Health literacy in Japanese people is often low because people find it difficult to evaluate health information and make informed decisions. Clarifying the association between health literacy and the skills to evaluate information and make appropriate decisions (not necessarily limited to health information) would inform efforts to improve health literacy. Therefore, the study objectives were to investigate the following issues using a nationwide survey in Japan: 1) When obtaining information, to what extent do people appropriately evaluate whether the information is reliable, and when making decisions, to what extent do they seek out available options and compare pros and cons based on their own values? 2) How strongly are these skills associated with health literacy and demographic characteristics? 3) What opportunities are available to learn these skills?
An online questionnaire survey was conducted using a Japanese Internet research company; 3,914 valid responses were received. The measures comprised health literacy (European Health Literacy Survey Questionnaire), five items on information evaluation, four items on the decision-making process, and items on the availability and location of learning opportunities. Pearson correlations were calculated to explore the association of health literacy with information-evaluation and decision-making skills. Multivariate analyses were also conducted using these factors as dependent variables.
Less than half of respondents always or often evaluated information and engaged in the decision-making process. Health literacy was significantly correlated with information evaluation and the decision-making process (.26 and .30, respectively). More than 40% of respondents had no learning opportunities. Respondents who did have learning opportunities learned on their own, rather than at school or work, using sources such as the Internet and television.
Both information-evaluation and decision-making skills were associated with health literacy. However, these skills are not sufficiently widespread in Japan, because there are few opportunities to learn them. More research is needed to raise awareness of the importance of these skills for improving health literacy, and to provide appropriate learning opportunities. Additionally, an environment must be created in which all individuals can easily receive support at any time, so that they can make appropriate decisions based on reliable information.