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Background Health literacy (HL) is a critical determinant of health and citizens’ control over their health. The European Health Literary consortium developed a conceptual model and related HLS-EU-Q47 tool of four cognitive and three health domains and showed high levels of inadequate HL in eight European countries. Methods This methodological and descriptive study evaluated the metric properties of the tool in a new setting and assessed HL among a Greek-Cypriot population. Differences in HL by social position and health behaviours was assessed. Results A sample of 300 adults from a General Hospital participated, 65%:35% urban vs rural, 15.3% divorced/widowed, 33% tertiary education, as expected according to census. 53% rated their health as “less than good”, 45.6% were current or past smokers and mean BMI was 26.8 (SD 5.2). Cronbach’s alpha coefficient for internal consistency was &amp;gt;0.80 for cognitive (access, understand, appraise, and apply) and health sub-scales (healthcare, prevention, health promotion). A three factor structure explaining 52.1% of the variance was identified in exploratory factor analysis (“access to information”, “prevention and promotion-related literacy” and “user-provider interaction”). Half of the participants (50.7%) reported inadequate or problematic HL with statistically lower HL in older age-groups but no difference by urban: rural status. A clear social gradient was observed by education, income and subjective social position on a 10-step ladder. Regular alcohol consumption and low physical exercise were related with low HL, but not smoking or BMI. Conclusions HLS-EU-Q47 showed good metric properties in a new language and setting. The proportion of population with inadequate or problematic HL appears high but consistent with findings from other European populations. The observed social gradient in HL supports the criterion known-group validity of the tool as well as highlights an important aspect of health inequality. Key messages There is support for HLS-EU-Q47 as a valid and reliable measure of health literacy. A high proportion of the Cypriot population with problematic health literacy with a clear social gradient.

Social gradient in health literacy among primary healthcare users in Cyprus