as a derived domain of the Adult Literacy and Life Skills Survey (ALLS). However, the ALLS considered only an individual’s functional aspects of health literacy, such as their ability to understand text and find key information in documents. Hence, the data from the ALLS is not comparable with that from the HLS (ABS 2019a).

National Survey of Australian Secondary Students and Sexual Health

The National Survey of Australian Secondary Students and Sexual Health is an anonymous survey of Australian year 10, 11 and 12 students that asks questions about knowledge, behaviour and educational experiences related to sexual health and wellbeing (Fisher & Kauler 2019). It has been conducted every 5 years since 1992 and is funded by the Department of Health. The 6th National Survey was conducted in 2018, involving 6,327 students across government, Catholic and independent school systems (Fisher et al. 2019).

How do young people assess their own health literacy?

In 2018, based on results from the ABS Health Literacy Survey, most young people aged 18–24 assessed their own health literacy positively across all aspects of health literacy considered (Figure 1). Of the aspects considered:

  • having sufficient information to manage one’s health had the highest proportion that agreed or strongly agreed (98% or 2.2 million young people)
  • being able to appraise health information had the lowest proportion that agreed or strongly agreed (78% or 1.8 million). Around 1 in 5 (21% or 467,000) strongly disagreed or disagreed that they can appraise health information (Figure 1).

Figure 1: Level of agreement with aspects of health literacy for young people aged 18–24, 2018

The stacked bar chart shows that most young people agree or strongly agree with the following aspects: Feeling understood and supported by healthcare providers (95%25), Having sufficient information to manage my health (98%25), Actively managing my health (90%25), Social support for health (98%25) and Appraisal of health information (78%25).

Notes:

  1. Proportions have been randomly adjusted to avoid the release of confidential data. The sum of proportions will not equal 100%.
  2. The percentage for Strongly disagree/Disagree in the category, Having sufficient information to manage my health, has a high margin of error and should be used with caution.

Chart: AIHW.
Source: ABS 2019a.

How are different aspects of health literacy perceived?

In 2018, based on results from the ABS Health Literacy Survey, most young people aged 18–24 found all health literacy characteristics assessed (e.g. ability to actively engage with healthcare providers) usually or always easy (Figure 2). Of the health literacy characteristics reported:

  • understanding health information well enough to know what to do had the highest proportion of young people rating it as usually or always easy (91% or 2 million young people)
  • navigating the healthcare system had the lowest proportion of young people rating it as usually or always easy, with around 4 in 5 (82% or 1.8 million) young people. Almost 1 in 5 (19% or 434,000) young people rated navigating the healthcare system as difficult (Figure 2); this is consistent with the interim report from the National Youth Taskforce that found this characteristic is a recurring concern for marginalised young people (DoH 2019b).

Figure 2: Perceived difficulty of health literacy characteristics for young people aged 18–24, 2018

The stacked bar chart shows that most young people found the following characteristics usually or always easy: Ability to actively engage with healthcare providers (87%25), Navigating the healthcare system (82%25), Ability to find good health information (85%25) and Understand health information well enough to know what to do (91%25).

(a) Comprises ‘Cannot do or always difficult’, ‘Usually difficult’ and ‘Sometimes difficult’.
Note: Proportions have been randomly adjusted to avoid the release of confidential data. The sum of proportions will not equal 100%.
Chart: AIHW.
Source: ABS 2019a.

Box 2: Sexual health literacy of Year 10 to 12 students

In 2018, the PDF DownloadNational Survey of Secondary Students and Sexual Health found that, overall, Year 10 to 12 students have a good knowledge of sexual health, are actively seeking trusted and reliable sources of information and are behaving responsibly.

The survey tested sexual health knowledge. While knowledge of sexually transmitted infections was good, there is room for improvement:

  • Human immunodeficiency virus (HIV) transmission knowledge was generally high, with students getting 80% of the questions correct, on average.
  • Students scored lower, on average, for general sexually transmitted infection (STI) knowledge (63% correct) and STI transmission (71%) than for HIV transmission knowledge.
  • Viral hepatitis knowledge and Human Papilloma Virus (HPV) knowledge was generally poor, with students getting 31% and 38% of questions correct, on average, respectively.

Of the sources of sexual health information students had ever used:

  • the most common were internet websites (79%) and female friends (75%)
  • the least common were school counsellors (9.5%), school nurses (9.0%) and youth workers (8.5%)
  • around a third had ever used a general practitioner (GP) for advice (33%).

Students rated the most trusted source of sexual health information as follows: GPs (89%), followed by mother/female guardian/stepmother (60%) and community health services (55%). Most rated the internet with a moderate level of trust (56%).

Most students reported receiving relationships and sexuality education (84%) at school, with 1 in 3 (38%) finding it very or extremely relevant (Fisher et al. 2019).

Over the last 10–25 years, a comparison with previous National Surveys suggests that general STI knowledge has improved, knowledge of HIV transmission has remained high and knowledge of HPV and hepatitis has remained low. In terms of sources of information, using the internet and friends has increased, while levels of trust in the accuracy of online information has remained low (Fisher & Kauler 2019). For data on responsible sexual behaviours, see Intimate relationships.

Where do I find more information?

For more information on Australia’s health and literacy, see:

  


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