Effects of Objective and Subjective Health Literacy on Patients' Accurate Judgment of Health Information and Decision-Making Ability: Survey Study

Peter Johannes Schulz, Annalisa Pessina, Uwe Hartung, Serena Petrocchi

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations


Background: Interpreting health information and acquiring health knowledge have become more important with the accumulation of scientific medical knowledge and ideals of patient autonomy. Health literacy and its tremendous success as a concept can be considered an admission that not all is well in the distribution of health knowledge. The internet makes health information much more easily accessible than ever, but it introduces its own problems, of which health disinformation is a major one. Objective: The objective of this study was to determine whether objective and subjective health literacy are independent concepts and to test which of the two was associated more strongly with accurate judgments of the quality of a medical website and with behavioral intentions beneficial to health. Methods: A survey on depression and its treatments was conducted online (n=362). The Newest Vital Sign was employed to measure objective, performance-based health literacy, and the eHealth Literacy Scale was used to measure subjective, perception-based health literacy. Correlations, comparisons of means, linear and binary logistic regression, and mediation models were used to determine the associations. Results: Objective and subjective health literacy were weakly associated with one another (r=0.06, P=.24). High objective health literacy levels were associated with an inclination to behave in ways that are beneficial to one's own or others' health (Exp[B]=2.068, P=.004) and an ability to recognize low-quality online sources of health information (?=-.4698, P=.005). The recognition also improved participants' choice of treatment (?=-.3345, P<.001). Objective health literacy helped people to recognize misinformation on health websites and improved their judgment on their treatment for depression. Conclusions: Self-reported, perception-based health literacy should be treated as a separate concept from objective, performance-based health literacy. Only objective health literacy appears to have the potential to prevent people from becoming victims of health disinformation.

Original languageEnglish
Article number20457
JournalJournal of Medical Internet Research
Issue number1
StatePublished - Jan 2021

Bibliographical note

Publisher Copyright:
© 2021 Journal of Medical Internet Research. All rights reserved.


  • Depression
  • Ehealth literacy scale
  • Health literacy
  • Mental health
  • Newest vital sign
  • Objective health literacy
  • Perception-based health literacy
  • Performance-based
  • Self-reported health literacy


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