Results of the Second Health Literacy Survey Germany (HLS-GER 2)

The second Health Literacy Survey Germany (HLS-GER 2) provides new data on the health literacy of the population in Germany. The survey is part of the international Health Literacy Survey (HLS19). It provides a new detailed measurement of the health literacy of the population in Germany; a thematic expansion through the inclusion of digital health literacy, navigation health literacy, and communicative health literacy;  a comparison of health literacy in Germany before and during the COVID-19 pandemic since the main study which took place between December 2019 and January 2020 was supplemented by an additional survey in August/September 2020 (HLS-GER 2').

Summary of Key Results

  • At 58.8 percent, considerably more than half of the population has low health literacy. During the COVID-19 pandemic, health literacy increased slightly.
  • In particular, people with a low educational level, low social status, migration experience, older people and people living with chronic illness or long-term health problems and also younger people between the age of 18 and 29 have a lower health literacy
  • Of the four steps in information processing appraising health information is perceived as the most difficult one: almost 75 percent of the population face problems with this step. Applying health information is also often perceived as difficult; the proportion of individuals with low health literacy in this step also increased. However, improvements have been made during the COVID-19 pandemic. In particular, the appraisal of information has become easier. Nevertheless, the proportion of low health literacy is still at a high level.
  • In all three domains of health literacy – health care, disease prevention, and health promotion – respondents perceive it as difficult to deal with information. However, this is particularly pronounced in health promotion.
  • Low health literacy has numerous negative consequences and is associated with unhealthy behavior such as less physical activity, an unhealthier diet, a higher likelihood of being obese, poorer self-perceived health, more days absent from work, and more intensive use of the health system. These associations are stronger in the additional survey conducted during the COVID-19 pandemic.
  • Digital health literacy of the respondents is very low. Three-quarter of the respondents have a low level of digital
    health literacy and thus have great difficulties in dealing with digital information. A similar picture emerges regarding the overall use of digital health information opportunities, which is not very high according to the study. Since the COVID-19 pandemic, the use of digital information opportunities has increased, and the share of low digital health literacy has decreased.
  • This also applies to navigation health literacy. More than 80 percent of the population often face difficulties in dealing with information regarding navigation and orientation. The COVID-19 pandemic has hardly changed this.
  • Interaction and communication with doctors is easier for the respondents. The proportion of those with low communicative health literacy is relatively lower compared to the other topics.

Overall, the results of the HLS-GER 2 and the complementary survey HLS-GER 2' underline the need for action. They show once again how important it is to continuously strengthen the population’s health literacy and to intensify the necessary intervention development, research, and networking. Only the cooperation of all relevant stakeholders and their networks from different areas of society allows for a sustainable promotion of health literacy in Germany.


Schaeffer, D., Berens, E.-M., Gille, S., Griese, L., Klinger, J., de Sombre, S., Vogt, D., Hurrelmann, K. (2021): Health Literacy of the Population in Germany before and during the COVID-19 Pandemic. Results of the Second Health Literacy Survey Germany (HLS-GER 2). Short Summary. Bielefeld: Interdisciplinary Centre for Health Literacy Research (ICHL). Bielefeld University. DOI: https://doi.org/10.4119/unibi/2951271