A global measurement tool to assess population health literacy fits all? A critical paper.

Health literacy (HL) is considered by the World Health Organization (WHO) as an important determinant of health and several instruments have been elaborated and adapted to measure this construct. In 2022, a group of researchers started a project aimed at developing a HL assessment instrument with global applicability, based on different versions of the European Health Literacy Survey Questionnaire (HLS-EU-Q). This article critically analyses the characteristics of those instruments to help improve health assessment practices and avoiding omitting measurement of locally important information, therefore committing an epistemic injustice. Analysis detected several flaws in the instruments' aforementioned aspects and the conceptual model proposed by WHO which limits their application as global instruments. Countries worldwide should develop specific instruments to measure the general HL of their population based on its sociocultural characteristics and specificities of their health care systems thus avoiding wrong decision-making, which can compromise the effectiveness of policies resulting from these surveys.