Mixed-mode data collection: general and communicative health literacy in France; the HLS24 survey

Background

The 2024 European Health Literacy Survey (HLS24) assessed health literacy in the general population. This analysis focused on two scales: the 12-item HLS-Q12, measuring general health literacy, and the 9-item HLS-COM, measuring communicative health literacy in interactions with doctors. Both cover accessing, understanding, appraising and applying health information. The aim was to assess whether telephone and web respondents differed in profile and health literacy results in France.

Methods

Weighted French HLS24 data were analysed. Telephone and web respondents were compared on sociodemographic and health characteristics. Age- and sex-adjusted mean scores and item-level difficulty were compared by survey mode for HLS-Q12 and HLS-COM.

Results

Among 1,529 respondents, 4.8% completed the survey by telephone. They were older, less educated and more often inactive than web respondents. For HLS-Q12, the adjusted mean score was lower among telephone respondents (59.3 vs 62.0/100; p = 0.039). The clearest item-level difference concerned understanding health advice from family or friends (37.8% vs 18.9%; p = 0.001). For HLS-COM, the overall score did not differ (67.8 vs 67.6/100; adjusted p = 0.838), although understanding information provided by the doctor was more often rated difficult by telephone respondents (28.3% vs 13.8%; p = 0.025).

Conclusions

Mixed-mode data collection reached different respondent profiles. Mode-related differences were mainly observed for understanding-related items. However, these differences were reflected in the overall HLS-Q12 score, but not in the overall HLS-COM score. This may suggest for telephone-respondent’s profiles that understanding difficulties have a greater impact on broader health literacy tasks, which rely on more general and system-related competencies, than communicational health literacy where interaction with health professionals may provide some support. Further analyses are needed to clarify these patterns.

Key messages

• Mixed-mode telephone/web data collection reached distinct respondent profiles; telephone respondents had lower adjusted general health literacy, but similar communicative health literacy with doctors.

• Across both health literacy scales, differences between telephone and web respondents were mainly concentrated in understanding-related items.