HLS-Asia-Q

Measurement of health literacy in Asia

The HLS-Asia Consortium 2013
1) The Health Literacy Study - Asia
The Health Literacy Study-Asia (HLS-Asia), a sister project of the European Health
Literacy Study project (HLS-EU), was set up to provide a validated measure tool for
health literacy in countries of interest in Asia and establish a regional network to
promote health literacy. The HLS-Asia was launched in spring 2013 and should be
completed by the end of 2015.

2) Definition
To provide a starting point for measuring health literacy, an “all inclusive” health
literacy definition, based on a systematic literature review, was developed by the
HLS-EU consortium:

Health literacy is linked to literacy and entails people’s knowledge, motivation and
competences to access, understand, appraise, and apply health information in
order to make judgments and take decisions in everyday life concerning healthcare,
disease prevention and health promotion to maintain or improve quality of life
during the life course.
Sorensen, K et al. (2012) Health literacy and public health: A systematic review and integration of
definitions and models, BMC Public Health, 12(80).
Kickbusch I., Pelikan J. M., Apfel F. & Tsouros A. D. (2013). Health Literacy: The solid facts. WHO
Regional Office for Europe.

3) Conceptual Model
From the HLS-EU definition a conceptual model was derived. The model describes
health literacy as knowledge, motivation and competences to access, understand,
appraise and apply information to make decisions in terms of health care, disease
prevention and health promotion. The HLS-EU conceptual model also provides
aframework of determinants for and consequences of health literacy:
4) The questionnaire
This questionnaire is based on the conceptual model and the copyright consent of
HLS-EU-Q obtained from Maastricht University and the HLS-EU Steering
Committee. In addition to the 86 questions under the HLS-EU-Q, another 18 were
added, in order to reflect the local diversities and specific interest in each country. The
18 questions are added in three parts, 11 questions relate to demographics, 4 questions
in Health Literacy Survey and 3 questions are about social and economic information.
The demographic part has been moved to the beginning of the questionnaire.
Therefore, the respondents may get used to the procedure and be ready to answer the
following questionnaire. The questionnaire consists of 5 parts:

Part 1 – Demographics
Part 2 – Health Literacy Survey
Part 3 – Personal Health Information
Part 4 – Functional Health Information
Part 5 – Social and Economic Information
5) Matrix of Health Literacy Survey (Part 2)
Closely aligned to the definition and conceptual model, a matrix was created guiding
the item formulation of the tool; developed by the HLS-EU Consortium in
collaboration with international health literacy experts. For every cell in the matrix
3-5 items were identified.

HLS Asia 1.Finding 2.Understanding 3.Appraising 4.Applying

Matrix information on information on /Judging information on
health(FHI) health(UHI) information on health(AHI)
health(JHI)
1.Health care 2.1 2.5 2.9 2.13
(HC) 2.2 2.6 2.10 2.14
2.3 2.7 2.11 2.15
2.4 2.8 2.12 2.16
2.Disease 2.17 2.21 2.24 2.29
prevention(DP) 2.18 2.22 2.25 2.30
2.19 2.23 2.26 2.31
2.20 2.27
2.28
3.Health 2.32 2.37 2.41 2.44
promotion(HP) 2.33 2.38 2.42 2.45
2.34 2.39 2.43 2.46
2.35 2.40 2.47
2.36

6) Different Versions according to the targets

The 18 questions added in the Asian version are marked in blue. The questions which
have been adjusted to respond to the targets’ particular characteristics are marked with
.
Part 1 – Demographics

Q 1.1 Which country and city were you born in?

_____________________(Country)_____________________(City)
Q 1.2 In which cities have you lived for more than 2 years before age 30?
1. Country: City: Year:
2. Country: City: Year:
3. Country: City: Year:

Q 1.3 Gender □1.Male □2.Female

Q 1.4 Which year were you born?
Q 1.5 How tall are you? (cm)
Q 1.6 How much do you weigh? (kg)
Q 1.7 What is your legal marital status?

□1.Not married；□2.Married；□3.Separated / Divorced；□4.Widowed

Q 1.8 What is your current household living situation?

□1.Single / Living alone；□2.Living together / shared household；□3.In a serious relationship

but not living together

Q 1.9 Do you have children (Multiple answers possible)

□1.Yes under 15；□2.Yes over 15；□3.I have no children

Q 1.10 What is your religious belief?

□1.Buddhism；□2.Taoism；□3.Christian；□4.Catholics；□5.Islam；□6.None；

□7.Other:
Q 1.11 What is the highest level of education you have successfully completed?
(Usually by obtaining a certificate or diploma)

□1.Elementary school；□2.Junior high school；□3.Senior high school；

□4.University/college；□5.Master degree；□6.Doctoral degree；□7.Other:

Q Which of the professionals below corresponds to your current situation?

1.12
□1.Arts, Performance, Music；□2.Business, Consulting, Finance, Management；

□3.Communication, Journalism, Media；□4.Community, Public, or Social Service；

□5.Education；□6. Entrepreneur；□7. Government, Public Policy, Politics；□8. Law；□9.

 Medicine；□10. Research/ Academia；□11.Technology, Engineering；□12. Agriculture ；

□13.Other:________________

Q 1.13 In which country(s) were your parents born?

1. Your father’s birth country:
2. Your mother's birth country:
Q 1.14 What is the highest level of education completed by your father?
(Usually by obtaining a certificate or diploma)

□1.Elementary school；□2.Junior high school；□3.Senior high school；

□4.University/college；□5.Master degree；□6.Doctor degree；□7.Other:

Q 1.15 What is the highest level of education completed by your mother?

(Usually by obtaining a certificate or diploma)

□1.Elementary school；□2.Junior high school；□3.Senior high school；

□4.University/college；□5.Master degree；□6.Doctor degree；□7.Other:

Q 1.16 Do your parents/ spouse/ children receive medical training or engage in medical-related
career? (eg. nurse, doctor, pharmacist etc)?

□1. Father；□2.Mother；□3.Spouse；□4. Children；□5.None

Q 1.17 What kind of diseases your parents and grandparents have had? (multi-choice)

□1.Diabetes；□2.Hypertension；□3.Hepatitis；□4.Heart disease；□5.Cancer；□6.Pneumonia；

□7.Cerebrovascular Disease；□8.Respiratory Disease；□9.Kidney Disease；□10.Mental

disorder；□11.Arthritis；□12.Eye Disease；□13.Ear Disease； □14. Other: ；

□15. None
Q 1.18 (1) Have you watched medical-related TV series or dramas?

□1.Often；□2.Sometimes；□3.Rarely；□4.Never

(2) How frequently do you get medical-related information on the Internet through computer
or cellphone?

□1.Often；□2.Sometimes；□3.Rarely；□4.Never

Q (1) Have you ever taken education courses in an educational institute?

1.19
□1.Often；□2.Sometimes；□3.Rarely；□4.Never
 (2) Have you ever taken health-related education courses and seminars?

□1.Often；□2.Sometimes；□3.Rarely；□4.Never

Q What kind of transportation do you usually use?

1.20
□Public transportation；□Car；□Motorcycle/Scooter；□Bicycle；□By foot

Part 2 – Health Literacy

On a scale from very easy to very difficult, how easy would you say it is to:
Very Fairly Fairly Very
difficult difficult easy easy
…find information about symptoms of illnesses that
Q 2.1
concern you?
…find information on treatments of illnesses that
Q 2.2
concern you?
…find out what to do in case of a medical
Q 2.3
emergency?
…find out where to get professional help (such as
Q 2.4
doctor, pharmacist, psychologist) when you are ill?
Q 2.5 …understand what your doctor says to you?
…understand the leaflets that come with your
Q 2.6
medicine?
Q 2.7 …understand what to do in a medical emergency?
…understand your doctor’s or pharmacist’s
Q 2.8
instruction on how to take a prescribed medicine?
…judge how information from your doctor applies to
Q 2.9
you?
…judge the advantages and disadvantages of
Q 2.10
different treatment options?
…judge when you may need to get a second opinion
Q 2.11
from another doctor?
…judge if the information about illness in the media
Q 2.12
(such as TV, Internet, or other media) is reliable?
…use information the doctor gives you to make
Q 2.13
decisions about your illness?
Q 2.14 …follow the instructions on medication?
Q 2.15 …call an ambulance in an emergency?
…follow instructions from your doctor or
Q 2.16
pharmacist?
Q 2.17 …find information about how to manage unhealthy
 behavior such as smoking, low physical activity and
drinking too much?
…find information on how to manage mental health
Q 2.18
problems like stress or depression?
…find information about vaccinations and health
Q 2.19 screenings (such as breast exam, blood sugar test,
blood pressure) that you should have?
…find information on how to prevent or manage
Q 2.20 conditions like being overweight, high blood pressure
or high cholesterol?
…understand health warnings about behavior such as
Q 2.21 smoking, low physical activity and drinking too
much?
Q 2.22 …understand why you need vaccinations?
…understand why you need health screenings (such
Q 2.23
as breast exam, blood sugar test, blood pressure)?
…judge how reliable health warnings are, such as
Q 2.24 smoking, low physical activity and drinking too
much?
…judge when you need to go to a doctor for a
Q 2.25
check-up?
Q 2.26 …judge which vaccinations you may need?
…judge which health screenings (such as breast
Q 2.27 exam, blood sugar test, blood pressure) you should
have?
…judge if the information on health risks in the
Q 2.28 media (such as TV, Internet or other media) is
reliable?
Q 2.29 …decide if you should have a flu vaccination?
…decide how you can protect yourself from illness
Q 2.30
based on advice from family and friends?
…decide how you can protect yourself from illness
Q 2.31 based on information in the media (such as
Newspaper, leaflets, Internet or other media)?
…find information on healthy activities such as
Q 2.32
exercise, healthy food and nutrition?
…find out about activities (such as meditation,
Q 2.33 exercise, walking, Pilates etc. ) that are good for your
mental well-being?
Q 2.34 …find information (such as reducing noise and
 pollution, creating green spaces, leisure facilities) on
how your neighborhood could be more
health-friendly?
…find out about political changes (such as
legislation, new health screening programs, change of
Q 2.35
government, restructuring of health services etc.) that
may affect health?
…find out about efforts to promote your health at
Q 2.36
work?
…understand advice on health from family members
Q 2.37
or friends?
Q 2.38 …understand information on food packaging?
…understand information in the media (such as
Q 2.39 Internet, newspaper, magazines) on how to get
healthier?
…understand information on how to keep your mind
Q 2.40
healthy?
…judge how where you live (such as your
Q 2.41 community, neighborhood) affects your health and
well-being?
…judge how your housing conditions help you to
Q 2.42
stay healthy?
…judge which everyday behavior (such as drinking
Q 2.43 and eating habits, exercise etc.) is related to your
health?
Q 2.44 …make decisions to improve your health?
Q 2.45 … join a sports club or exercise class if you want to?
…influence your living conditions that affect your
Q 2.46
health and wellbeing?
…take part in activities that improve health and
Q 2.47
well-being in your community?

Part 3 – Personal Health Information

Q 3.1 How is your health in general?

□1. Very bad；□2. Bad；□3. Fair；□4. Good；□5. Very good

Q 3.2 Do you have any long-term illness or health problem?

By long-term I mean problems which have lasted, or you expect to last, 6 months or more?

□1.Yes, more than one；□2.Yes, one；□3.No

Q 3.3 For at least the last 6 months, how much have your health problems limited the activities you would
usually do?

□1.Severely limited；□2.Limited but not severely；□3.Not limited at all

Q 3.4 What kind of health insurance do you have?

□1.Public；

□2.Public and private（Multiple answers possible：□Life insurance、□Casualty insurance、

□Health Insurance、□Others、□Don’t know）；

□3.Private（Multiple answers possible：□Life insurance、□Casualty insurance、

□Health Insurance、□Others、□Don’t know）；

□4.None；

□5.Don’t know/Refuse to answer

Q 3.5 How many times have you … ?
6 Don’t
1–2 3–5 times know/
0
times times or Refuse to
more answer
A …had to contact the emergency service in the last 2 years?
(e.g. Ambulance, out of hours clinic, emergency
department)
B … been to the doctor (Western medicine) in the last 12
months?
…been to the doctor (Dentist) in the last 12 months?
…been to the doctor (Chinese medicine) in the last 12
months?
C …used a hospital service in the last 12 months?
D …used service from other health professionals, such as
dentist, physiotherapist, psychologist, dietician, or optician
in the last 12 months?
E …raised a question during your doctor appointment?
Q 3.6 For the past 12 months, on average, how long is your doctor’s appointment?
Less than 5 6-10 11-20 21-30 Over 30 Not
minutes minutes minutes minutes minutes applicable
A When you visit for a Western
medicine doctor appointment, on
average, how long is your doctor’s
appointment?
B How long do you think a Western
medicine doctor appointment should
be?
C When you visit for a Dentist
appointment, on average, how long is
your doctor’s appointment?
D How long do you think a Dentist
appointment should be?
E When you visit for a Chinese
medicine doctor appointment, on
average, how long is your doctor’s
appointment?
F How long do you think a Chinese
medicine doctor appointment should
be?
Q 3.7 For the past 12 months, on average, how long is the waiting time when you visit for an appointment?
Less than 5 6-10 11-20 21-30 Over 30 Not
minutes minutes minutes minutes minutes applicable
A When you visit for a Western
medicine doctor appointment, on
average, how long is the waiting
time?
B How long do you think the waiting
time for a Western medicine doctor
appointment should be?
C When you visit for a Dentist
appointment, on average, how long is
the waiting time?
D How long do you think the waiting
time for a Dentist appointment
should be?
E When you visit for a Chinese
medicine doctor appointment, on
average, how long is the waiting
time?
F How long do you think the waiting
time for a Chinese medicine doctor
appointment should be?
Q 3.8 Have you used internet, or registration booking system or other methods to avoid
appointment-waiting time?

□1.Often；□2.Sometimes；□3.None
Q 3.9 Regarding betel nut, which of the following applies to you?

□1.You chew betel nut at the present time；□2.You used to chew but you have stopped；

□3.You have never chewed

Q 3.10 Regarding smoking cigarettes, cigars, or a pipe, which of the following applies to you?

□1.You smoke at the present time；□2.You used to smoke but you have stopped；

□3.You have never smoked

Proceed Question 11 if “smoke at the present time”, others Go To Question 12
Q 3.11 Do you use the following tobacco products everyday, occasionally or not all?
Yes, Yes, No,
every occasion not at all
day ally
Manufactured cigarettes
Hand-rolled cigarettes
Q 3.12 During the past 12 months, did you drink any alcoholic beverage (beer, wine, spirits, cider, or other
local beverages?)

□1.Yes；□2.No

Proceed Question 13 if “Yes”, others Go To Question 18

Q 3.13 How often in the past 12 months have you had 5 or more drinks on one occasion?

□1.Several times a week；□2.Once a week；□3.Once a month；□4.Less than once a month；□5.Never

Q 3.14 Do you drink any alcoholic beverages (beer, wine, spirits, cider, or other local beverages) in the last
30 days?

□1.Yes；□2.No

Proceed Question 16 if “Yes”, others Go To Question 17

Q 3.15 In the last 30 days, how many times did you drink any alcoholic beverages?

□1.Daily；□2.4–5 times；□3.2–3 times；□4.Once a week；□5.2–3 times a month；□6.Once

Q 3.16 On a day when you drink alcoholic beverages, how many do you usually drink?

□1.Less than 1 drink；□2.1–2 drinks；□3.3–4 drinks；□4.5–6 drinks；□5.7–9 drinks；

□6.10 or more drinks；□7.It depends

Q 3.17 How often during the last month did you exercise for 30 minutes or longer e.g. running, walking,
cycling?

□1.Almost everyday；□2.A few times a week；□3.A few times this month；□4.Not at all；

□5.I haven’t been able to exercise

Q 3.18 Do you have a family member or a friend to take with you to a doctor’s appointment?

□1.Often；□2.Seldom；□3.None

Q 3.19 Are you actively involved in your community, for example do you volunteer or take part in
activities?

□1.Almost everyday；□2.A few times a week；□3.A few times a month；□4.A few times a year；

□5.Not at all

Part 4 – Social and Economic Information

Q 4.1 What is your current ‘main status’ of employment? (Choose the best fit answer)

□1.Carried out a job or profession, including unpaid work for a family business or holding,
including an apprenticeship or paid traineeship, etc.；

□2.Full-time；□3.Part-time；□4.Unemployed；

□5.Pupil, student, further training, unpaid work experience；

□6.In retirement or early retirement or has given up business；

□7.Permanently disabled；□8.In military or community services；

□9.Full-time homemaker, parent or career；□10.Inactive；

□11.Other (Please specify )

Q 4.2 Have you ever been trained or employed in a healthcare profession e.g. as nurse, doctor,
pharmacist?

□1.Yes；□2.No

Q 4.3 Are you able to pay for medication if needed to manage your own health? Is it?

□1.Very easy；□2.Fairly easy；□3.Fairly difficult；□4.Very difficult

Q 4.4 Are you able to afford to see the doctor in regard to time, health insurance, cost, and transport? Is it?

□1.Very easy；□2.Fairly easy；□3.Fairly difficult；□4.Very difficult

Q 4.5 During the last twelve months, would you say you had difficulties to pay your bills at the end of the
month?

□1.Most of the time；□2.From time to time；□3.Almost never/never

Q 4.6 On average, what is your net income per month?

□1. Less than USD $333 (include no income)；□2. USD $333-1,000；□3. USD $1,000-1,666；

□4. USD $1,666-2,333；□5. USD $2,333-3,000； □6. USD $3,000-4,000；□7. USD $4,000-5,000；

□8. USD $5,000 or more

Q 4.7 On average, what is your spouse’s net income per month in the recent year?

□1. I have no Spouse； □2. Less than USD $333 (include no income)；□3. USD $333-1,000；

□4. USD $1,000-1,666；□5. USD $1,666-2,333；□6. USD $2,333-3,000； □7. USD $3,000-4,000；

□8. USD $4,000-5,000；□9. USD $5,000 or more

Q 4.8 On the following scale, step “1” corresponds to the “lowest level in the society”; step “10”
corresponds to the “highest level in the society.” Could you tell on which step you would place
yourself?

□1(The lowest level in the society)；□2；□3；□4；□5；□6；□7；□8；□9；□10(The highest level

in the society)
Q 4.9 Comparing yourself to other people in your age and gender, how do you think about your health?

□1. Worse than the majority；□2. Worse than a few other people；□3.Average；

□4. Better than a few other people；□5. Better than the majority

Q 4.10 Which of the following principles applies to your concept of health?

□1.Health weighs more than job/work；

□2.It’s acceptable to sometimes compromise your health for job/work；

□3.You are perfectly capable of balancing both health and job/work at the same time；

□4.Job/work weighs more than health；

□5.It’s difficult to decide which is more important；

□6.I don’t know

Part 5 – Functional Health Literacy

This part of the Study will look at health information on food packaging.
The following information gives you the kind of information you might find on the back of a container of
ice cream that you just bought at the supermarket.
Please read the information carefully before you move on to the questions.
The questions are designed to be difficult, if you cannot answer them, please leave them blank.
Thank you for your cooperation!

Product Description: Ice Cream

Serving Size: 100ml
Servings per container: 4
Nutritional Information
Per 100ml
Energy 1050 KJ
250 kcal (calories)
Protein 4g
Carbohydrate 30 g
of which sugars 23 g
Fat 13 g
of which saturates 9g
of which monounsaturates 0g
of which polyunsaturates 3g
of which trans fats 1g
Fibre 0g
Sodium 0.05 g
Ingredients: Cream, Skimmed Milk, Sugar, Whole Egg, Stabilisers (Guar Gum),
Peanut Oil, Vanilla Extract (0.05%)
Q 5.1 How many calories (kcal) will you eat if you eat the whole container of ice Ans:
cream?
Q 5.2 If you are advised to eat no more than 60 grams of carbohydrate for dessert, Ans:
what is the maximum amount of ice cream you could have?
Q 5.3 Imagine that your doctor advises you to reduce the amount of saturated fat Ans:
in your diet. You usually have 42 g of saturated fat each day, some of which
comes from one serving of ice cream. If you stop eating ice cream, how
many grams of saturated fat would you be eating each day?
Q 5.4 If you usually eat 2500 calories each day, what percentage of your daily Ans:
calorie (kcal) intake will you get if you eat one serving of ice cream?
Imagine that you are allergic to the following substances: penicillin, peanuts, latex gloves, and bee
stings.
Q 5.5 Is it safe for you to eat this ice cream? Ans:
Proceed Question 6 if you answered “It’s not safe”
Q 5.6 Why not? Ans:
Proceed Question 7 if you answered “Because you might have an allergic reaction”
Q 5.7 Why would you have an allergic reaction? Ans: