In one self-assessment questionnaire study of students' perceptions of their study experience in English medium faculties of Social Science, Humanities, Engineering and Business at Norwegian and German universities, 42% of the Norwegian sample and 72% of the German students reported substantial comprehension difficulties (Hellekjaer, 2010).
A systematic review of 21 studies on how informed consent was defined and measured in African research settings reported that comprehension is often poor among such study participants and this means that there is a need to develop a definition for informed consent which can be applied better in low literacy settings in Africa [ 32].
Table 1 reports the mean level of self-reported comprehension of health information among men vis-à-vis women, classified by the health literacy level.
Model 1, which included only the gender variable, showed that men were significantly more likely than women to report good comprehension of health information.
The interviewer interviewee gender difference may increase male respondents' propensity to disguise their reading problems and to over-report their comprehension abilities.
A significant gender difference was observed among participants who had inadequate health literacy: while women's self-report was in line with the MHLS test result, men had a significant tendency to over-report their comprehension of health information.
Moreover, the differences were small and non-significant in women and were significantly larger in men, suggesting that, of those tested to have inadequate health literacy, women's self-report was in line with the MHLS test result and men, on the other hand, had a significant tendency to over-report their comprehension of health information.
Most of these studies reported problems with comprehension and understanding of the informed consent process by patients including the right of withdrawal [ 52- 55].
Parents also reported on their comprehension of nutrition labels, how often they cooked "fresh food from scratch at home", and how often the family ate meals together at the table.
The improvements reported in reading comprehension by Dahlin (2010) were significant in comparison to a no-contact rather than an active control group, which guards against test retest but not the Hawthorne effect (see McCarney, Warner, Illife, van Haselen, Griffin & Fisher, 2007).
