New analysis of a national survey suggests health‑promotion tasks are the hardest for nearly everyone—and especially for those living with mental illness.

A new study of 2,093 adults in Germany reports that people living with chronic mental illness have the lowest “health literacy”—the everyday ability to find, understand, judge and use health information—compared with people who have chronic physical (somatic) illness or no chronic illness at all. The pattern held across three areas of daily life: getting healthcare, preventing disease, and promoting health.  

What the researchers did

The team analyzed data from the Second Health Literacy Survey Germany (HLS‑GER 2), a paper‑based, face‑to‑face survey conducted just before the pandemic (Dec 2019–Jan 2020). Participants answered 47 questions covering tasks in healthcare, prevention, and health promotion. Researchers also looked at age, education, social status, finances, social support and self‑efficacy (confidence in handling difficulties).

Who was in the study

Of the 2,093 respondents, 1,026 reported no chronic illness, 920 had at least one chronic physical illness, and 147 reported at least one chronic mental illness. Most people with mental illness also had a physical condition (124 of 147).

Key findings at a glance

• Lowest scores for mental illness: In all three domains—healthcare, disease prevention, and health promotion—the mental‑illness group scored lowest. In Figure 1 (page 5), the average total health‑literacy score is visibly lowest for this group (roughly mid‑50s) versus the no‑illness group (mid‑60s).  
• Health promotion is hard for almost everyone: Tasks like “finding information about changes in laws that may affect your family’s health” were rated difficult by about 78% of respondents, regardless of health status. Next hardest: “how to promote health at work/school/neighborhood” (about 71–76%). Figure 4 (page 8) illustrates these gaps, and the text highlights similar percentages.  
• Mental‑health information is a sticking point: More than half of respondents found it difficult to “find information on how to handle mental health problems,” as shown in Figure 3 (page 7).  
• What helps: Across groups, higher education and greater self‑efficacy were linked with better health literacy. Among people with mental illness, stronger social support was also associated with higher scores. For those with chronic physical illness, older age was linked with lower scores, while higher social status was linked with better scores. Women generally reported higher health literacy than men in the no‑illness and chronic‑physical groups.

Why it matters

Chronic diseases drive most deaths globally, and navigating care, prevention and daily health behaviors depends on health literacy. The authors argue that people with chronic mental illness may be especially vulnerable—partly due to disease‑related challenges (e.g., low motivation during depression) and partly due to how information and services are organized. They urge health systems to improve the “information environment” (clearer, easier‑to‑find, tailored information) and to build social‑support networks that make information easier to use.

Caveats

The survey relied on self‑reports, was cross‑sectional (so it can’t prove cause and effect), and the mental‑illness group was relatively small and mostly included people reporting depression. Data were collected in 2019/2020, so follow‑up studies should confirm whether patterns persist.

Bottom line for readers

If you—or someone you care for—lives with chronic mental illness, you’re not alone if health information feels hard to navigate. Ask clinicians for plain‑language explanations and step‑by‑step next actions, lean on support networks, and look for resources tailored to mental health needs. The study suggests these strategies can make a real difference—and that health systems should meet people halfway with clearer, more accessible information.  

Study details: Griese L, Schaeffer D. “Health literacy and chronic disease: a comparison of somatic and mental illness.” Frontiers in Public Health. Published Feb. 18, 2025 (open access).  

Editor’s note: Figure references are from the article’s charts—Figure 1 (page 5) and Figures 3–4 (pages 7–8)—which visualize score gaps and the specific tasks people find hardest.  

Editor’s note: This article is for information only and is not a substitute for professional medical advice.