Christopher Le

• Bevilacqua, Roberta; Sgolastra, Arianna; Giammarchi, Cinzia; Finbråten, Hanne Søberg; Guttersrud, Øystein & Le, Christopher [Show all 24 contributors for this article] (2026). Organisational health literacy in healthcare in Europe: a content analysis to explore stakeholders perspectives for supporting the adoption of effective strategies and interventions. Archives of Public Health. ISSN 0778-7367. 84(1). doi: 10.1186/s13690-026-01956-6. Full text in Research Archive
• Le, Christopher; Straßmayr, Christa; Giraudeau, Nicolas; Cresswell-Smith, Johanna; Barailla, Camille & Berrefjord, Peder Ringnes [Show all 10 contributors for this article] (2025). Strengthening population and organizational health literacy to reduce social inequalities within the JA PreventNCD. Scandinavian Journal of Public Health. ISSN 1403-4948. 53(Non-communicable disease prevention and health promotion across Europe), p. 43–53. doi: 10.1177/14034948251372119. Full text in Research Archive Show summary

  Aims: Health literacy is considered a key social determinant of health. It plays an important role in the prevention and management of non-communicable diseases (NCDs), contributing to better health and well-being. Therefore, the overall aim of the health literacy focus (Action) within the European Joint Action to prevent NCDs (JA preventNCD) is to promote general, digital, mental and organizational health literacy to improve health outcomes and counteract NCD-related health inequities in Europe. This paper presents a rational and methodological approach for strengthening health literacy in Europe. Methods: The Action will be implemented through collaboration among 13 Eu member States and three non-Eu member States, using both quantitative and qualitative research approaches including questionnaire-based surveys, literature reviews, in-depth interviews, and focus groups, as well as stakeholder and user involvement. The implementation will be guided by a Health Literacy Approach to Theory of Change and carried out in three main phases: 1) project development, 2) data collection, data-analysis and tool development, and 3) recommendations for policy, research, and practice and dissemination. Conclusions: The project supports participating countries in conducting a comprehensive national-level situation analysis and provides a solid foundation for further developing national health literacyrelated policies, strategies or action plans. The project’s expected outcome will contribute to promoting general, digital, mental and organizational health literacy in the prevention of NCDs in Europe. A Theory of Change and a coordinated approach facilitate the development of shared platforms, such as the European Health Literacy Arena, which help maintain collaboration and visibility beyond the lifetime of the project.

• Christa, Straßmayr,; Finbråten, Hanne Søberg; Maria, Bitzer, Eva; Guglielmo, Bonaccorsi,; Gabriella, Cacciuttolo, Maria & Jan, Dudra, [Show all 24 contributors for this article] (2025). Assessing organizational health literacy in hospitals by using the International Self-Assessment Tool for Organizational Health Literacy of Hospitals – a feasibility study in six European countries. BMC Health Services Research. 25. doi: 10.1186/s12913-025-13367-4. Full text in Research Archive Show summary

  Hospitals can gain valuable insights into their current level of organizational health literacy (OHL) by using self-assessment tools. OHL self-assessment tools can serve as useful instruments for supporting the planning and implementation of OHL interventions aimed at promoting health equity and improving patient outcomes. This explorative study aimed to pilot the International Self-Assessment Tool for Organizational Health Literacy (Responsiveness) of Hospitals (OHL-Hos) among hospitals across six countries. The OHL-Hos, grounded in a comprehensive theoretical framework consisting of eight standards, 21 sub-standards and 141 indicators, was piloted in seven hospitals: one in Austria, Germany, the Czech Republic, Norway and Serbia, and two in Italy. In each hospital, the feasibility of using the OHL-Hos was investigated regarding acceptability, implementation, practicality, and integration, identifying strengths and areas for improvement using descriptive analyses. The self-assessment process included individual rating of an interdisciplinary and inter-hierarchical assessment team regarding OHL-Hos indicators from their personal perspectives, followed by a joint assessment to reach a consensus on different ratings. The process and experiences were documented in semi-structured forms, while the ratings on the indicators were documented numerically. All hospitals successfully self-assessed their OHL, identifying strengths and areas for improvement. The self-assessment process varied slightly among countries. While the tool was considered important but lengthy and complex, introductory workshops facilitated successful implementation. The self-assessment process raised awareness and stimulated discussions on improving OHL, highlighting the tool’s potential for organizational development. The OHL-Hos can serve as a useful tool to identify strengths and areas for improvement in OHL in hospitals. The overall experience with the tool was positive and the joint assessment with the tool was found to foster consensus and enable reflection on OHL, but its comprehensive nature poses challenges to its implementation, leading to recommendations for developing a shortened version of the tool with simple language. Certain indicators require specific knowledge, suggesting different professional groups should address relevant parts.

• Kamperud, Pia Emilie; Tapper, Trine; Spilker, Ragnhild Storstein; Le, Christopher; Guttersrud, Øystein & Finbråten, Hanne Søberg (2025). Helsekompetansevennlige helsetjenester fra brukerperspektivet – en tematisk analyse. Sykepleien Forskning. ISSN 1890-2936. 20. doi: 10.4220/Sykepleienf.2025.100410. Full text in Research Archive Show summary

  Bakgrunn: Forskning viser at befolkningens helsekompetanse varierer. Målet om likeverdig tilgang til helseinformasjon og helsetjenester krever at helsetjenestene tilpasses befolkningens kompetanse. Helsekompetansevennlige helsetjenester kjennetegnes ved at de tilrettelegger for at brukere finner frem i helsetjenestene og kan forstå og anvende helseinformasjonen som bli gitt. I en norsk pilotundersøkelse rapporterte ledere og ansatte i ulike helseinstitusjoner at helsepersonell i direkte pasientkontakt er opptatt av å tilpasse informasjonen til brukernes helsekompetanse, men at tiltakene i liten grad er forankret i prosedyrer og retningslinjer. Foreløpig har vi begrenset kunnskap om hvor helsekompetansevennlige brukerne opplever at tjenestene er. Brukererfaringer kan bidra til å gjøre helsetjenestene mer helsekompetansevennlige. Hensikt: Hensikten med vår studie var å beskrive brukeres erfaringer med hvor helsekompetansevennlig helsetjenestene er. Metode: Studien har et deskriptivt kvalitativt design. Datamaterialet ble samlet inn gjennom fokusgruppeintervjuer på fem ulike helseinstitusjoner fra juni 2022 til januar 2023. Vi analyserte datamaterialet ved å bruke tematisk analyse inspirert av Braun og Clarke. Resultat: Analysen identifiserte fire hovedtemaer: 1) «Å finne frem», 2) «Digital tilgang og forberedthet hos brukere», 3) «Kommunikasjon med helsetjenestene» og 4) «Tilrettelegging i overganger». Hovedtema 1 og 3 omfatter to undertemaer hver. Konklusjon: Brukerne mente det var enklere å finne frem til helseinstitusjonene enn å finne frem inne på dem. Flere og flere helsetjenester krever digital tilgang og tilstrekkelig forberedte brukere. Helsekompetansevennlige helsetjenester forutsetter at helsepersonell tilpasser kommunikasjonen til brukernes helsekompetanse. Tilstrekkelig og tilpasset informasjon kan bidra til å skape trygge overganger fra helseinstitusjonen til hjemmet, og brukererfaringer kan bidra til å gjøre helsetjenestene mer helsekompetansevennlige. Helsetjenestene har flere rutiner og tiltak som fremmer brukernes helsekompetanse, men brukerne uttrykte et behov for ytterligere forbedringer.

• Levin-Zamir, Diane; Broucke, Stephan Van den; Bíró, Éva; Bøggild, Henrik; Bruton, Lucy & Gani, Saskia Maria De [Show all 24 contributors for this article] (2025). Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries. Frontiers in Public Health. 13. doi: 10.3389/fpubh.2025.1472706. Full text in Research Archive Show summary

  Introduction: Digital health information sources are playing an increasingly prominent role in health promotion, public health and in healthcare systems. Consequently, digital health literacy skills are likewise becoming increasingly important. Methods: Using a concept validation approach, the aim of the study was to validate the digital health literacy measure HLS19-DIGI, applied in the European Health Literacy Survey (2019–2021) of the WHO M-POHL network, analyzing data from 28,057 respondents from 13 countries. The instrument is a modified and extended version of the Digital Health Literacy Instrument (DHLI). Results: The scale displayed high internal consistency. Confirmatory factor analysis (CFA) strengthened the hypothesized one-factor structure. In most countries, the data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). Pearson correlation with a measure of general health literacy showed sufficient discriminant validity, and a social gradient was found. Testing for predictive validity showed that the scale score predicts health-related outcomes. Discussion: The study shows that considerable proportions of the general adult populations across countries in Europe have limited DHL skills. The level of DHL has direct potential consequences for some forms of health service utilization, in some countries. Implications of the study include recommendations for improving digital health literacy, promoting organizational health literacy and quality assurance for digital health information and resources.

• Le, Christopher; Finbråten, Hanne Søberg; Griebler, Robert; Levin-Zamir, Diane & Guttersrud, Øystein (2025). Ability to Utilize Digital Health Services: Validation of the Digital HealthCare Scale in Adolescents and Young Adults. HLRP: Health Literacy Research and Practice. 9(1), p. e19–e28. doi: 10.3928/24748307-20241204-01. Full text in Research Archive Show summary

  Background: While adolescents and young adults are increasingly expected to take more responsibility for their health and wellbeing, continuing digital transformation and increased implementation of digital health services (DHS) demand skills to utilize digital solutions offered to successfully undertake self-care and self-management. However, research is lacking regarding measurement of adolescents' and young adults' “ability to utilize DHS” (or “DHC”). Objective: This study aims to measure young people's DHC by (1) validating the Digital HealthCare Scale (DHC scale) in adolescents and in young adults and (2) exploring the extent to which DHC and digital health literacy (DHL) are associated with the number of general practitioner, emergency, or specialist visits. Methods: A cross-sectional survey was conducted among 890 Norwegian adolescents and young adults age 16 to 25 years. Data were collected from April 2020 to October 2020 using computer-assisted telephone interviewing. Rasch modeling, independent samples t-test, chi-square test, and negative binomial regression models were used to analyze the data. Key Results: The DHC scale is considered valid for measuring DHC in adolescents and young adults, showing sufficient unidimensionality, good overall data-model fit, and no disordered response categories nor differential item functioning. Results showed that female participants and adolescents age 16 to 20 years self-reported significantly lower DHL and DHC than male participants and young adults age 21 to 25 years. Regression analyses displayed a statistically significant association between adolescents' and young adults' DHL (n = 371) and DHC (n = 389) and their utilization of specialist health services. For every unit (logit) increase in DHL and DHC, the number of specialist visits decreased by 25% and 28%, respectively. Conclusions: Aligned with previous research calling for new up-to-date instruments to measure the new aspects of DHL, our study has introduced a new measurement scale (DHC scale) for use among adolescents and young adults. This scale may be useful for health authorities, public health workers, and health providers in evaluating and adapting DHC. [HLRP: Health Literacy Research and Practice. 2025;9(1):e19–e28.] Plain Language Summary: We validated the DHC scale for measuring young people's ability to use DHS. We found that DHL and DHC differed between sex and age groups and associated with the number of specialist visits. Findings foster a forward-thinking approach to measure and promote young people's health literacy toward the digitally transitioning generation.

• Baron-Epel, Orna; Link, Thomas; Griebler, Robert; Bøggild, Henrik; Berens, Eva-Maria & Bíró, Éva [Show all 19 contributors for this article] (2025). Pathways of how health literacy and social support are associated with health outcomes in 17 European countries: Results of mediation analyses. Public Health. ISSN 0033-3506. 241, p. 12–18. doi: 10.1016/j.puhe.2025.01.032. Full text in Research Archive
• Metanmo, Salvatore; Finbråten, Hanne Søberg; Bøggild, Henrik; Nowak, Peter; Griebler, Robert & Guttersrud, Øystein [Show all 39 contributors for this article] (2024). Communicative health literacy and associated variables in nine European countries: results from the HLS19 survey. Scientific Reports. 14(1). doi: 10.1038/s41598-024-79327-w. Full text in Research Archive Show summary

  Our study aimed to report on variables associated with communicative health literacy (COM-HL) in European adults. The HLS19 survey was conducted in 2019–2021 including nine countries which measured COM-HL by using a validated questionnaire (HLS19-COM-P-Q6 with a score ranging from 0 to 100). Linear regression models were used to study variables associated with COM-HL globally (multilevel model with random intercepts and slopes and at country level) and in each country. Additional models studied each of the HLS19-COM-P-Q6 items separately. The mean COM-HL score ranged between 62.5 and 76.6 across countries. Among the 18,137 pooled participants, COM-HL was positively associated with age, a higher self-perceived social status, previous training in healthcare, an increasing number of general practitioner visits; and negatively associated with female sex, reported financial difficulties, having a chronic condition and an increasing number of specialist visits. These effects were heterogeneous from one country to another, and from one item to another when analysing the different COM-HL items separately. However, there was a consistent statistically significant association between COM-HL (score and each item) and financial difficulties as well as self-perceived social status in all countries. Interventions to improve communication between patients and physicians should be a high priority to limit communication disparities.

• Le, Christopher; Guttersrud, Øystein; Levin-Zamir, Diane; Griebler, Robert & Finbråten, Hanne Søberg (2024). Associations between digital health literacy and health system navigating abilities among Norwegian adolescents: validating the HLS19-DIGI scale using Rasch modeling. BMC Public Health. 24(1). doi: 10.1186/s12889-024-19405-w. Full text in Research Archive Show summary

  Background Despite increasing global attention to health literacy and adolescents’ digital health information seeking, no unidimensional instruments measuring digital health literacy (DHL) in adolescents have reportedly been validated using Rasch modeling. Moreover, the evidence of adolescents’ abilities to navigate the health system (NAV-HL) in light of their DHL proficiency is still scarce. Therefore, our study aims to evaluate the psychometric properties of a DHL instrument (HLS19-DIGI scale) in order to investigate DHL in adolescents and young adults aged 16–25 and associations with abilities to navigate the health system. Methods A population-based cross-sectional survey among 890 Norwegian adolescents was conducted during April–October 2020 using computer-assisted telephone interviewing. Rasch modeling, independent samples t-test, chi-square test, and binary regression models were used to analyze the data. Results The HLS19-DIGI scale was sufficiently unidimensional, whereas no differential item functioning or disordered response categories were observed. However, relatively poor targeting was revealed indicating too many easy items for the target population. Yet, a high proportion (54%) of low DHL proficiency in adolescents was observed, as well as DHL was positively associated with the abilities to navigate the health system. Conclusions The HLS19-DIGI scale is considered a sufficiently unidimensional and valid instrument for measuring DHL in adolescents, which may be a useful tool for health authorities, public health workers, and health service providers. While DHL affects adolescents’ abilities to navigate the health system, future research should measure and examine their ability to utilize digital health services, separately.

• Le, Christopher; Guttersrud, Øystein; Joranger, Pål; Okan, Orkan & Finbråten, Hanne Søberg (2024). Associations between health literacy proficiencies and health-related quality of life and GP visits among young people in Norway: a population-based cross-sectional study. BMJ Open. 14(10). doi: 10.1136/bmjopen-2023-081892. Full text in Research Archive Show summary

  Objectives Despite globally increased attention from policymakers and being recognised as a critical determinant of health, health literacy (HL) research in young people (YP) remains limited. This study aims to describe HL in YP across person factors and explore the associations between HL and health-related quality of life (HRQoL) and the number of visits to general practitioners (GP visits). Design Cross-sectional study. Setting Population-based data collection applying country representative strata in Norway. Participants 890 participants aged 16–25 years. Primary and secondary measures Rasch modelling and Wright’s method were used to identify statistically distinct levels of HL proficiency. Multiple linear regression and negative binomial regression models were applied to explore the associations between HL and HRQoL, and between HL and GP visits, respectively. Results Among YP, HL was statistically significantly associated with HRQoL and the number of GP visits, when adjusting for age, gender, education, self-perceived social status and financial deprivation. For every logit increase in HL, the number of GP visits decreased by 22%. Four statistically distinct levels of HL proficiency were identified for the 12-item HLS19-YP12 scale, started from a cut-point of 23, 30, 37 and 44 out of 48. Relatedly, 70% of respondents were observed at or below level 2 (30–36 points), indicating a varying lack of central skills. The span from lowest (1) to highest (4) HL level was associated with a decrease of 2.1 GP visits per year and an increase of .12 on the EQ-5D index. Conclusions This study provides new empirical insights into the impact of HL in YP. Identified cut-points for the HLS19-YP12 may contribute to simplifying the process of adapting information and communication for various HL skills. The study also suggests the need for more efforts in HL policy and structural intervention development to enhance YP health and well-being.

• Riiser, Kirsti; Haugen, Anders L. Hage; Helseth, Sølvi; Bjørnsen, Hanne Nissen & Le, Christopher (2024). The Norwegian Perspective. In Nash, Rosie; Vaughan, Cruickshank & Shandell, Elmer (Ed.), Global Perspectives on Children’s Health Literacy. Springer. ISSN 9783031638398. p. 175–189. doi: 10.1007/978-3-031-63840-4. Full text in Research Archive
• Le, Christopher; Dahl, Kari Gire & Stein, Linda Maria (2024). Helsekompetanse hos urfolk og innvandrere. In Helseth, Sølvi; Pettersen, Kjell Sverre & Wahl, Astrid Klopstad (Ed.), Helsekompetanse Teori, forskning og praksis. Fagbokforlaget. ISSN 9788245043426. Full text in Research Archive
• Hou, Yufeng; Laasmaa, Martin; Li, Jia; Shen, Xin; Manfra, Ornella & Nordén, Einar Sjaastad [Show all 12 contributors for this article] (2023). Live-cell photoactivated localization microscopy correlates nanoscale ryanodine receptor configuration to calcium sparks in cardiomyocytes. Nature Cardiovascular Research. 2(3), p. 251–267. doi: 10.1038/s44161-022-00199-2. Full text in Research Archive
• Le, Christopher; Guttersrud, Øystein; Sørensen, Kristine & Finbråten, Hanne Søberg (2022). Developing the HLS19-YP12 for measuring health literacy in young people: a latent trait analysis using Rasch modelling and confirmatory factor analysis. BMC Health Services Research. 22, p. 1–21. doi: 10.1186/s12913-022-08831-4. Full text in Research Archive Show summary

  Background Accurate and precise measures of health literacy (HL) is supportive for health policy making, tailoring health service design, and ensuring equitable access to health services. According to research, valid and reliable unidimensional HL measurement instruments explicitly targeted at young people (YP) are scarce. Thus, this study aims at assessing the psychometric properties of existing unidimensional instruments and developing an HL instrument suitable for YP aged 16–25 years. Methods Applying the HLS19-Q47 in computer-assisted telephone interviews, we collected data in a representative sample comprising 890 YP aged 16–25 years in Norway. Applying the partial credit parameterization of the unidimensional Rasch model for polytomous data (PCM) and confirmatory factor analysis (CFA) with categorical variables, we evaluated the psychometric properties of the short versions of the HLS19-Q47; HLS19-Q12, HLS19-SF12, and HLS19-Q12-NO. A new 12-item short version for measuring HL in YP, HLS19-YP12, is suggested. Results The HLS19-Q12 did not display sufficient fit to the PCM, and the HLS19-SF12 was not sufficiently unidimensional. Relative to the PCM, some items in the HLS19-Q12, the HLS19-SF12, and the HLS19-Q12-NO discriminated poorly between participants at high and at low locations on the underlying latent trait. We observed disordered response categories for some items in the HLS19-Q12 and the HLS19-SF12. A few items in the HLS19-Q12, the HLS19-SF12, and the HLS19-Q12-NO displayed either uniform or non-uniform differential item functioning. Applying one-factorial CFA, none of the aforementioned short versions achieved exact fit in terms of non-significant model chi-square statistic, or approximate fit in terms of SRMR ≤ .080 and all entries ≤ .10 that were observed in the respective residual matrix. The newly suggested parsimonious 12-item scale, HLS19-YP12, displayed sufficiently fit to the PCM and achieved approximate fit using one-factorial CFA. Conclusions Compared to other parsimonious 12-item short versions of HLS19-Q47, the HLS19-YP12 has superior psychometric properties and unconditionally proved its unidimensionality. The HLS19-YP12 offers an efficient and much-needed screening tool for use among YP, which is likely a useful application in processes towards the development and evaluation of health policy and public health work, as well as for use in clinical settings.

• Griese, Lennert; Finbråten, Hanne Søberg; Francisco, Rita; Gani, Saskia Maria De; Griebler, Robert & Guttersrud, Øystein [Show all 15 contributors for this article] (2022). HLS19-NAV-Validation of a New Instrument Measuring Navigational Health Literacy in Eight European Countries. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(21). doi: 10.3390/ijerph192113863. Full text in Research Archive Show summary

  To manoeuvre a complex and fragmented health care system, people need sufficient navigational health literacy (NAV-HL). The objective of this study was to validate the HLS19-NAV measurement scale applied in the European Health Literacy Population Survey 2019-2021 (HLS19). From December 2019 to January 2021, data on NAV-HL was collected in eight European countries. The HLS19-NAV was translated into seven languages and successfully applied in and validated for eight countries, where language and survey method differed. The psychometric properties of the scale were assessed using confirmatory factor analysis (CFA) and Rasch modelling. The tested CFA models sufficiently well described the observed correlation structures. In most countries, the NAV-HL data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). For some countries, some items showed poor data-model fit when tested against the PCM, and some items displayed differential item functioning for selected person factors. The HLS19-NAV demonstrated high internal consistency. To ensure content validity, the HLS19-NAV was developed based on a conceptual framework. As an estimate of discriminant validity, the Pearson correlations between the NAV-HL and general health literacy (GEN-HL) scales were computed. Concurrent predictive validity was estimated by testing whether the HLS19-NAV, like general HL measures, follows a social gradient and whether it forms a predictor of general health status as a health-related outcome of general HL. In some countries, adjustments at the item level may be beneficial. Keywords: HLS19 survey; Rasch modelling; confirmatory factor analysis; health care system; health information; health literacy; instrument; navigation; questionnaire; validation.

• Link, Thomas; Pelikan, Jurgen M.; Mikšová, Dominika; Straßmayr, Christa; Alfers, Tobias & Berens, Eva Maria [Show all 23 contributors for this article] (2021). The HLS19-Q12 measure. In Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (Ed.), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. p. 88–110. Full text in Research Archive
• Levin-Zamir, Diane; Broucke, Stephan van den; Pelikan, Jurgen M.; Biro, Eva; Bøggild, Henrik & Bruton, Lucy [Show all 25 contributors for this article] (2021). Digital Health Literacy. In Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (Ed.), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. p. 275–311. Full text in Research Archive
• Doyle, Gerardine; Rowlands, Gill; Joranger, Pål; Le, Christopher; Bøggild, Henrik & Finbråten, Hanne Søberg [Show all 11 contributors for this article] (2021). Health literacy and health-related quality of life as a mediator for health costs. In Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (Ed.), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. p. 344–365. Full text in Research Archive
• Griebler, Robert; Guttersrud, Øystein; Cadeddu, Chiara; Straßmayr, Christa; Link, Thomas & Mikšová, Dominika [Show all 15 contributors for this article] (2021). Vaccination Health Literacy. In Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (Ed.), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. p. 312–343. Full text in Research Archive
• Dietscher, Christina; Pelikan, Jurgen M.; Nowak, Peter; Straßmayr, Christa; Berens, Eva Maria & Castro, Paola De [Show all 21 contributors for this article] (2021). Recommendations for policy, practice, and research. In Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (Ed.), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. p. 366–386. Full text in Research Archive
• Straßmayr, Christa; Pelikan, Jurgen M.; Link, Thomas; Mikšová, Dominika; Berens, Eva Maria & Broucke, S Van den [Show all 21 contributors for this article] (2021). Study design. In Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (Ed.), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. p. 24–56. Full text in Research Archive
• Link, Thomas; Pelikan, Jurgen M.; Mikšová, Dominika; Straßmayr, Christa; Berzelak, Nejc & Bøggild, Henrik [Show all 12 contributors for this article] (2021). Methods. In Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (Ed.), International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. p. 70–87. Full text in Research Archive
• Le, Christopher; Kale, Emine; Jareg, Kirsti & Kumar, Bernadette. N (2013). Når pasienten snakker litt norsk: En dypere forståelse av underforbruk av tolk i helsetjenester. Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 50(10), p. 999–1005. Full text in Research Archive

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• Bucciardini, Raffaella; Calabrò, Giovanna Elisa; Cresswell-Smith, Johanna; Csizmadia, Peter; Girolamo, Chiara Di & Destefanis, Cinzia [Show all 21 contributors for this article] (2025). Reducing Europe’s cancer and NCD burden through coordinated strategies on health determinants: The Joint Action on Cancer and other NCDs Prevention (JA-PreventNCD). doi: 10.1177/14034948251365171. Full text in Research Archive Show summary

  Aims:Non-communicable diseases (NCDs), including cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases, are responsible for 74% of deaths worldwide (2019). In Europe, they account for over 91% of deaths and 87% of disability-adjusted life years (DALYs). Mental disorders, also considered NCDs, rank seventh globally in terms of DALYs. These burdens are exacerbated by socioeconomic and educational inequalities that shape the distribution of risk factors and cause preventable disparities in health and mortality. This article presents the new Joint Action on Cancer and other NCDs (JA-PreventNCD), outlining its objectives and methodological strategies to tackle inequalities in Europe. Methods:The JA-PreventNCD started in January 2024. It was launched under the EU4Health Programme for the period of 2021–2027, with a specific focus on social inequalities. Over its four-year span, the initiative will: (1) collect evidence on inequalities in major NCDs and their risk factors; (2) review policies targeting these disparities; (3) provide training based on an equity lens approach; (4) enhance health literacy through multi-level activities. Conclusions:The JA-PreventNCD initiative represents a crucial opportunity to address health inequalities related to NCDs across Europe. Its findings will contribute to evidence-based health policies and promote sustainable strategies aimed at closing the gaps. Enhanced collaboration among European countries and the exchange of best practices will foster informed policy-making, leading to long-term improvements in public health.

• Haaland, M.; Helseth, S.; Skirbekk, Helge; Finbråten, Hanne Søberg; Le, Christopher & Guttersrud, Øystein (2025). Navigation health literacy and digital health literacy in individuals with long-term conditions. Patient Education and Counseling. ISSN 0738-3991. 137. doi: 10.1016/j.pec.2025.108915. Full text in Research Archive
• Haaland-Øverby, Mette; Helseth, Sølvi; Skirbekk, Helge; Finbråten, Hanne Søberg; Le, Christopher & Guttersrud, Øystein (2024). Navigational health literacy and digital health literacy in indivduals with long-term conditions. Full text in Research Archive
• Nutbeam, Don; Okan, Orkan & Le, Christopher (2024). Round table: Improving digital health literacy in the era of generative artificial intelligence. Full text in Research Archive
• Le, Christopher & Griebler, Robert (2024). Health literacy in Europe: Building a comparative database for shaping public health policy. Full text in Research Archive
• Le, Christopher (2023). Helsekompetanse (health literacy). MAEMP4200 Helsepedagogikk (3 timers forelesning). Full text in Research Archive
• Le, Christopher (2023). Digital helsekompetanse i en tid med rask digitalisering av helsetjenester. Full text in Research Archive
• Le, Christopher (2023). Effects of health literacy proficiency on health-related quality of life and GP visits among young people. Full text in Research Archive
• Le, Christopher (2023). Hvorfor snakker alle om helsekompetanse for tiden,- hva er det og hvorfor er det viktig? Full text in Research Archive
• Riiser, Kirsti; Haugen, Anders L. Hage; Helseth, Sølvi; Bjørnsen, Hanne Nissen & Le, Christopher (2023). Barn og unges helsekompetanse i skjæringspunktet mellom helse og utdanning. Et norsk perspektiv. Full text in Research Archive
• Le, Christopher; Guttersrud, Øystein & Finbråten, Hanne Søberg (2023). Helsekompetansevennlige helsetjenester – Hvordan kan vi få til det? Full text in Research Archive
• Haaland-Øverby, Mette; Guttersrud, Øystein; Helseth, Sølvi; Skirbekk, Helge; Finbråten, Hanne Søberg & Le, Christopher (2023). Digital health literacy and Navigation health literacy in people with long-term conditions - Applied Rasch modeling for latent trait analysis. Full text in Research Archive
• Finbråten, Hanne Søberg; Guttersrud, Øystein; Spilker, Ragnhild Anne Caroline Storste & Le, Christopher (2022). Pilotering av standarder for helsekompetansevennlige organisasjoner. Full text in Research Archive
• Le, Christopher (2022). Health literacy. MAVIT5100 Health Communication (2 hours lecture). Full text in Research Archive
• Le, Christopher; Guttersrud, Øystein; Sørensen, Kristine & Finbråten, Hanne Søberg (2022). Utviklingen av måleskalaen HLS19-YP12 for måling av helsekompetanse hos unge personer, ved bruk av Rasch-modellering og konfirmerende faktor analyse. Full text in Research Archive
• Le, Christopher; Guttersrud, Øystein & Finbråten, Hanne Søberg (2022). Using Rasch-modelling to assess the psychometric properties of the HLS19-COM-NO, HLS19-NAV-NO, HLS19-DSK, and HLS19-DHL scales for measuring communicative, navigational and digital health literacy in adolescents and young adults. A nation-wide cross-sectional study in Norway. Full text in Research Archive
• Haaland-Øverby, Mette; Helseth, Sølvi; Stenberg, Una; Le, Christopher; Finbråten, Hanne Søberg & Pettersen, Kjell Sverre [Show all 7 contributors for this article] (2022). Helsekompetanse og langvarige helseutfordringer En presentasjon av ph.d.-studie ved Institutt for sykepleie og helsefremmende arbeid på OsloMet. Full text in Research Archive
• Guttersrud, Øystein; Finbråten, Hanne Søberg; Haaland-Øverby, Mette; Sørensen, Kristine & Le, Christopher (2022). Måling av helsekompetanse – videreutvikling av måleskalaer ved bruk av lineær logistisk testmodell. Full text in Research Archive
• Le, Christopher (2021). Nordic Network on Health Literacy - Policy Development in Norway. Full text in Research Archive
• Le, Christopher; Guttersrud, Øystein; Pettersen, Kjell Sverre & Finbråten, Hanne Søberg (2021). HLS19, preliminære resultater fra ungdom og unge voksne 16-24 år. Full text in Research Archive
• Le, Christopher; Guttersrud, Øystein; Pettersen, Kjell Sverre & Finbråten, Hanne Søberg (2021). Measuring youth health literacy in Norway during the COVID-19 pandemic. Full text in Research Archive
• Le, Christopher; Guttersrud, Øystein; Pettersen, Kjell Sverre & Finbråten, Hanne Søberg (2021). Helsekompetanse blant unge personer under Covid-19 pandemien. Full text in Research Archive
• Le, Christopher (2021). European health literacy policy - a recipe for success! A panel discussion. Full text in Research Archive
• Le, Christopher (2021). Collaborating on the future of health; The European Health Union - how and why? [Internet]. https://www.youtube.com/watch?v=Dfs0wrx43u8&list=PLV5yuHAZ8t. Full text in Research Archive
• Le, Christopher (2021). Øke helsekompetansen i befolkningen - hva må til for å ruste sykehus og kommuner for oppgaven? [Internet]. https://vimeo.com/570196136. Full text in Research Archive
• Le, Christopher (2021). Helsekompetanse i et europeisk perspektiv. Full text in Research Archive
• Stenberg, Una; Riiser, Kirsti; Bjørnsen, Hanne Nissen; Helseth, Sølvi; Le, Christopher & Haraldstad, Kristin [Show all 9 contributors for this article] (2021). Helsekompetanse i alt vi gjør- også for de unge. Full text in Research Archive
• Le, Christopher; Finbråten, Hanne Søberg; Pettersen, Kjell Sverre & Guttersrud, Øystein (2021). Inn med målrettede løsninger for helsekompetanse i Europa! Full text in Research Archive
• Bregård, Ida Marie & Le, Christopher (2021). Mangelfull identifisering av mulige ofre for menneskehandel i Norge. Full text in Research Archive
• Le, Christopher; Heradstveit, Katarina; Lopez, Gro Saltnes; Freng, Espen; Linnestad, Hege & Spilker, Ragnhild Anne Caroline Storste [Show all 13 contributors for this article] (2020). Workshop: Koronaepidemi og innvandrere - COVID-19: Informasjon til innvandrere. Migrasjonskonferanse 2020: Helse og arbeid i det nye landet. Bergen. Full text in Research Archive
• Pelikan, Jurgen M.; Link, Thomas M.; Berens, Eva Maria; Pettersen, Kjell Sverre; Le, Christopher & Sørensen, Kristine [Show all 10 contributors for this article] (2020). Comprehensive health literacy in general populations–An international comparison. European Journal of Public Health. ISSN 1101-1262. 30, p. ckaa165.123–ckaa165.123. doi: 10.1093/eurpub/ckaa165.123. Full text in Research Archive
• Guttersrud, Øystein; Wångdahl, Josefin; Sørensen, Kristine; Le, Christopher; Finbråten, Hanne Søberg & Pettersen, Kjell Sverre [Show all 7 contributors for this article] (2020). Helsekompetanse – om det å kunne ta kunnskapsbaserte beslutninger om egen helse. Naturfag. ISSN 1504-4564. p. 54–57. Full text in Research Archive
• Pelikan, Jurgen M.; Link, Thomas M.; Stassmayr, Christa; Griebler, Robert; Schaeffer, Doris & Berens, Eva Maria [Show all 12 contributors for this article] (2020). Comprehensive health literacy in general populations – An international comparison – Preliminary results. Full text in Research Archive
• Le, Christopher (2019). Helsekompetanse, språkbarrierer og likeverdige helsetjenester. Full text in Research Archive
• Dietscher, Christina; Doyle, Gerardine; Le, Christopher; Lopatina, Maria; Pelikan, Jurgen M. & Rowlands, Gill [Show all 9 contributors for this article] (2019). The Action Network on Measuring Population and Organizational Health Literacy (M-POHL) of WHO Europe's Health Information Initiative (EHII): an introduction. Full text in Research Archive
• Le, Christopher (2013). Hvordan sikre likeverdige helsetjenester? 50(1), p. 49–51. Full text in Research Archive
• Le, Christopher & Kumar, Bernadette. N (2013). Workshop of the HPH-Taskforce for Migrant-friendly and Culturally Competent Hospitals: Equitable access and utilisation of health services. Clinical Health Promotion. 3, p. 56–57. Full text in Research Archive
• Le, Christopher (2013). Perception of Equity in a Nursing Home in Norway. Full text in Research Archive
• Le, Christopher & Kumar, Bernadette. N (2013). Equitable access and utilisation of health services. Session O3.7: Workshop of the HPH-Taskforce for Migrant-friendly and Culturally Competent Hospitals. Full text in Research Archive
• Le, Christopher; Finbråten, Hanne Søberg; Pettersen, Kjell Sverre; Joranger, Pål & Guttersrud, Øystein (2021). Helsekompetansen i fem utvalgte innvandrerpopulasjoner i Norge: Pakistan, Polen, Somalia, Tyrkia og Vietnam. Befolkningens helsekompetanse, del II. Rapport IS-2988. Helsedirektoratet. Full text in Research Archive Show summary

  Rapporten Befolkningens helsekompetanse, del I ble lansert i januar 2021. Med dette følger rapport del II om helsekompetansen i fem utvalgte innvandrerpopulasjoner i Norge; innvandrere med bakgrunn fra Pakistan, Polen, Somalia, Tyrkia eller Vietnam. Resultater tyder på behov for igangsetting av kortsiktige og langsiktige tiltak rettet mot innvandrerbefolkningen i Norge.

• Guttersrud, Øystein; Le, Christopher; Pettersen, Kjell Sverre & Finbråten, Hanne Søberg (2021). Rasch analyses of data collected in 17 countries: A technical report to support decision-making within the M-POHL consortium. @ The Norwegian NST of HLS19. Full text in Research Archive
• Le, Christopher; Finbråten, Hanne Søberg; Pettersen, Kjell Sverre; Joranger, Pål & Guttersrud, Øystein (2021). Health Literacy in the Norwegian Population. English Summary. In Befolkningens helsekompetanse, del I. The International Health Literacy Population Survey 2019 – 2021 (HLS19) – et samarbeidsprosjekt med nettverket M-POHL tilknyttet WHO-EHII. The Norwegian Directorate of Health. Full text in Research Archive Show summary

  Norway has for the first time conducted a survey to assess health literacy in a large and representative sample of the population. The results show that a significant proportion of the population faces a variety of challenges in dealing with health information. This has implications for the health of individuals and society's expenditure relating to health. On behalf of the Norwegian Ministry of Health and Care Services, the Directorate of Health has conducted a national survey of the population's health literacy in partnership with Oslo Metropolitan University and Inland Norway University of Applied Sciences. The survey forms part of an international collaboration initiated by the WHO-EHII affiliated network Action Network on Measuring Population and Organisational Health Literacy (M-POHL) concerning implementation of the Health Literacy Population Survey 2019–2021 (HLS19). The aim of M-POHL and HLS19 is to provide knowledge to support the differentiated work of government agencies relating to the development of targeted measures to raise the level of health literacy amongst the population, and to adapt the health service to meet the needs of people with different levels of health literacy.

• Le, Christopher; Finbråten, Hanne Søberg; Pettersen, Kjell Sverre; Joranger, Pål & Guttersrud, Øystein (2021). Health Literacy in Five Immigrant Populations in Norway: Pakistan, Poland, Somalia, Turkey, and Vietnam. English summary. In Helsekompetansen i fem innvandrerpopulasjoner i Norge: Pakistan, Polen, Somalia, Tyrkia og Vietnam. Befolkningens helsekompetanse, del II. The Norwegian Directorate of Health. Full text in Research Archive Show summary

  The report Befolkningens helsekompetanse, part I was published in January 2021. The present part (Part II) describes health literacy in five immigrant populations in Norway: immigrants from Pakistan, Poland, Somalia, Turkey, or Vietnam. The findings indicate the need for initiating short-term and long-term interventions aimed at immigrants in Norway. The objective of the HLS19 survey project was to obtain new evidence in support of authorities’ policy-based interventions to strengthen population health literacy. It is known that segments of the Norwegian immigrant population have public health challenges and experience barriers when interacting with health services, making it essential to collect data on various health literacy aspects among immigrants. Thus, HLS19 in Norway was expanded to include five immigrant populations with a background from Pakistan (n = 200), Poland (n = 400), Somalia (n = 379), Turkey (n = 352), or Vietnam (n = 402). The data was collected using two different sets of questionnaires (from 1733 persons in total). We only applied one set of the questionnaires to collect data from the Pakistani sample.

• Pelikan, Jurgen M.; Straßmayr, Christa; Pettersen, Kjell Sverre; Le, Christopher & al., the HLS19 Consortium of M-POHL et (2021). International Report on the Methodology, Results, and Recommendations of the European Health Literacy Population Survey 2019-2021 (HLS19) of M-POHL. The HLS19 Consortium of the WHO Action Network M-POHL. Full text in Research Archive
• Le, Christopher; Finbråten, Hanne Søberg; Pettersen, Kjell Sverre; Joranger, Pål & Guttersrud, Øystein (2021). Befolkningens helsekompetanse, del I. The International Health Literacy Population Survey 2019–2021 (HLS19) – et samarbeidsprosjekt med nettverket M-POHL tilknyttet WHO-EHII. Rapport IS-2959. Helsedirektoratet. Full text in Research Archive Show summary

  Norge har for første gang kartlagt helsekompetansen i et stort og representativt utvalg av befolkningen. Resultater viser at en vesentlig andel i befolkningen har varierte utfordringer med å forholde seg til helseinformasjon. Dette har betydning for individets helse og samfunnets helseutgifter. Bakgrunn På oppdrag fra Helse- og omsorgsdepartementet har Helsedirektoratet i samarbeid med OsloMet og Høgskolen i Innlandet gjennomført en nasjonal kartlegging av befolkningens helsekompetanse. Kartleggingen inngår i et internasjonalt samarbeid initiert av det WHO-EHII tilknyttede nettverket Action Network on Measuring Population and Organisational Health Literacy (M-POHL) om gjennomføringen av Health Literacy Population Survey 2019–2021 (HLS19). Formålet med M-POHL og HLS19 er å skaffe til veie kunnskap som kan understøtte myndigheters differensierte arbeid med utvikling av målrettede tiltak for å styrke helsekompetansen i befolkningen, og for å tilpasse helsetjenesten slik at den ivaretar personer med ulik helsekompetanse. Gjennomføring I Norge valgte vi å bruke hele det omfattende spørreskjemaet International Health Literacy Population Survey Questionnaire (HLS19-Q47), som består av en base på 47 spørsmål. Undersøkelsen i Norge inkluderte også ulike skalaer for måling av digital helsekompetanse (herunder digital helseinformasjon, generelle digitale ferdigheter, og bruk av digitale helsetjenester), kompetanse i å navigere i helsevesenet, og ferdigheter i å kommunisere med helsepersonell. Undersøkelsen hentet videre inn helseøkonomiske variabler for å estimere størrelser som produktivitet og helsekostnader. Det ble samlet inn data fra to tilfeldige og representative utvalg på til sammen 6.000 respondenter. Spørreundersøkelsen ble gjennomført av et norsk gallupbyrå, som brukte metoden Computer-Assisted Telephone Interviewing (CATI). Deltakerlandene kunne velge mellom CAPI1, CATI og CAWI2/online. De fleste landene valgte CAPI. Befolkningens generelle helsekompetanse i lys av «pasientens helsetjeneste» Vi har rapportert enkel deskriptiv statistikk for alle de 47 spørsmålene i HLS19-Q47. Med bakgrunn i mer avanserte psykometriske analyser, har vi foreslått ulike delskalaer for hvert domene av helsekompetanse (helsefremming, sykdomsforebygging og helsetjenesterelatert). For å tilfredsstille strenge måletekniske ...

• Le, Christopher & Bregård, Ida Marie (2020). Nasjonalt nettverk for arbeid mot menneskehandel i helse- og omsorgstjenestene 2018-2020. Rapport IS-2961. Helsedirektoratet. Full text in Research Archive
• Le, Christopher; Isaksen, Joachim Vogt (1.amanuensis ved NTNU) & Pettersen, Kjell Sverre (professor ved OsloMet) (2019). Pasientmedvirkning i praksis? En studie om implementering av HLS-Q12 for systematisk vurdering av pasienters Health Literacy i norske helse- og omsorgstjenester. Norges teknisk-naturvitenskapelige universitet. Full text in Research Archive Show summary

  Bakgrunn: For å møte målet for pasienters lovbestemte rett til brukermedvirkning, må pasientene ha tilgang til helseinformasjon og kommunikasjon tilpasset deres Health Literacy nivå (HL). I utformingen og tilpasningen av helsetjenestene er individenes HL et sentralt utgangspunkt for å sette den enkelte i stand til å ta helsefremmende avgjørelser og handle med utgangspunkt i egne forkunnskaper. Da denne studien tar sikte på å utvikle en strategi for implementering av health literacy måleinstrumentet HLS-Q12 i helsetjenestene, gjennomførte jeg en flernivå-situasjonsanalyse. Metode: Studien bruker en kvalitativ formativ forskningsmetode med bruk av et skreddersydd konseptuelt rammeverk. Datainnsamlingen besto av seks individuelle intervjuer og to fokusgruppeintervjuer á fire informanter. Intervjuspørsmålene adresserte fremmende og hemmende faktorer på tre nivåer: klinikere, administrative og personell fra helseforvaltningen. En enkel dokumentanalyse ble utført i tillegg for å belyse strukturelle og legale rammer og forvaltningens handlingsrom for implementering av HLS-Q12 i helsetjenestene. Resultater: Dagens lovverk, helsepolitikk og nasjonale satsninger i helsesektoren understøtter HL-kompetent kommunikasjon og informasjon i helsetjenestene, tilpasset individenes HL. Studien avdekker at det i helsetjenestene både er et behov for og vilje til å bruke et standardisert måleinstrument for systematisk vurdering av pasienters HL. Klinikere, administrative og forvaltningens personell erkjente at pasientenes HL er en viktig faktor for god kommunikasjon mellom helsepersonell og pasienter. Imidlertid, stram arbeidsplan, manglende lederforankring og helsepersonells overestimering av egen evne til å gjenkjenne kritisk kommunikasjonsvansker kan hemme implementeringen av HLS-Q12. Konklusjon: Et interdisiplinær konseptuelt rammeverk og en variert datainnsamling var viktig for å avdekke interagerende flernivå-påvirkningsfaktorer. Basert på funnene ble det utviklet en flernivå-strategi for implementering av HLS-Q12 i helsetjenestene. Strategien kan operasjonaliseres samtidig på alle nivåer eller separat for hvert nivå i rett tid. For å avdekke potensielle feilkilder, invalide og upresise funn, er utprøving og evaluering av strategien nødvendig.

• Chiarenza, Antonio; Abraham, Elizabeth; Atungo, Simone; Coune, Isabelle; Fortier, Julia Puebla & Ramirez, Manuel Garcia [Show all 21 contributors for this article] (2014). Standards for equity in health care for migrants and other vulnerable groups: Self-assessment tool for pilot implementation. HPH Task Force on Migrant-Friendly and Culturally Competent Health Care. Full text in Research Archive
• Le, Christopher (2013). Når er "litt norsk" for lite: En kvalitativ undersøkelse av tolkebruk i helsetjenesten (NAKMI rapport 2/2013). Nasjonal kompetanseenhet for minoritetshelse (NAKMI). Full text in Research Archive
• Le, Christopher (2013). Standarder for likeverdig helsetjeneste for innvandrere og andre sårbare grupper: Pilotering av WHO-HPH MFCCH - Standards for Equity in Health Care for Migrants and other Vulnerable Groups (Forskningsrapport 2013). Nasjonal kompetanseenhet for minoritetshelse (NAKMI). Full text in Research Archive

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