Development of a health literacy prediction model: Using HLS-EU-Q16 questionnaire data from a population-based survey

Background Health literacy (HLIT) has been linked to both individual- and population-level outcomes; however, the large-scale measurement of HLIT presents practical challenges. This study aimed to develop a predictive model for HLIT using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16), a standardised survey instrument created by the HLS-EU consortium, to facilitate assessment and comparison of HLIT across countries.

Data were derived from the Korea Health Panel Survey, conducted between March and July 2021, involving a final sample selection of 9,510 participants. Variables were selected based on previously demonstrated theoretical and empirical relevance, and backward multiple linear regression was conducted to develop the prediction model on 70% of the data, which was later validated on the remaining 30%.

The final model identified age, sex, education level, and annual household income as significant predictors of HLIT scores while maintaining model parsimony. The model explained approximately one-third of the variance in HLIT within the test set with a weighted R2 of 0.34 and showed a root-mean-square error of approximately 3.73 points in predicting the 0–16 HLIT score. Pearson’s correlation analysis further supported the validity of the model, showing a strong positive correlation between the observed and predicted HLIT scores (r = 0.63, p < 0.001).

The findings of our study provide a feasible model for predicting HLIT scores from population-based data, in this case, Korea Health Panel Survey data in combination with the HLS-EU-Q16, allowing for the effective measurement of HLIT, which would otherwise be time-consuming. This model has implications for use in cross-country comparisons of HLIT and in helping to inform public health policies and planning. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study adhered to the Declaration of Helsinki and the Institutional Review Board of Korea University approved the study protocol, granting an IRB exemption and waiving the requirement for informed consent (reference No. KU_IRB-2025-0153-01). The data is owned by a third party and the authors had no special access privileges others would not have. A request for the data used for this study can be made on https://www.khp.re.kr:444/eng/data/data.do. Inquiries regarding data acquisition should be sent to the Korea Institute for Health and Social Affairs (email: khp{at}kihasa.re.kr). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data is owned by a third party and the authors had no special access privileges others would not have. A request for the data used for this study can be made on https://www.khp.re.kr:444/eng/data/data.do. Inquiries regarding data acquisition should be sent to the Korea Institute for Health and Social Affairs (email: khp{at}kihasa.re.kr). LIST OF ABBREVIATIONS - HLIT - Health literacy - HLS-EU-Q16 - European Health Literacy Survey Questionnaire