Gesundheitskompetenz bei sozioökonomischer Benachteiligung: Determinanten, Interventionsstrategien, Bedarfe und Messung unter Personen in Langzeitarbeitslosigkeit

Significant health literacy deficits in Germany and across Europe led to the publication of the National Action Plan for Health Literacy in 2018, providing a framework for targeted interventions. Subsequently, the literature revealed initial efforts to promote health literacy among specific population groups. Despite these efforts, systematic approaches—particularly for socioeconomically disadvantaged groups—remain scarce. This dissertation aims to bridge these gaps by (a) identifying modifiable predictors of health literacy, (b) analyzing effective intervention strategies to promote health literacy among populations experiencing socioeconomic disadvantage, (c) exploring the specific health literacy needs of long-term unemployed individuals, and (d) assessing the suitability of standard health literacy measurement tools for socioeconomically disadvantaged populations, using long-term unemployed individuals as a case example. Long-term unemployed individuals were chosen as a focal group because they fulfill multiple risk factors for low health literacy, such as socioeconomic disadvantage and a high prevalence of chronic mental and physical illnesses, making them particularly vulnerable.

To address these objectives, the study employed a variety of methodological approaches: (a) a rapid review, (b) a systematic review, (c) a triangulation of qualitative data with a scoping review, and (d) an explorative qualitative think-aloud study.
Key findings highlighted language proficiency, frequency of internet use, and use of online and television-based resources for obtaining health-related information as the most significant modifiable predictors of health literacy. Successful intervention strategies identified in the literature often assessed group-specific needs prior to implementation, utilized multilingual intervention materials, and involved bilingual facilitators. Among unemployed populations, the primary health literacy needs identified pertained to mental health. Furthermore, these individuals faced primarily difficulties in applying health information to their daily lives. Participants in long-term unemployment demonstrated significant difficulties in comprehending standard health literacy assessment questions, such as those in the HLS-EU-Q16 questionnaire. These challenges were primarily attributed to the level of abstraction required by the questionnaire, which was often too demanding for respondents.

Culturally sensitive, tailored interventions that provide multilingual informational materials emerged as promising approaches to promote health literacy. Long-term unemployed individuals could benefit from interventions designed to facilitate the practical application of health information in everyday life. Additionally, the comprehensibility of standard health literacy measurement tools could be improved by incorporating context-specific explanations and audiovisual elements.