Enwald - Everyday

Special Issue – I3 Conference – Aberdeen – June 2015
Journal of Information Science

1–12
Everyday health information literacy Ó The Author(s) 2016
Reprints and permissions:
among young men compared with adults sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/0165551516628449
with high risk for metabolic syndrome – jis.sagepub.com
a cross-sectional population-based study
Heidi Enwald
Information Studies, Faculty of Humanities, University of Oulu; Medical Research Center Oulu, Oulu University Hospital; and University of Oulu,
Finland
Noora Hirvonen
Information Studies, Faculty of Humanities, University of Oulu; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
Maija-Leena Huotari
Information Studies, Faculty of Humanities, University of Oulu; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
Raija Korpelainen
Center for Life Course Epidemiology and Systems Medicine, University of Oulu; Oulu Deaconess Institute; Medical Research Center Oulu, Oulu
University Hospital and University of Oulu, Finland
Riitta Pyky
Center for Life Course Epidemiology and Systems Medicine, University of Oulu; Oulu Deaconess Institute; Medical Research Center Oulu, Oulu
University Hospital and University of Oulu, Finland
Markku Savolainen
Department of Internal Medicine, Oulu University Hospital and University of Oulu; Medical Research Center Oulu, Oulu University Hospital and
University of Oulu, Finland
Tuire Salonurmi
University of Oulu, Finland
Anna-Maria Keränen
University of Oulu, Oulu, Finland
Terhi Jokelainen
University of Oulu, Oulu, Finland
Raimo Niemelä
Kastelli Upper Secondary School, The City of Oulu Department of Education, Finland
Corresponding author:
Maija-Leena Huotari, Information Studies, Faculty of Humanities, PO Box 1000, 90014 University of Oulu, Finland.
Email: maija-leena.huotari@oulu.fi
Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Enwald et al. 2
Abstract
This cross-sectional population-based study aims at identifying differences in the aspects of everyday health information literacy among
young healthy men and adults with an increased risk for metabolic syndrome. Data were collected with a self-assessment-based 10-
item screening tool administered at the Finnish Defence Force’s call-ups (n=2507, response rate 59%) and at health intervention study
(n=571, response rate 98%). Adults with increased risk for metabolic syndrome seemed to value health information but had more dif-
ficulty in knowing who to believe in health issues and understanding the terminology used. The difficulties applied especially to respon-
dents 35 years old or over. Men, and especially young men, had lower motivation than women to seek health information. Although
the results are indicative, the everyday health information literacy screening tool seems to be useful in revealing areas that health com-
munication should be focused on among different populations.
Keywords
Age; Finland; gender; health information literacy; health promotion; motivation
1. Introduction
The competencies that people possess with regard to finding, evaluating and using health information may influence
their information behaviour [1]. The concept of health information literacy (HIL) has been used to describe these compe-
tencies. It has been defined as ‘the set of abilities needed to recognize a health information need, identify likely informa-
tion sources and use them to retrieve relevant information, assess the quality of the information and its applicability to a
specific situation, and analyse, understand, and use the information to make good health decisions’ [2]. The concept of
everyday health information literacy (EHIL) refers to competencies to find, evaluate and understand health-related infor-
mation in everyday life situations, and is directed especially towards literate populations [3]. It can be considered as
information literacy in a health context or as a combination of the concepts of health literacy (HL) and information
literacy.
Research on HIL has focused on different population subgroups and these studies (further discussed in Section 1.1.)
indicate that there are significant differences in HIL based on individuals’ age, education, economical situation and health
status. However, research within this area is still scarce. It has been proposed that HIL should be studied among various
populations and that different aspects of health information literacy (e.g. motivation, skills, confidence) should be investi-
gated separately but in parallel [3]. This study responds to this demand by comparing the different aspects of HIL among
two population subgroups: generally healthy young men and adults with an increased risk for metabolic syndrome. Both
populations have characteristics that make health promotion important to them.
1.1. Theoretical background and literature review

If people lack knowledge about the health risks and benefits of a behaviour, they may be unmotivated to alter unhealthy
habits. Hence, increased knowledge can be considered a precondition for change [4, 5] but increased knowledge alone
does not necessarily lead to improvements in behaviour (e.g. [6–8]). Moreover, those who are passive in seeking health
information also tend to be passive in discovering information by chance [9] or may avoid heath information altogether
(see [10–12]). Thus, those individuals whom health promoters attempt to influence with health messages may be the most
difficult to reach.
Health information literacy is complex to measure and many measures focus on some narrow aspect of the concept.
Based on an operationalization of the Medical Library Association’s (2003) definition of HIL, Niemelä et al. [3] have
designed a 10-item screening tool aiming at identifying differences in individuals’ EHIL. Their aim was to develop a
simple and practical screening tool that could be used to detect individuals who would benefit from HIL counselling.
The 10 statement items of the tool are presented in the Methods section. An addition to former (HL or) HIL screening
tools is a question about a diagnosis of dyslexia [3].
Niemelä et al. [3] conducted a pilot study of the EHIL tool among Finnish upper secondary school students (n=217).
Based on a factor analysis, they identified three independent factors of EHIL: motivation on finding health information,
confidence in one’s ability to find, understand and use health information, and evaluation of health information.
Furthermore, an item on the ability to understand terminology in health contexts was considered to be ‘a fundamental
HIL statement’ and was therefore analysed separately [3]. The identified factors were assumed to encompass the most
fundamental aspects of everyday health information literacy among the literate population [3]. From these factors, for
instance, motivation has generally been regarded as an important factor of HL and HIL (e.g. [7, 13, 14]). Niemelä et al.
propose that HIL should be studied among various populations and that different aspects of health information literacy,
for example, motivation, skills and confidence, should be investigated separately but in parallel [3].
Journal of Information Science, 2016, pp. 1–11 Ó The Author(s), DOI: 10.1177/0165551516628449

Enwald et al. 3
Research on HIL has mainly focused on health professionals and the roles of libraries and librarians in the promo-
tion of HIL [15, 16]. In everyday life settings HIL has been studied among upper secondary school students [3],
young men [1], adults attempting to manage their weight [17] and older adults [18–21]. These studies indicate that
there are significant differences in HIL based on individuals’ age, education, economical situation and health status.
For example, high educational level (seniors [19], young men [10], university students [22]) and female gender
(upper secondary school student [3]) have been found to be associated with higher HIL. HIL has also been positively
associated with self-rated health among older people (aged 65–79) [19] and health-promoting behaviours and physi-
cal fitness among young men (aged 17–23) [23]. Moreover, among young men, low EHIL has been associated with
avoidance of physical activity information [1] and non-preference of fear appeals [24]. These results indicate that
individuals who are unconfident in their abilities to find, understand and use health-related information may be more
prone to avoid this information.
In this study, we focus on comparing the different aspects of HIL among two population subgroups: generally healthy
young men and adults with an increased risk for metabolic syndrome. The metabolic syndrome is a cluster of the most
dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pres-
sure [25].
Metabolic syndrome has been defined as a combination of abdominal obesity and two of the other listed risk factors:
raised triglycerides, reduced HDL cholesterol, raised blood pressure and raised fasting plasma glucose or diagnosed type
2 diabetes. Individuals’ knowledge, attitudes and behaviour play a large role in preventing and managing the risk factors
making up metabolic syndrome and many lifestyle interventions are based on this understanding [26]. Individuals with a
high risk for metabolic syndrome should be aware of and informed about their situation as there are good possibilities to
promote their wellbeing and prevent the onset of diseases such as type 2 diabetes.
Young men represent a generally healthy population but may engage in risky behaviours, physical inactivity and
unhealthy dietary habits, placing them at risk of acute and chronic health conditions in the future (see e.g. [27]).
Increased age is associated with more protective health behaviours [28]. Elderly people are generally regarded having
higher health consciousness [29]. Young people, in turn, may be rather confident in their abilities to find and use health-
related information but may lack motivation to seek for information on health [1]. Furthermore, women have been
shown to be more proactive and engaged in seeking, gaining and discussing health-related issues (e.g. [30–32]). Yet gen-
der differences tend to decrease as age increases [28].
1.2. Objectives
The aim of this study is to increase our knowledge of EHIL among different kinds of individuals. The objective of this
population-based study is to compare different aspects of EHIL (i.e. motivation, confidence, evaluation and terminology)
between adults with increased risk for metabolic syndrome (aged 20–61) and healthy young men (aged 17–23). This
knowledge can be utilized in tailoring health communication for these target groups. The association of gender and age
are further investigated by comparing (a) men and women and (b) men who were under 35 years old with men who were
35 or older in the population subgroup of adults with increased risk for metabolic syndrome. The study also contributes
to the validation of the EHIL screening tool.
The research questions were set as follows:
(1) Are there significant differences between the two populations in the total scores or item-based scores of the
EHIL screening tool?
(2) Are there significant differences in the EHIL between genders or different age groups among adults with
increased risk for metabolic syndrome?
2. Methods
2.1. Survey design
The EHIL screening tool by Niemelä et al. [3] includes 10 statements to which individuals are instructed to respond on a
scale from 1 (strongly disagree) to 5 (strongly agree). The statements are:
(1) It is important to be informed about health issues.

(2) I know where to seek health information.
(3) I like to get health information from a variety of sources.

Enwald et al. 4
(4) It is difficult to find health information from printed sources (magazines and books).
(5) It is difficult to find health information from the Internet.
(6) It is easy to assess the reliability of health information in printed sources (magazines and books).
(7) It is easy to assess the reliability of health information on the Internet.
(8) Health-related terminology and statements are often difficult to understand.
(9) I apply health-related information to my own life and/or that of people close to me.
(10) It is difficult to know who to believe in health issues.
There are some limitations relating to this data collection methodology. When data is collected at a single point in
time, changes in the population cannot be measured. Furthermore, surveys generally cannot provide strong evidence of
cause and effect. Without this temporal association there is lack of proof about the causality.
2.2. Study populations and questionnaire distribution

To collect data on young men’s EHIL, the screening tool was administered at the Finnish Defence Forces call-ups in the
city of Oulu, Finland, in September to December 2012 and 2013 within the MOPO study [1, 23, 24, 33]. The MOPO
study (2009–2016) combines traditional health promotion, modern technology and measurements of physical activity in
the activation of young men.
In Finland military or civilian (non-military) service is mandatory for all male citizens, and annually all 18-year-old
men are called for service in call-ups. Thus the sampling methodology of MOPO study was a total population sampling
and a large, representative, population-based sample of young men was reached. All 2507 men present at the call-ups in
Oulu area in 2012 and 2013 were invited to participate in the study, and 1870 (66%) agreed to participate. The partici-
pants were given oral and written information about the study and its benefits and risks, including their right to refuse to
take part or withdraw from the study without it affecting their future health care or military service. The local ethics com-
mittee granted approval (ETTM123/2009) to conduct the MOPO study [33]. All participants were asked to fill in a ques-
tionnaire including items about, for example, socio-demographic information (e.g. age and educational level), physical
activity and EHIL. Of the men 1842 (73.5%) filled in the questionnaire and of them 1481 (59.1%) responded to each of
the 10 EHIL statements.
Information on EHIL of individuals with high risk for metabolic syndrome was collected within the ongoing (from
2013 to 2016) multidisciplinary intervention study ‘Improved Methods of Life-style Modification for Patients at High
Risk for Metabolic Syndrome (PrevMetSyn)’ (see [34, 35]). The PrevMetSyn study aims at revealing the effects of a
web-based tailored lifestyle support system on weight loss, eating behaviour, self-efficacy and health. During the project
a persuasive ICT application is developed to support making lifestyle and eating habit modifications.
The sampling methodology of PrevMetSyn study was a random sampling. A population-based sample of 571
participants living in the area of the city of Oulu (age 20–60 years) was collected using the address and information
system of the Finnish Population Register Centre. In total, an invitation letter was sent to randomized 12,500 peo-
ple and 1065 agreed to participate. Of them 423 individuals did not meet the inclusion criteria, which were both
high body mass index (27–35 kg/m2) and possibility and ability to use a computer and the Internet. Some were also
interrupted before the beginning of the intervention. In the end the study population consisted of 289 men and 282
women.
Body mass index 27 was set as the minimum inclusion criteria instead of 25, which is normally used as a minimum
index for overweight, because 25 was considered too low for the purposes of the intervention study.
Some of the participants already had metabolic syndrome, defined as a waist circumference in males of > 94 cm and
in females > 80 cm and at least two of the following criteria: high fasting glucose (impaired fasting glucose > 5.6 or
diagnosed with diabetes), high triglycerides ( > 1.7 mmol/l or medication), low HDL cholesterol (men < 1.0, females
< 1.3 mmHg or medication) and high blood pressure ( ≥ 130/ ≥ 85 or medication) [25].
The data were collected through a questionnaire that received 571 (99%) responses at the beginning of the
PrevMetSyn intervention study in February 2013 to February 2014. Of the participants, 37 answered a paper question-
naire on the occasion when physiological measurements and laboratory tests were conducted. The rest filled in an elec-
tronic questionnaire, for example, with their home computer. Furthermore, 530 electronic questionnaire answers were
received, but some of the answers needed to be rejected owing to incorrect identification number. The final number of
valid answers to the questionnaire was 563 (98%) and of them 559 (98%) had responded to all 10 EHIL statements (see
Table 1).

Enwald et al. 5
Table 1. The number and percentages of the population-based samples and EHIL respondents included in this study.
Study Population-based sample EHIL respondents from the

population-based sample
MOPO – young generally healthy men 2507 (100%) 1481 (59.1%)

PrevMetSyn – men and women 571 (100%) 559 (97.9%)
with high risk for metabolic syndrome
2.3. Data analysis

Statistical analyses were performed using the IBM SPSS Statistics for Windows, version 19.0 (IBM Corp, 2010). The
individual statements of the EHIL screening tool were summed to form a sum variable with a minimum of 10 and a max-
imum of 50 points as suggested by Niemelä et al. [3]. Variables 4, 5, 8 and 10 were reversed. Cronbach’s alphas were
calculated to assess the internal consistency of the EHIL sum variable. It was 0.70 in the population of young men, and
0.57 in the population of adults with high risk for metabolic syndrome. Furthermore item-based comparisons were pre-
sented according to different aspects of EHIL [3].
For comparison of adults at high risk for metabolic syndrome with healthy young men, the adults at risk were categor-
ized into two groups according to age: (a) 20–35 years; and (b) 35–61 years.
Mean and standard deviation values were calculated for continuous variables and percentages for categorical vari-
ables. All continues variables were normally distributed and correlation analysis was used to examine the relationships
between continuous variables. Associations between the categorical response and explanatory variables were analysed
using cross-tabulation with Pearson’s chi-square test or its non-parametric alternative, Fisher’s exact test (two-sided).
The non-parametric test was used when the expected cell counts were low ( < 5) because of unequally distributed data
among the cells of the table. Student’s t-test was used to analyse the statistical significance of the differences between
group sum variable means.
3. Results
3.1. Characteristics of the study participants
The mean age of the young men was 17.9 years (standard deviation 0.688) and the mean age of the adults with increased
risk for metabolic syndrome was 45.8 (standard deviation 9.979, aged 20–61 years). Approximately half of respondents
with increased risk for metabolic syndrome were men (n=283) and half were women (n=271). Information about the
gender and age were missing from some of the respondents. Of the young men 8.2% (n=137) and of the high-risk indi-
viduals, 4.1% (n=23) reported an expert diagnosis of dyslexia.
3.2. Everyday health information literacy

First the sum variables of the EHIL screening tool were investigated and compared. For young men (participating MOPO
study) the EHIL sum variable mean was 34.70 with a standard deviation of 4.998. For adults with increased risk (partici-
pating the PrevMetSyn study) mean EHIL was 36.57 with a standard deviation of 4.639. The difference was statistically
significant (t-test, p < 0.000).
In the following section an item-based comparison of the 10 EHIL statements is presented. These results are organized
based on the different aspects of EHIL identified in the study by Niemelä et al. [3].
3.2.1. Motivation. Of the young men 62.5% (n=926) and of the individuals with high risk for metabolic syndrome 96.1%
(n=538) thought that it is important to be informed about health issues. Of the young men 38.4% (n=563) agreed that
they like to get health information from a variety of sources and 35.5% (n=525) that they apply health information to
their own lives and/or the lives of people close to them, whereas these proportions among the adults with increased risk
were 86.8% (n=485) and 70.4% (n=396), respectively. Of the adults with increased risk 89.3% (n=500) and of the young
men 70.4% (n=1042) were confident in their ability to know where to seek information (see Table 2).

Enwald et al. 6
Table 2. An item-based comparison of EHIL statements among young generally healthy men (n=1481) and adults with increased risk
for metabolic syndrome (n=559).
Statement Young men who High-risk individuals

agreed, N (%) who agreed, N (%)
Motivation
It is important to be informed about health issues (EHIL 1) 926 (62.5) 538 (96.1)*
I know where to seek health information (EHIL 2) 1042 (70.4) 500 (89.3)*
I like to get health information from a variety of sources (EHIL 3) 563 (38.4) 485 (86.8)*
I apply health-related information to my own life and/or that of people close to 525 (35.5) 396 (70.8)*
me (EHIL 9)
Confidence
It is difficult to find health information from printed sources (magazines and 251 (16.9) 103 (18.4)
books) (EHIL 4)
It is difficult to find health information from the Internet (EHIL 5) 192 (13.0) 79 (14.1)
It is difficult to know who to believe on health issues (EHIL 10) 195 (13.2) 253 (45.2)*
Evaluation
It is easy to assess the reliability of health information in printed sources 493 (33.5) 195 (34.8)
(magazines and books) (EHIL 6)
It is easy to assess the reliability of health information on the Internet (EHIL 7) 461 (31.3) 172 (30.7)
Terminology
Health-related terminology and statements are often difficult to understand 237 (16.0) 225 (40.2)*
(EHIL 8)
*Statistically significant difference between the young men and adults with increased risk for metabolic syndrome (Pearson’s chi-square or Fisher’s
exact test p < 0.05).
3.2.2. Confidence. Of the young men 16.9% (n=251) and of the adults with increased risk for metabolic syndrome 18.4%
(n=103) agreed with the statement concerning the difficulty of finding health information from printed sources, and
13.0% (n=192) of young men and 14.1% (n=79) of high-risk individuals agreed with the statement relating the Internet.
Of young men 13.2% (n=195) agreed with the statement ‘it is difficult to know who to believe in health issues’ while
the proportion was 45.2% (n=253) for the adults with increased risk.
3.2.3. Evaluation. Over one-third of both young men (33.8%, n=493) and of adults with increased risk (34.8%, n=195)
agreed that it is easy to assess the reliability of health information in printed sources. The percentages relating to the
easiness of assessing the reliability of health information on the Internet were 31.3% (n=461) for young men and 30.7%
(n=172) for the adults with increased risk.
3.2.4. Terminology. Of the young men 16.0% agreed that health-related terminology and statements are often difficult to
understand, whereas 40.2% of the high-risk individuals had experienced these difficulties. We were interested in finding
out whether there is a difference between genders. Therefore the women and men with increased risk for metabolic syn-
drome were further investigated. An EHIL item-based comparison of high-risk women and men is presented in Table 3.
Of the adults with high risk for metabolic syndrome, both men and women aged from 35 to 61 years were more likely
to find it difficult to know who to believe in health issues (p=0.027), to assess the reliability of health information in
printed sources (p < 0.001), and to understand health-related terminology (p < 0.001) when compared with men and
women from aged 20 to 34.
When high-risk men under the age of 35 were compared with men of the age of 35 or older statistically significant dif-
ferences applied to the statements ‘it is easy to assess the reliability of health information in printed sources (magazines
and books)’ (p=0.023) and to ‘health-related terminology and statements are often difficult to understand’ (p=0.003).
Of the women in the population of the adults with increased risk for metabolic syndrome, 94.1% (n=255) agreed that
they know where to seek health information and 92.6 (n=251) preferred getting health information from a variety of
sources. The percentages for men were 84.5 (n=238) (p < 0.001) and 81.2 (n=228) (p < 0.001), respectively. Of women,
76.7% (n=207) agreed with the statement ‘I apply health-related information to my own life and/or that of people close
to me’ and of men 65.4% (n=185) (p=0.004). A comparison of EHIL item scores of high-risk men aged from 20 to 34
and from 35 to 61 is presented in Table 4.

Enwald et al. 7
Table 3. EHIL item-based comparison of high-risk women (n=282) and men (n=289) of all ages with increased risk for metabolic
syndrome.
Statement High-risk women High-risk men

who agreed, N (%) who agreed, N (%)
Motivation
It is important to be informed about health issues (EHIL 1) 264 (97.3) 267 (94.7)
I know where to seek health information (EHIL 2) 255 (94.1) 238 (84.5)*
I like to get health information from a variety of sources (EHIL 3) 251 (92.6) 228 (81.2)*
I apply health-related information to my own life and/or that of people close 207 (76.7) 185 (65.4)*
to me (EHIL 9)
Confidence
books) (EHIL 4)
It is difficult to know who to believe in health issues (EHIL 10) 134 (49.4) 117 (41.3)
Evaluation
It is easy to assess the reliability of health information in printed sources 94 (34.7) 98 (34.6)
Terminology
Health-related terminology and statements are often difficult to understand 107 (39.5) 114 (40.3)
(EHIL 8)
*Statistically significant difference between women and men with increased risk for metabolic syndrome (Pearson’s chi-square or Fisher’s exact test
p < 0.05).
Table 4. EHIL item-based comparison of men under 35 years (n=51) and men 35 or older (n=230) with increased risk for metabolic
syndrome.
Statement High-risk men High-risk men

(20–35 years old) (35–61 years old)
who agreed, N (%) who agreed, N (%)
Motivation
It is important to be informed about health issues (EHIL 1) 46 (90.2) 220 (95.7)
I know where to seek health information (EHIL 2) 42 (82.4) 195 (84.8)
I like to get health information from a variety of sources (EHIL 3) 38 (74.5) 189 (82.5)
I apply health-related information to my own life and/or that of people close to 33 (64.7) 151 (65.7)
me (EHIL 9)
Confidence
books) (EHIL 4)
It is difficult to know who to believe in health issues (EHIL 10) 15 (29.4) 101 (43.9)
Evaluation
It is easy to assess the reliability of health information in printed sources 25 (49.0) 73 (31.7)*
Terminology
Health-related terminology and statements are often difficult to understand 11 (21.6) 103 (44.8)*
(EHIL 8)
*Statistically significant difference between men under 35 years and men 35 or older participating PrevMetSyn study (Pearson’s chi-square or Fisher’s
exact test p < 0.05).
4. Discussion
This study focuses on comparing adults with an increased risk for metabolic syndrome (aged from 20 to 61 years) to
healthy young men (aged from 17 to 23 years) in the total scores and item-based scores of the EHIL screening tool. The
main results of the comparison are discussed in this section.
The sum variable mean of the EHIL screening tool for young men was lower than for adults with increased risk for
metabolic syndrome. This finding is discussed later in this section.

Enwald et al. 8
4.1. Aspects of everyday health information literacy

Based on the results of this study, different aspects of EHIL stand out for different population subgroups. Adults with
increased risk for metabolic syndrome seem to value health information but have more difficulty in knowing who to
believe on health issues. Young men seem to be rather confident in their competencies but may lack motivation to seek
health information.
These differences may be explained by the different health statuses and situations of life of the two population groups.
Also, the young, healthy individuals may have a more confident attitude towards their abilities to find and evaluate health
information [10, 23] when compared with individuals who already are at high risk of serious health conditions. It may be
that the young men have not had experiences on serious health conditions or diseases that would have ‘forced’ them to
seek information on complex health issues.
If only the sum variables of EHIL screening tool of young men and high-risk individuals were under scrutiny we
would have concluded that the mean score for high-risk individuals is higher and thus it would seem that their EHIL is
better. However, based on previous knowledge on the topic, the result is not very informative in its entirety and seems
even unreliable. This is why it is important to investigate the different aspects of EHIL, as suggested by Niemelä et al.
[3], separately. Moreover, especially for the PrevMetSyn study, the low values of Cronbach’s alpha support this finding.
4.2. Gender and age

With high-risk individuals we took a closer look into the responses related to different aspects of EHIL based on the
respondents’ gender and age. According to the results men tended to have lower motivation than women to seek health
information (according to three items out of four) (see Table 3). This finding is in line with previous research indicating
that men are less likely to be motivated to seek health information than women [10, 31, 36–39]. Moreover, high-risk
men of the age 35–61 reported problems relating to evaluation of health information and understanding the terminology
used when compared with younger high-risk men. This finding indicates that they need support with evaluating the relia-
bility of printed sources and understanding the terminology used in health settings.
The EHIL of the high-risk men of the aged from 20 to 34 differed from those of the healthy young men. Young men
in the MOPO study were more confident in their competencies to evaluate health information and understand the termi-
nology used. This was an expected finding as gender differences in health behaviour tend to decrease as age increases
[28]. Reasons for this can be that high-risk men were somewhat older and already aware that they have increased risks
for several diseases. The number of the respondents in the younger subgroup of high-risk men in the PrevMetsyn study
was moderately low. Therefore, scrutinizing the differences between young healthy men and young men with increased
risk for metabolic syndrome can only be regarded as indicative in this comparative cross-sectional study.
According to the results of this study men, and especially younger men, have low motivation to seek health informa-
tion. Thus gender seems to be associated with motivation as an EHIL factor. Previously, women have been shown to have
better EHIL in the study by Niemelä et al. [3] and HL in the study by Sørensen et al. [14]. Women were observed to be
more motivated [3]. Furthermore, in the study by Wellstead and Norriss [40] many men who were experiencing a major
stressful life event were unfamiliar with likely sources of information or help. Moreover in the study by Johnson et al.
[41] men, generally speaking, had limited motivation to promote and maintain good health.
The theoretical and practical lessons learned from this study relate to differences in EHIL among different population
groups. Another important observation applies to the difference between utilizing the EHIL measure as a sum variable
and as individual statements. In this case the latter alternative was considered as more informative and probably more
accurate as well.
4.3. Practical applications, study limitations and future studies

The results of this cross-sectional population-based study show differences in EHIL of young healthy men and adults
with increased risk for metabolic syndrome. The found differences should be taken into account when designing health
information literacy promotion, targeted health communication strategies and intervention studies. The provided health
information should be tailored according to individual’s personal preferences and life situation (see e.g. [42]). Tailored
health communication is a means to increase the effectiveness of health information by providing more user-centred
information. It aims to increase the possibility that the information content is received, processed and accepted by the
receiver [43, 44].
Information on the aspects of the EHIL screening tool has already been utilized in intensive face-to-face group coun-
selling on healthy eating and lifestyle in an intervention study [45]. One of the counselling visits was targeted on the

Enwald et al. 9
perceived ability to assess the quality of health information. Applying the EHIL screening tool together with cognitive
behavioural therapy built up a novel counselling approach [45].
We argue that men, and especially younger men, need motivational health communication. Another option would be
to provide health information literacy assessment and feedback to reveal skill gaps [46] or help individuals evaluate their
competencies [47] in relation to specific tasks. The results imply that young men have high confidence in their EHIL
skills, but we could ponder whether this high confidence is actually connected with good skills. In fact, there is an
ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also
more broadly captures personal activation or motivation to manage health [48]. However, both aspects are important
and they also make independent contributions to health [48]. In general, the EHIL screening tool may reflect confidence
rather than actual skills [1, 23].
The study has some limitations. Data for this study were collected at a single point in time and we were not able to
investigate changes in the populations or draw conclusions on cause and effect.The results indicate that the EHIL of
‘healthy’ and ‘unhealthy’ individuals’ differs, especially according to the different aspects of EHIL. This study provided
comparison with large population-based samples, but the results can be considered as indicative. They are not necessa-
rily generalizable to all ‘healthy’ and ‘unhealthy’ population groups. Therefore this difference should be further exam-
ined among different health subgroups and countries.
Moreover, future studies should focus on the further development and validation of the EHIL screening tool. Among
the study populations of this cross-sectional study, different aspects of EHIL and on how they are associated with health
behaviour and the physical health of individuals could be examined too. The EHIL screening tool should also be further
developed to better suite different population groups and their changing health information environments. Another
demand for developing the tool arises from the dramatic changes that have occurred in individuals’ information environ-
ment during recent years. The new challenges commenced by new technological tools and information practices have
been taken into account in a recently published Framework for Information Literacy for Higher Education by the
Association of College & Research Libraries [49]. This framework highlights the role of individuals’ understanding on
authority and information creation as key elements for information literacy. These perspectives could be taken into
account in studying EHIL as well.
In addition, the theoretical and practical development of the EHIL should take into account individuals’ personality
and information behaviour and their preferences. Furthermore, an instrument such as the self-perceived health-related
quality of life construct would be useful as support for the EHIL screening tool.
5. Conclusions
According to the results, different aspects of EHIL stand out for young healthy men and adults with increased risk for
metabolic syndrome. Young men seem to be rather confident in their competencies but may lack motivation to seek
health information. Adults with increased risk for metabolic syndrome seem to value health information but have more
difficulty in knowing who to believe in health issues and understanding the used terminology. Among adults (both men
and women) with increased risk for metabolic syndrome, those aged 35 years or older were more likely to find it diffi-
cult to know who to believe in health issues, assess the reliability of health information in printed sources and under-
stand health-related terminology than those under 35 years old. Furthermore, the results indicate that men in general,
and especially young men, have lower motivation than women to seek health information. Thus gender seems to be
associated with motivation as an EHIL factor. This finding is in line with previous research.
Found differences should be taken into account when designing health information literacy promotion, targeted health
communication strategies and intervention studies. The study also contributes to the validation of the EHIL screening
tool.
Future studies should focus on the different aspects of EHIL and how they are associated with health behaviour and
physical health of individuals. The EHIL screening tool seems to be useful in revealing areas on which health communi-
cation should be focused on among different populations. However, it could be further developed to better suit different
population groups and their changing health information environments.
Funding
MOPO study was financially supported by the Finnish Cultural Foundation, the Juho Vainio Foundation, the Ministry of Education
and Culture, the Centre for Military Medicine, the European Social Fund, the European Regional Development Fund, Tekes – The
Finnish Funding Agency for Technology and Innovation, and the Northern Ostrobothnia Hospital District. PrevMetSyn study has

Enwald et al. 10
received financial support from the Academy of Finland, Ministry of Social Affairs and Health, Finnish Foundation for Cardiovascular
Research, Sigrid Juselius Foundation and City of Oulu.
References
[1] Hirvonen N, Korpelainen R, Pyky R and Huotari ML. Health information literacy and stage of change in relation to physical
activity information seeking and avoidance: A population-based study among young men. In: 78th Association for Information
Science and Technology (ASIS&T) annual meeting, St Louis, MO, 6–10 November 2015.
[2] Medical Library Assocation. The Medical Library Association Task Force on Health Information Literacy, 23 July 2003,
https://www.mlanet.org/resources/healthlit/define.html (2003, accessed 3 March 2015).
[3] Niemelä R, Ek S, Eriksson-Backa K and Huotari ML. A screening tool for assessing everyday health information literacy.
Libri: International Journal of Libraries and Information Services 2012; 62(2): 125–134.
[4] Bandura A. Health promotion by social cognitive means. Health Education and Behavior 2004; 31(2): 143–164.
[5] Bar-Ilan J, Shalom N, Shoham S, Baruchson-Arbib S and Getz I. The role of information in a lifetime process: A model of
weight maintenance by women over long time periods. Information Research 2006; 11(4): paper 263, http://www.informa-
tionr.net/ir/11–4/paper263.html (accessed 7 April 2015).
[6] Sligo FX and Jameson AM. The knowledge–behavior gap in use of health information. Journal of the American Society for
Information Science 2000; 51(9): 858–869.
[7] Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strate-
gies in the 21st century. Health Promotion International 2000; 15: 259–267.
[8] Mazanov J and Byrne DG. Changes in adolescent smoking behaviour and knowledge of health consequences of smoking.
Australian Journal of Psychology 2007; 59: 176–180.
[9] Pálsdóttir Á. The connection between purposive information seeking and information encountering: A study of Icelanders’
health and lifestyle information seeking. Journal of Documentation 2010; 66(2): 224–244.
[10] Ek S and Heinström J. Monitoring or avoiding health information – the relation to inner inclination and health status. Health
Information and Libraries Journal 2011; 28(3): 200–209.
[11] Sairanen A and Savolainen R. Avoiding health information in the context of uncertainty management. Information Research
2010; 15(4): paper 443, http://www.informationr.net/ir/15–4/paper443.html (accessed 4 April 2015).
[12] Barbour JB, Rintamaki LS, Ramsey JA and Brashers DE. Avoiding health information. Journal of Health Communication
2012; 17(2): 212–229.
[13] Paasche-Orlow MK and Wolf MS. The causal pathways linking health literacy to health outcomes. American Journal of Health
Behavior 2007; 31(suppl. 1): 19–26.
[14] Sørensen K, Van den Broucke S, Fullam J, Gerardine Doyle G, Pelikan J, Slonska Z and Brand H and (HLS-EU) Consortium
Health Literacy Project European. Health literacy and public health: A systematic review and integration of definitions and
models. BMC Public Health 2012; 12: 80, http://www.biomedcentral.com/1471–2458/12/80 (accessed 20 May 2015).
[15] Shipman JP, Kurtz-Rossi S and Funk CJ. The health information literacy research project. Journal of Medical Library
Association 2009; 97(4): 293–301.
[16] Yates C, Stoodley ID, Partridge HL, Bruce CS, Cooper H, Day G and Edwards SL. Exploring health information use by older
Australians within everyday life. Library Trends 2012; 60(3): 460–478, http://eprints.qut.edu.au/49808/ (accessed 7 April
2015).
[17] Marshall A, Henwood F and Guy ES. Information and health literacy in balance: Findings from a study exploring the use of
ICTs in weight management. Library Trends 2012; 60(3): 479–496.
[18] Yates CL. Informed for health: Exploring variation in ways of experiencing health information literacy. PhD thesis, Queensland
University of Technology, 2013, http://eprints.qut.edu.au/65354/ (accessed 7 April 2015).
[19] Eriksson-Backa K, Ek S, Niemelä R and Huotari ML. Health information literacy in everyday life: A study of Finns aged 65–79
years. Health Informatics Journal 2012; 18(2): 83–94.
[20] Gazibara T, Kurtagic I, Kisic-Tepavcevic D, Nurkovic S, Kovacevic N, Gazibara T and Pekmezovic T. Computer and online
health information literacy among Belgrade citizens aged 66–89 years. Health Promotion International 2015; Epub ahead of
print 9 January 2015, http://heapro.oxfordjournals.org/content/early/2015/01/09/heapro.dau106.long (accessed 22 January 2016).
[21] Hallows KM. Health information literacy and the elderly: Has the Internet had an impact? The Serials Librarian: From the
Printed Age to the Digital Age 2013; 65(1): 39–55.
[22] Ivanitskaya L, O’Boyle I and Casey AM. Health information literacy and competencies of information age students: Results
from the interactive online research readiness self-assessment (RRSA). Journal of Medical Internet Research 2006; 8(2): e6,
http://www.jmir.org/2006/2/e6/ (accessed 18 January 2014).
[23] Hirvonen N, Ek S, Niemelä R, Korpelainen R and Huotari ML. Socio-demographic characteristics associated with everyday
health information literacy of young men. In: Proceedings of ISIC, the information behaviour conference, Leeds, 2–5
September, 2014. Information Research 2015; 20(1): paper isic25, http://InformationR.net/ir/20–1/isic2/isic25.html (accessed
20 May 2015).

Enwald et al. 11
[24] Enwald H, Hirvonen N, Korpelainen R and Huotari ML. Young men’s perceptions of fear appeal versus neutral health messages
– associations with everyday health information literacy, education, and health. In: Proceedings of ISIC, the information beha-
viour conference, Leeds, 2–5 September, 2014. Information Research 2015; 20(1): paper isic22, http://InformationR.net/ir/20–
1/isic2/isic22.html (accessed 8 April 2015).
[25] International Diabetes Federation. IDF worldwide definition of the metabolic syndrome, http://www.idf.org/metabolic-syn-
drome (2014, accessed 2 May 2015).
[26] Enwald H and Huotari ML. Preventing the obesity epidemic by second generation tailored health communication: An interdis-
ciplinary review. Journal of Medical Internet Research 2010; 12(2): e24. http://www.jmir.org/2010/2/e24/ (accessed 13 May
2015).
[27] Ashton L, Hutchesson MJ, Rollo ME, Morgan PJ and Collins CE. A scoping review of risk behaviour interventions in young
men. BMC Public Health 2014; 14: 957.
[28] Tseng TS and Lin HY. Gender and age disparity in health-related behaviors and behavioral patterns based on a national survey
of Taiwan. International Journal of Behavioral Medicine 2008; 15: 14–20.
[29] Macias W and McMillan S. The return of the house call: The role of internet-based interactivity in bringing health information
home to older adults. Health Communication 2008; 23: 34–44.
[30] Rice RE. Influences, usage, and outcomes of Internet health information searching: Multivariate results from the Pew surveys.
International Journal of Medical Informatics 2006; 75: 8–28.
[31] Wellstead P. Information behaviour of Australian men experiencing stressful life events: The role of social networks and confi-
dants. Information Research 2011; 16(2): paper 474, http://informationr.net/ir/16–2/paper474.html (accessed 20 May 2015).
[32] Ek S. Gender differences in health information behaviour: A Finnish population-based survey. Health Promotion International
2013; 30(3): 736–745, http://heapro.oxfordjournals.org/content/early/2013/08/28/heapro.dat063.full (accessed 10 September
2015).
[33] Ahola R, Pyky R, Jämsä T, Mäntysaari M, Koskimäki H, Ikäheimo TM, Huotari ML, Röning J, Heikkinen HI and Korpelainen
R. Gamified physical activation of young men – a multidisciplinary population-based randomized controlled trial (MOPO
study). BMC Public Health 2013; 14, http://www.biomedcentral.com/content/pdf/1471–2458–13–32.pdf (accessed 7 April
2015)
[34] Alahäivälä T, Oinas-Kukkonen H and Jokelainen T. Software architecture design for health BCSS: Case Onnikka. Persuasive
Technology 2013; 7822: 3–14.
[35] Karppinen P, Alahäivälä T, Jokelainen T, Keränen A-M, Salonurmi T and Oinas-Kukkonen H. Flow or no flow? A qualitative
study of health behavior change support system. In: Proceedings of the 47th annual Hawaii international conference on systems
sciences (HICSS 2014), Waikoloa, Big Island, HI, 4–7 January 2014. New York: IEEE Computer Society Press.
[36] Ek S, Eriksson- Backa K, Niemelä R and Huotari ML. Patterns of gender differences in health information behaviour and body
mass index (BMI): Findings from a Finnish population-based study. In: Papanikos GT (ed.), Health economics, management
and policy. Abstract book from the 10th annual international conference on health economics, management and policy, 27–30
June 2011. Athens Institute for Education and Research, Athens, pp. 17–18, http://www.atiner.gr/abstracts/2011HEA-ABST.pdf
(accessed 20 May 2015).
[37] Arora NK, Hesse BW, Rimer BK, Viswanath K, Clayman ML and Croyle RT. Frustrated and confused: The American public
rates its cancer-related information-seeking experiences. Journal of General Internal Medicine 2008; 23(3): 223–228.
[38] Drentea P, Goldner M, Cotton S and Hale T. The association among gender, computer use, and online health searching, and
mental health. Information Communication and Society 2008; 11(4): 509–525.
[39] Niedzwiedzka B, Mazzocchi M, Aschemann-Witzel J, Gennaro L, Verbeke W and Traill WB. Determinants of information
behaviour and information literacy related to healthy eating among Internet users in five Europen countries. Information
Research 2014; 19(3): paper 633.
[40] Wellstead P and Norriss H. Information-seeking to support wellbeing: A pilot study of New Zealand men. International Journal
of Wellbeing 2014; 4(2): 32–44, http://internationaljournalofwellbeing.org/index.php/ijow/article/viewFile/240/428 (accessed
20 August 2015).
[41] Johnson L, Huggard P and Goodyear-Smith F. Men’s health and the health of the nation. New Zealand Medical Journal 2008;
121: 69–76.
[42] Enwald H. Tailoring health communication: The perspective of information users’ health information behaviour in relation to
their physical health status. Acta Universitatis Ouluensis. Series B, Humaniora 118. Oulu. PhD thesis, Information Studies,
University of Oulu, Finland, 2013, http://urn.fi/urn:isbn:9789526202792 (accessed 8 April 2015).
[43] Kreuter M, Farrell D, Olevitch L and Brennan L. Tailoring health messages – customizing communication with computer tech-
nology. Mahwah, NJ: Lawrence Erlbaum Associates, 1999.
[44] Hawkins RP, Kreuter M, Resnicow K, Fishbein M and Dijkstra A. Understanding tailoring in communicating about health.
Health Education Research 2008; 23(3): 454–466.
[45] Huotari ML, Enwald H, Hirvonen N, Keränen AM, Jokelainen T, Salonurmi T and Niemelä R. Everyday health information lit-
eracy in counselling on healthy eating. The case of PrevMetSyn. In: Kurbanoğlu S, Špiranec S, Boustay J, Grassian E, Mizrachi
D and Roy L (eds) Information Literacy: Moving Towards Sustainability. Communications in Computer and Information
Science Series, 52. Berlin: Springer. In press.

Enwald et al. 12
[46] Ivanitskaya L, Hanisko KA, Garrison JA, Janson SJ and Vibbert D. Developing health information literacy: A needs analysis
from the perspective of preprofessional health students. Journal of Medical Library Association 2012; 100(4): 277–283, http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3484940/ (accessed 9 September 2015).
[47] Rosman T, Mayer AK and Krampen G. Measuring psychology students’ information seeking skills in a situational judgment
test format: Construction and validation of the PIKE-P test. European Journal of Psycological Assessment 2015; Epub ahead
of print 27 February 2015, doi: 10.1027/1015-5759/a000239.
[48] Smith SG, Curtis LM, Wardle J, von Wagner C and Wolf MS. Skill set or mind set? Associations between health literacy,
patient activation and health. PLoS One 2013; 8(9): e74373, http://journals.plos.org/plosone/article?id=10.1371/journal.po-
ne.0074373#pone-0074373-t004 (accessed 20 May 2015).
[49] Association of College and Research Libraries. Framework for information literacy for higher education, http://www.ala.org/
acrl/standards/ilframework (2015, accessed 4 September 2015).

Enwald - Everyday

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Enwald - Everyday

Uploaded by

Copyright:

Available Formats

Special Issue – I3 Conference – Aberdeen – June 2015

Journal of Information Science

a cross-sectional population-based study

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

1.1. Theoretical background and literature review

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

(1) It is important to be informed about health issues.

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

2.2. Study populations and questionnaire distribution

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Study Population-based sample EHIL respondents from the

MOPO – young generally healthy men 2507 (100%) 1481 (59.1%)

2.3. Data analysis

3.2. Everyday health information literacy

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Statement Young men who High-risk individuals

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Statement High-risk women High-risk men

Statement High-risk men High-risk men

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

4.1. Aspects of everyday health information literacy

4.2. Gender and age

4.3. Practical applications, study limitations and future studies

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

Downloaded from jis.sagepub.com at MCMASTER UNIV LIBRARY on March 25, 2016

You might also like