Low health literacy among individuals with chronic disease in Kalaallit Nunaat: a cross-sectional study with implications for health literacy responsiveness

Chronic diseases are an increasing public health challenge in Greenland (Kalaallit Nunaat), requiring self-management and navigation in healthcare information. Health Literacy (HL) refers to the ability to access, understand, and use health information. Low HL is prevalent in other Indigenous populations, negatively affecting self-care, health outcomes, mortality and contributing to social inequalities. Despite health inequalities in Kalaallit Nunaat, HL has not been quantitatively assessed. The aim was to investigate HL among individuals with chronic diseases in Kalaallit Nunaat and assess the HLS19-Q12 questionnaire in Greenlandic (Kalaallisut). This cross-sectional study (25 February - 2 April 2025) included participants (≥18 years) with diabetes, chronic obstructive pulmonary disease, hypertension, obesity, and/or asthma. HL was assessed using the concise HLS19-Q12 questionnaire in Kalaallisut and Danish. Internal consistency and test-retest reliability were evaluated using Cronbach’s alpha and intraclass correlation coefficient (ICC). 230 individuals completed the questionnaire, including 28 retests. HL levels were categorised into four levels: inadequate 32.2%, problematic 50%, sufficient 12.4% and excellent 5.4%. The Kalaallisut HLS19-Q12 demonstrated acceptable internal consistency (Cronbach's alpha = 0.88; 95% CI: 0.78-0.93) and test-retest reliability (ICC = 0.86; 95% CI: 0.71-0.94). Overall, 82.2% of participants had inadequate or problematic HL, highlighting the need for interventions to strengthen HL responsiveness in Kalaallit Nunaat.