Cent Eur J Nurs Midw 2026, 17(2):2430-2437 | DOI: 10.15452/cejnm.2026.17.0011

Assessment of Slovak nursesʼ Health Literacy Knowledge and Experience (HLKES-2): a preliminary study

Martina Solárová , Miloš Čakloš , Emília Miklovičová , Jarmila Kristová , Zuzana Bachratá , Gabriela Pénzesová
Department of Nursing, Faculty of Nursing and Professional Health Studies, Slovak Medical University in Bratislava, Slovak Republic

Aim: The study aimed to assess nurses’ knowledge and experience of health literacy using the Slovak 14-item HLKES-2 (Health Literacy Knowledge and Experience Survey 2) and explore its links with selected variables.

Design: Quantitative, cross-sectional study.

Methods: The sample consisted of 255 Slovak nurses. The data were analyzed using basic statistical methods (Mann–Whitney U test and Spearman’s correlation) and we evaluated the psychometric properties of the tool.

Results: The results indicated low levels of health literacy knowledge (39.65%; 4.43 ± 2.58) and moderate levels of experience with health literacy (5.05 ± 2.58). Nurses’ knowledge was not related to their education, workplace, or prior training in health literacy (p > 0.05). Nurses working in general wards reported higher levels of health literacy experience compared to those in intensive care units (p = 0.018). The analysis showed low reliability for the ten multiple-choice knowledge items and good reliability for the four Likert-type experience items.

Conclusion: The findings indicate that nurses demonstrated substantial practical experience but possessed limited knowledge of health literacy. These results underscore the need to strengthen education in this area to enhance patient communication.

Keywords: experience, health literacy, HLKES-2, knowledge, nursing, Slovakia

Received: October 5, 2025; Revised: March 8, 2026; Accepted: March 17, 2026; Published: June 5, 2026  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Solárová M, Čakloš M, Miklovičová E, Kristová J, Bachratá Z, Pénzesová G. Assessment of Slovak nursesʼ Health Literacy Knowledge and Experience (HLKES-2): a preliminary study. Central European Journal of Nursing and Midwifery. 2026;17(2):2430-2437. doi: 10.15452/cejnm.2026.17.0011.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Al-Fayyadh, S., Al-Jubouri, M. B., Al-Hadrawi, H., Jaafar, S. A., & Hussein, S. M. (2022). Health literacy-related knowledge and experience among nurses practicing in medical-surgical wards. Nurse Media Journal of Nursing, 12(1), 24-31. https://doi.org/10.14710/nmjn.v12i1.42697 Go to original source...
    2. Angelopoulou, E., Apostolara, P., Kardari, A., & Velonaki, V. S. (2023). Nursesʼ knowledge and experience of health literacy: translation and validation of the HL-KES 2 scale in Greek. International Journal of Caring Sciences, 16(3), 1101-1115.
    3. Bertiz, T., Cortes, T., Ma, C., & Pandey, E. (2024). Improvement of nurses' ability in addressing low health literacy to reduce hospital readmission in adult heart failure patients: a quality improvement initiative. Practical Implementation of Nursing, 3(2), 45-46. https://doi.org/10.29024/pins.89 Go to original source...
    4. Chang, Y. W., Li, T. C., Chen, Y. C., Lee, J. H., Chang, M. C., & Huang, L. C. (2020). Exploring knowledge and experience of health literacy for Chinese-speaking nurses in Taiwan: a cross-sectional study. International Journal of Environmental Research and Public Health, 17(20), 7609. https://doi.org/10.3390/ijerph17207609 Go to original source... Go to PubMed...
    5. Cormier, C. M., & Kotrlik, J. W. (2009). Health literacy knowledge and experiences of senior baccalaureate nursing students. Journal of Nursing Education, 48(5), 237-248. https://doi.org/10.3928/01484834-20090416-02 Go to original source... Go to PubMed...
    6. Cutilli, C., & Christensen, S. A. (2024). Promoting health literacy. American Nurse, 19(8). Go to original source...
    7. Čakloš, M., & Bóriková, I. (2023). Using health literacy communication strategies in clinical practice. Praktický lékař, 103(1), 23-28.
    8. Čakloš, M., Kristová, J., Solárová, M., & Pénzesová, G. (2024). Health literacy in the education of nursing students in Slovakia. In Proceedings of abstracts: New Trends in Nursing X (s. 51-52). Faculty of Health and Social Work, Trnava University in Trnava. https://konferenciefzsp.truni.sk/konferencia/nove-trendy-v-osetrovatelstve-xnew-trends-nursing-x
    9. Güner, M. D., & Ekmekci, P. E. (2019). A survey study evaluating and comparing the health literacy knowledge and communication skills used by nurses and physicians. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 56, 1-11. https://doi.org/10.1177/0046958019865831 Go to original source... Go to PubMed...
    10. Haney, M. Ö., & Yoğurtcu, H. (2023). Psychometric properties of the Health Literacy Knowledge and Experience Survey-2 for Turkish nursing students. Health Promotion International, 38(5), daad117. https://doi.org/10.1093/heapro/daad117 Go to original source... Go to PubMed...
    11. Herndon, J. B., Chaney, M., & Carden, D. (2011). Health literacy and emergency department outcomes: A systematic review. Annals of Emergency Medicine, 57(4), 334-345. https://doi.org/10.1016/j.annemergmed.2010.08.035 Go to original source... Go to PubMed...
    12. Kaper, M. S., Sixsmith, J., Koot, J. A. R., Meijering, L. B., van Twillert, S., Giammarchi, C., Bevilacqua, R., Barry, M. M., Doyle, P., Reijneveld, S. A., & de Winter, A. F. (2018). Developing and pilot testing a comprehensive health literacy communication training for health professionals in three European countries. Patient Education and Counseling, 101(1), 152-158. https://doi.org/10.1016/j.pec.2017.07.017 Go to original source... Go to PubMed...
    13. Ludwick, R. (2009). Overview and summary: promoting health literacy: strategies for healthcare providers. The Online Journal of Issues in Nursing, 14(3). https://doi.org/10.3912/OJIN.Vol14No03ManOS Go to original source...
    14. Macabasco-OʼConnell, A., & Fry-Bowers, E. K. (2011). Knowledge and perceptions of health literacy among nursing professionals. Journal of Health Communication, 16(Suppl. 3), 295-307. https://doi.org/10.1080/10810730.2011.604389 Go to original source... Go to PubMed...
    15. Nantsupawat, A., Wichaikhum, O. A., Abhicharttibutra, K., Kunaviktikul, W., Nurumal, M. S. B., & Poghosyan, L. (2020). Nursesʼ knowledge of health literacy, communication techniques, and barriers to the implementation of health literacy programs: a cross-sectional study. Nursing & Health Sciences, 22(3), 577-585. https://doi.org/10.1111/nhs.12698 Go to original source... Go to PubMed...
    16. Nesari, M., Olson, J. K., Nasrabadi, A. N., & Norris, C. (2019). Registered nursesʼ knowledge of and experience with health literacy. Health Literacy Research and Practice, 3(4), e268-e279. https://doi.org/10.3928/24748307-20191021-01 Go to original source... Go to PubMed...
    17. Perrin, A., Damiolini, E., Schott, A. M., Zermati, J., Bravant, E., Delahaye, F., Dima, A. L., & Haesebaert, J. (2022). Considering health literacy in cardiovascular disease management: a qualitative study on healthcare professionalsʼ and patientsʼ perspectives. BMC Health Services Research, 22(1), 1121. https://doi.org/10.1186/s12913-022-08455-8 Go to original source... Go to PubMed...
    18. Polit, D. F., & Beck, C. T. (2006). The content validity index: are you sure you know whatʼs being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489-497. https://doi.org/10.1002/nur.20147 Go to original source...
    19. Rubio, D. M., Berg-Weger, M., Tebb, S. S., Lee, E. S., & Rauch, S. (2003). Objectifying content validity: conducting a content validity study. Social Work Research, 27(2), 94-104. https://doi.org/10.1093/swr/27.2.94 Go to original source...
    20. Scrivner, B., Szaflarski, M., Baker, E. H., & Szaflarski, J. P. (2019). Health literacy and quality of life in patients with treatment-resistant epilepsy. Epilepsy & Behavior, 99, 106480. https://doi.org/10.1016/j.yebeh.2019.106480 Go to original source... Go to PubMed...
    21. Shahid, R., Shoker, M., Chu, L. M., Frehlick, R., Ward, H., & Pahwa, P. (2022). Impact of low health literacy on patients' health outcomes: a multicenter cohort study. BMC Health Services Research, 22(1), 1148. https://doi.org/10.1186/s12913-022-08527-9 Go to original source... Go to PubMed...
    22. Sheehan, J., Laver, K., Bhopti, A., Rahja, M., Usherwood, T., Clemson, L., & Lannin, N. A. (2021). Methods and effectiveness of communication between hospital allied health and primary care practitioners: a systematic narrative review. Journal of Multidisciplinary Healthcare, 14, 493-511. https://doi.org/10.2147/JMDH.S295549 Go to original source... Go to PubMed...
    23. Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 12(1), 80. https://doi.org/10.1186/1471-2458-12-80 Go to original source... Go to PubMed...
    24. Subedi, S., Ghimire, A., Uprety, S., & Pokharel, P. K. (2022). Health literacy knowledge and understanding of registered nurses in tertiary care teaching hospital of eastern Nepal: two important dimensions for better health results. Journal de Investigação Médica, 3(1), 7-21. https://doi.org/10.29073/jim.v3i1.540 Go to original source...
    25. Walker, D., Howe, C., Dunkerley, M., Deupree, J., & Cormier, C. (2019). The HLKES-2: revision and evaluation of the Health Literacy Knowledge and Experiences Survey. Journal of Nursing Education, 58(2), 86-92. https://doi.org/10.3928/01484834-20190122-05 Go to original source... Go to PubMed...
    26. Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., & Erikson, P. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in Health, 8(2), 94-104. https://doi.org/10.1111/j.1524-4733.2005.04054.x Go to original source... Go to PubMed...
    27. World Health Organization. (2016). Shanghai declaration on promoting health in the 2030 Agenda for Sustainable Development. 9th Global Conference on Health Promotion, Shanghai. https://www.who.int/publications/i/item/WHO-NMH-PND-17.5

    This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content