AUTHOR=Ulrich Till Werner , Klein Jens , von dem Knesebeck Olaf 
  
TITLE=Social disparities, navigational health literacy, and unmet needs in Germany: results of a population survey
  
JOURNAL=International Journal of Public Health
  
VOLUME=Volume 71 - 2026
  
YEAR=2026
  
URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2026.1609928
  
DOI=10.3389/ijph.2026.1609928
  
ISSN=1661-8564
  
ABSTRACT=ObjectivesNavigational health literacy is increasingly important in the German health system. While social disparities have been reported, less is known about its association with unmet needs and whether it attenuates the associations between social characteristics and unmet needs.MethodsThis cross-sectional online survey in Germany included a random sample of 2,201 adults. Participants completed the validated HLS19-NAV instrument and reported unmet needs during the past 12 months. Associations were examined using descriptive and multiple Poisson regression analyses.ResultsOverall, 70% of participants showed inadequate navigational health literacy. Lower navigational health literacy was associated with lower income, lower education, statutory health insurance, and age 41–59 years. Unmet needs were more common among younger adults, women, and lower-income or statutorily insured participants. Better navigational health literacy was associated with lower prevalence of unmet needs. After adding navigational health literacy to the model, associations between social characteristics and unmet needs remained largely unchanged.ConclusionNavigational health literacy was unequally distributed across groups and strongly associated with unmet needs but did not reduce the observed social disparities in access to care.