Background
Method
Search strategy and screening process
Topic |
And
| Sub-topic | |
English: | Health literacy, “health literacy”, health competence | Skill*, competen*, concept*, theor*, model*, framework*, Defin* | |
Fähigkeit*, Kompetenz*, Konzept*, Theorie*, Model*, Rahmen*, Definition* | |||
OR
| |||
German: | Gesundheitskompetenz, −mündigkeit, −bildung | Target population | |
Child*, adolescen*, youth, teen* pupil*, student* | |||
Kind*, Jugend*, Teen*, Schüler* |
Data extraction and analysis
Results
Children & Primary School Students | ||
A | Fok & Wong [17] | The meaning of health literacy to children is defined as “to understand and act upon physical and psycho-social activities with appropriate standards, being able to interact with people and cope with necessary changes and; demands reasonable autonomy so as to achieve complete physical, mental and social well-being. |
B | Brown et al. [32] | “For this study, health literacy was defined simply as the ability to understand health information and to understand that actions taken in youth affect health later in life, combined with the ability to access valid health information.” |
Young people & Secondary School Students | ||
C | Massey et al. [33] | “We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and practices relevant when managing one’s health environment.” |
D | Paakkari & Paakkari [8] | “Health Literacy is defined in the following terms: Health literacy comprises a broad range of knowledge and competencies that people seek to encompass, evaluate, construct and use. Through health literacy competencies people become able to understand themselves, others and the world in a way that will enable them to make sound health decisions, and to work on and change the factors that constitute their own and others’ health chances.” |
E | Wu et al. [18] | “Health literate individuals are able to understand and apply health information in ways that allow them to take more control over their health through, for example, appraising the credibility, accuracy and relevance of information and acting on that information to change their health behaviours or living conditions.” |
F | Gordon et al. [19] | “Health Literacy is the degree to which individuals have the capacity to obtain, access, process, and understand basic health information and services needed to take appropriate health decisions and involves an ongoing process of building individual and community capacity to understand the components of health.” |
Different age groups or considering a life course perspective | ||
G | Borzekowski [1] | “Health literacy is not just the ability to read, rather, it is a set of skills that involve recognizing, processing, integrating, and acting on information from a variety of platforms. Those between the ages of 3 and 18 can seek, comprehend, evaluate, and use health information, especially if materials are presented in ways that are age appropriate, culturally relevant, and socially supported. The development of health literacy among children and young people can empower this vulnerable and “marginalized” group to be more engaged, more productive, and healthier.” |
H | Soellner et al. [36] | [Translated] The working definition defines health competences (Gesundheitskompetenz) as an accumulation of skills and capabilities that someone has at one’s command to be able to act in daily life and in dealing with the health system, in such a ways that positively affect one’s health and well-being. |
I | Mancuso [34] | “A process that evolves over one’s lifetime and encompasses the attributes of capacity, comprehension, and communication. The attributes of health literacy are integrated within and preceded by the skills, strategies, and abilities embedded within the competencies needed to attain health literacy. The outcomes of health literacy are dependent upon whether one has achieved adequate or inadequate health literacy and have the potential to influence individuals and society.” |
J | Nutbeam [35] | “The personal, cognitive and social skills which determine the ability of individuals to gain access to, understand, and use information to promote and maintain good health” |
K | Sørensen et al. [10] | “Health literacy is linked to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course.” |
L | Zarcadoolas, Pleasant & Greer [20] | “Health literacy evolves over one’s life course, starting at an early age, and, like most complex human competencies, is impacted by health status as well as demographic, socio-political, psychosocial and cultural factors.” “We define health literacy as the wide range of skills, and competencies that people develop to seek out, comprehend, evaluate and use health information and concepts to make informed choices, reduce health risks and increase quality of life.” |
Definitions of health literacy in childhood and youth
Components: • collection/set of skills (n = 6) • competencies (n = 5) • knowledge (n = 3) • capacity (n = 2) | • motivation (n = 1) • strategies (n = 1) • comprehension (n = 1) • communication (n = 1) |
Action/Agency: • to understand (n = 5) • to access (n = 4) • to use (n = 4) • to apply (n = 3) • to comprehend (n = 3) • to evaluate (n = 3) • to act (upon) (n = 3) • to seek (out) (n = 2) | • to appraising (n = 2) the credibility, accuracy and relevance of • to process (n = 2), • to obtain (n = 1) • to encompass (n = 1) • to integrate (n = 1) • to construct (n = 1) • to interact with people (n = 1) • to cope with necessary changes (n = 1) • to organize (n = 1) |
Subjects: • (basic) health information (n = 7) • health-related concepts (n = 1) • health services (n = 1) | • health knowledge, attitudes and practice (n = 1) • physical and psycho-social activities with appropriate standards (n = 1) |
Sources: from a variety of platforms (n = 1) | |
Purposes: • to take/make appropriate/sound health decisions (n = 3) (concerning healthcare, disease prevention and health promotion) • to make informed choice (n = 1) • to manage one’s health environment (n = 2) • to maintain or improve quality of life (n = 2) • to improve or achieve complete well-being (n = 2) to promote and maintain good health (n = 1) • to make judgments (n = 1) | • to take more control over their health (n = 1) • to understand themselves, others and the world (n = 1) • to reduce health risks (n = 1) • to change their health behaviours or living conditions (n = 1) • to empower this group to be more engaged, more productive, and healthier (n = 1) • to build individual and community capacity to understand the components of health (n = 1) • the potential to influence individuals and society (n = 1) • to understand that actions taken in youth affect health later in life (n = 1) |
Age- and development-specific conditions: • if materials are presented in ways that are age appropriate, culturally relevant, and socially supported (n = 1) • demands reasonable autonomy (n = 1) | |
Time: • ongoing process (n = 2) • evolves over one’s lifetime (n = 2) | • during the life course (n = 1) • starting at an early age(n = 1) |
Models of health literacy in children and young people
No | Author | Target group (TG) as expressed by papers | HL definition (Source: primary = by same author as model); secondary = different source) | Primary purpose of study | Context in which or for which developed/tested | Models described specificities of TG | TG participation in development | Empirically tested? |
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Children & Primary and Lower Secondary School Students | ||||||||
1 | Brown et al. [32] Exemplary for the US NHES [37] | Students, grade 5-8, Age 9-13 | Primary (see Table 2) | Operationalization: Conceptual base for measurement tool | (School) health education | Yes | No | Yes |
2 | Paek et al. [28] | Students, grade 7, Age 12-13 | Secondary (WHO, 1998) | Conceptualization; explorative & testing | Health Socialization | Yes | Yes | Yes |
3 | Schmidt et al. [25] | Children, grade 5, 9–13 years | Secondary (Nutbeam, 2008) | Operationalization: Effect model for intervention study | (School) health education | Yes | No | Yes |
Young people & Secondary School Students | ||||||||
4 | Manganello [21] | Young people, n.s. | Secondary (IOM, 2004) | Conceptualization; Explorative | Health care; Disease prevention | Yes | No | No |
5 | Massey et al. [33] | Young people, aged 13-17 | Primary (see Table 2) | Conceptualization inductive and explorative | Health care system | Yes | Yes | No |
6 | Paakkari & Paakkari [8] | Students, n.s. | Primary (see Table 2) | Conceptualization; theoretical exploration | (School) health education | Yes | No | No |
7 | Rask, Uusiautti, Määttä, [29] | Secondary school students, aged app. 18-20 | Secondary, WHO (1998), as cited by Mancuso (2009) | Conceptualization; inductive | (School) health education | No | Yes | No |
8 | Steckelberg et al. [22] | Students, grade 11, Age 16-18 | Secondary (IOM, 2004) | Operationalization: Effect model for intervention study | School curricula programme | Yes | No | Yes |
9 | Subramaniam et al. [26] | Young people, aged 10-15 | Secondary (NAAL, 2013) | Operationalization: Deductive for intervention testing & evaluation | School health programme | Yes | No | Yes |
10 | Wharf Higgins, Begoray, & MacDonald [27] | Students, grade 10 (Canadian system) | Secondary (e.g. Kickbusch, 2007) | Conceptualization; inductive and testing | School health education | Yes | No | Yes |
11 | Wu et al. [18] | Students, grade 10 (Canadian system) | Primary (see Table 2) | Operationalization: Conceptual base for scale development | School health education | Yes | No | Yes |
Different age groups or considering a life course perspective | ||||||||
12 | General population, empirically tested for young people 17-21. | Secondary (Soellner et al., 2009) | Conceptualization; inductive and testing | Different health related domains | No | No | Yes | |
13 | Mancuso [34] | Population across the life course, n.s. | Primary (see Table 2) | Conceptualization; explorative | Different health related domains | No | No | No |
14 | Martin & Chen [24] | Population across the life course | None stated | Conceptualization; explorative | Impact factors on child health | No | No | No |
15 | Nutbeam [35] | General population, focus upon health education | Primary (see Table 2) | Conceptualization; explorative | Public health; different health related domains | No | No | Yes |
16 | Children at different ages | Secondary (IOM, 2004) | Conceptualization; explorative | Different health related domains | Yes | No | No | |
17 | Soellner et al. [36] DE | General population, including young people | Primary (see Table 2) | Conceptualization; inductive and testing | Different health related domains | No | No | Yes |
18 | Sørensen et al. [10] | Population across the life course, n.s. | Primary (see Table 2) | Conceptualization; explorative & testing | Health care; Disease prevention; Health Promotion | No | No | Yes |
19 | Wolf et al. [23] | Population across the life course, n.s. | Secondary (IOM, 2004) | Conceptualization; Explorative | Health care | No | No | No |
20 | Zarcadoolas, et al. [4] | Population across the life course, n.s. | Primary (see Table 2) | Conceptualization; inductive and explorative | Public Health | No | No | No |
21 | Zeyer & Odermatt [30] DE | Students, n.s | Secondary (HCC-Lab, 2005) | Conceptualization; explorative | (School) health education/biology | No | No | No |
How are target group specificities considered?
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become increasingly responsible for their own health and for dealing with different kinds of health-related issues [22];
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are citizens in their own right, within their current surroundings [8];
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are at a crucial stage of development characterized by many physical, emotional and cognitive changes [21].
Dimensions of health literacy for children and young people in the 21 models
No | Author | Dimensions of HL (Skill, knowledge, …) | Nature/understanding of HL, as described in article |
---|---|---|---|
Children & Primary and Lower Secondary School Students | |||
1 | Brown et al. 2007, [32] Exemplary for the US NHES [37] | (1) Critical thinking and problem solving, (2) responsibility and productivity, (3) self-directedness, and (4) effective communication Health literacy was operationalized in measurement as the ability - to comprehend concepts related to health promotion and disease prevention - to access valid health information - to demonstrate the ability to advocate for health by sharing information | Applies National Health Education Standards (NHES) in measurement instrument |
2 | Paek et al., 2011 [28] | Interests in health topics, Understanding of health subjects, Motivation to act on what they had learned about staying healthy | The model integrates perspectives from social ecological models and health socialization models, adopted from political and consumer socialization |
3 | Schmidt et al. 2010 [25] | Health literacy domains, which were operationalized in measurement:: Health knowledge, Communication, Attitude, Behaviour, Self-efficacy | Health literacy was assessed a construct consisting of the five dimensions mentioned; dimensions were based on author’s understanding of Nutbeam (2000); |
Young people & Secondary School Students | |||
4 | Manganello 2008 [21] | Functional literacy (basic ability to read and write) Communicative/interactive literacy (ability to participate in daily activities and communication Critical literacy (person’s potential to evaluate information) Media literacy (the ability to critically evaluate media messages) | Based on author’s understanding of Nutbeam (2000) & Kaiser Family Foundation (2006) |
5 | Massey et al. 2012 [33] | Navigating the system (e.g. to access service, understand (non-)emergency care, to make appointment & fill a prescription) Rights and responsibilities (self-care perceptions, asking questions, knowing rights regarding sensitive topics) Preventive care (well-care visit, screening behaviours, related attitudes/perceptions to visit doctor) Information seeking (Ability to evaluate information, passive and active information seeking, relevance of information provided by physician) Patient–provider relationship (perceived trust, comfort level, communication issues, continuity of provider care) Cross-sectional: knowledge, attitudes, practices within the health care setting | Focus on health care setting: Identification of dimensions was based on results from focus groups with young people & interviews with primary care physicians |
6 | Paakkari & Paakkari,2012 [8] | Health literacy as broad range of knowledge and competencies: Theoretical knowledge (explicit, factual, formal and declarative knowledge about health matters) Practical knowledge (procedural or skills-based knowledge; capability to do something) Critical thinking (ability to think clearly and rationally; e.g. understand health issues in deeper way, make sound choices, participate as active member of society) Self-awareness (ability to self-reflect on oneself, own decisions, and oneself as learner; Citizenship (ability to act in an ethically-responsible way and take social responsibility; consider health matters beyond one’s own perspective (the ones of others and of the collective) Cross-sectional skills: Basic reading, writing and speech skills social skills, communication skills, and information-gathering skills | Health literacy is defined as a learning outcomes of the school health education subject in Finland. It focusses on a health promoting and empowerment perspective with effects for the personal and societal health. |
7 | Rask, Uusiautti, Määttä, 2013 [29] | Basic/Functional literacy (basic ability to read and write) Communicative/interactive literacy (ability to participate in daily activities and communication Critical literacy (person’s potential to evaluate information) Extended with fourth dimension: Holistic health literacy, with four sub dimensions: - tolerance, - understanding culture as wide and multidimensional phenomena, - environmental consciousness, analysis of the state of the world from various points of view | Based on author’s understanding of Nutbeam’s typology (2000), complemented with own holistic health literacy models (adapted from Stewart et al. 2008), dimensions are elaborated from students’ perspectives & point of views, based on their answers from the Finnish Matriculation Examination |
8 | Principles of critical health literacy related to evidence-based medicine (EBM): Understanding medical concepts (e.g. informed choice in diagnostic tests; appraising patient information) Skills of searching literature (e.g. searching the internet and databases) Basic statistics (e.g. critical appraisal of RCT’s) Design of health experiments and sampling (e.g. Fallacies and misinterpretations of data representation: observational articles versus randomized controlled trials (RCT) – What are the differences?; Understanding systematic reviews) | Based authors understanding of Nutbeam’s critical literacy dimension | |
9 | Subramaniam et al. 2015 [26] | Health literacy skills inventory with main categories: Foundational elements: general abilities/characteristics (e.g. health-related knowledge, ability to listen, communicate, motivation, attitudes, intention & self-efficacy), access to information Health-related information: information need identification and question formulation, information search, information comprehension, information assessment, information management, information use (dependent on context/goal of health information seeking) | Integration of results from an own narrative literature review on definitions and models |
10 | Wharf Higgins et al., 2009 [27] | Skills to access, understand, and communicate health information, resources and services Cross-sectional skills: knowledge, attitude | Integration of results from a literature review on general health literacy dimensions, reflect a socio ecological understanding and health promotion perspective |
11 | Wu et al. 2010 [18] | Understand health information: - literacy types (prose, numeracy and document) & levels of difficulty. Evaluating health information: - result is a judgment or conclusion about the information that is presented; and this judgment or conclusion is based on applying one or more criteria:(1) accuracy, (2) impartiality, (3) relevance, (4) comprehensiveness, (5) internal consistency | |
Different age groups or considering a life course perspective | |||
12 | (Translated from German) |
Basic skills:
- health-related basic knowledge (Comprehension of basic terms describing the body or simple health-related coherences and functions) - health-related basic skills (health-related reading, writing and numeracy skills)
Advanced skills:
- perceptual-motivational level: health-related self-perception, acceptance of responsibility (Verantwortungsübernahme) - action-oriented level: (a) dealing with health information, (b) self-control, (c) self-regulation, (d) communication and cooperation. [translated] | Integration of the model by Soellner et al. (2009); models were tested in and evaluated by four different population samples |
13 | Mancuso, 2008 [34] |
Attributes of health literacy:
Capacity (skills and innate potential of individual, including gathering, analysing and evaluating health information for credibility and quality, working together, managing resources, seeking guidance and support, developing and expressing a sense of self, creating and pursuing a vision and goals, and keeping pace with change; oral language skills, social skills, reading, listening, analytical, decision-making and numerical abilities, ability to act on health information etc.) Comprehension (complex process based on effective interaction of logic, language, and experience; what the individual understands; identify and creatively address health issues) Communication (message or information exchange process, including speech, signals, writing or behaviour and involves input, decoding, encoding, output and feedback. Essential skills are reading with understanding, conveying ideas in writing, speaking so others can understand, listening actively, and observing critically) | Health literacy as competence: to have the capability to function effectively in health-care situations; explored from an education, library science, health care, public health and mental health context. |
14 | Martin & Chen, 2014 [24] | reading, writing, numeracy (ability to understand basic probability and numerical concepts), listening (aural language), and speaking (oral language) skills within a health context | |
15 | Nutbeam, 2000 [35] | Basic/Functional health literacy (basic skills in reading and writing to function effectively in everyday situations) Communicative/Interactive health literacy (more advanced cognitive and literacy skills which, together with social skills, can be used to actively participate in everyday situations, extract information and derive meaning from different forms of communication, and apply this to changing circumstance) Critical health literacy (more advanced cognitive skills which, together with social skills, can be applied to critically analyse information and use this to exert greater control over life events and situations) Foundational: Cognitive development, exposure to different information/messages (communication content and message), personal and social skills, self-efficacy | Focus on a health promoting and empowerment perspective. |
16 | Prose/document-literacy skills (Writing, text comprehension, filling out form) Oral literacy skills (from basic communication to negotiation) Numeracy skills (e.g. food portion size or to understanding screening results) Systems-navigation skills (describe media influence on behaviour to complete enrolment process) Foundational: collective of family health literacy skills is important (child, parent(s), other caregivers) | Integration of results from a own systematic literature review on child health and literacy; Adapted from NHES & Bright Future Guidelines; skills are individually composed; complexity increases with age (examples are provided for age 4, 10, 14 and 18) | |
17 | Soellner et al., 2010 [36] (Translated from German) | Foundational skills (literacy/numeracy), Operational competence: (1) to navigate and act in the health system, (2) communication and cooperation, (3) information retrieval and processing, (4) self-awareness and self-regulation. Knowledge component: (1) system-specific und (2) health-related knowledge, Motivation: (1) willingness to take responsibility for own health. [translated] | Integration of results from an own narrative literature review on models and a stakeholder concept mapping |
18 | Sørensen et al.,2012 [10] | Access (ability to seek, find and obtain health information); Understand (ability to comprehend the health information that is accessed); Appraise (ability to interpret, filter, judge and evaluate the health information); Apply (ability to communicate and use the information to make a decision to maintain and improve health In three health domains: health care, disease prevention, health promotion Cross-sectional: knowledge, competence and motivation | Integration of results from an own systematic literature review on definitions and models |
19 | Wolf et al. 2009 [23] | Cognitive skill sets (processing speed, memory, reasoning and attention; literacy & numeracy, verbal ability and reading) Psychosocial skill set (self-efficacy, communication and prior experience) | Focuses on Health literacy as learning capacity in the health (care) setting. |
20 | Zarcadoolas et al., 2005 [4] | Fundamental literacy/numeracy (printed and spoken language, numerals, and basic mathematical symbols and terms) Science and technology literacy (e.g. knowledge of fundamental health and scientific concepts, comprehend technical complexity) Community/civic literacy (knowledge about sources of information and agendas, enables citizens to engage in dialogue and decision-making, includes media literacy skills and knowledge of civic and governmental processes) Cultural literacy (recognizing and using collective beliefs, customs, world-views, and social identity) | |
21 | Zeyer & Odermatt, 2009 [30] (Translated from German) | Situation-specific knowledge (to realize health-relevant situations, to match information) Conceptual knowledge (to realize health-relevant principles, facts, terms) Operational knowledge (knowledge on how to adequately act in an situation) Evaluation of health promotion (Does this action promote health and is feasible in daily life?) Evaluation of personal consequences Self-reflection (to break up every day routines and to consider and analyse one’s own action plan) | Health literacy is regarded as a set of competences. |
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Knowledge
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Basic or functional health-related skills
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Comprehension and understanding
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Appraisal and evaluation
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Critical thinking
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Seeking and accessing information
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Communication and interaction
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Application of information
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Other context-specific skills for the application of information and accessing services
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Citizenship
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Self-awareness and self-reflection
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Self-control and self-regulation
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Self-efficacy
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Interest and motivation
Antecedents and consequences of health literacy in children and young people
No | Author | Factors that influence the development and maintenance of HL | Factors that are influenced by Health Literacy or impact on the relationship between HL & health outcomes |
---|---|---|---|
Children & Primary and Lower Secondary School Students | |||
2 | Paek et al. 2011 [28] | Demographics & Environments (Gender, Ethnicity, Residence (rural/urban), health status, environmental risk factors, access to health information. Socialization Process: - socialization agents a) interpersonal channel (parents, peer, school) vs. b) Media (push media: TV, Radio, Newspaper; pull media: Internet), - health information behaviour, frequent consumption of health information, source of health information | (Health) behavioural outcomes |
3 | Schmidt et al. 2010 [25] | n.m. | health behaviour (as intermediate health outcome) |
Young people & Secondary School Students | |||
4 | Manganello, 2008 [21] | - individual traits/characteristics: such as age, ethnicity, gender, cultural background, cognitive and physical abilities and social skills; - media use - peer and parental influences: home setting, parental (health) literacy; - systems: media, education and health care | Health behaviour: e.g. to be informed and skilled health care consumers, Health service use: e.g. to effectively navigate the health care system & use health insurance benefits Health costs |
5 | Massey et al. 2012 [33] | n.m. | - health environment requires individuals to be informed and skilled HC consumers, - overcome environmental & interpersonal barriers when interacting with the HC system |
6 | Paakkari & Paakkari, 2012 [8] | Learning process and learning environment/conditions: teaching methods for health literacy need to be age-adjusted, pupil-focused, reflective, through discussion and negotiation | Empowerment, be able to understand oneself, others and the world, make sound health decisions, contribute to changing the factors that impact one’s own health and the health of other |
7 | Rask, Uusiautti, Määttä, 2013 [29] | poverty, gender, cultural differences, level of education, social economic status | knowledge & skills in maintaining their own health, ability to discuss health-related social issues |
10 | Wharf Higgins et al., 2009 [27] | Mico context:- Internal influences: age, gender, beliefs, values, experiences, SES,- General literacy (ability to read/write, listen/speak, view/represent; - other abilities, e.g. technological abilities with information mediaMeso Context: - School, family, and peer factors affecting health (e.g. family SES, peer norms and behaviour, safe/healthy schools etc.)- Health curricula: teaching, assignments, activities, testing, resources, etc.Macro context: - External influences: societal, community and neighbourhood factors affecting health (e.g. community-level SES, culture, media, government policies, etc.). | To establish and maintain an individual’s health-related goals (e.g. do not drink before driving, to exercise) |
Different age groups or considering a life course perspective | |||
12 | n.m. | Health behaviour and health | |
13 | Mancuso, 2008 [34] |
Competences: Operational (ability to utilize tools, procedures, and techniques for handling language proficiently), - Interactive (collaboration with others for individual improvement & enhancement through self-management.), - Autonomous (personal empowerment & self-awareness), - Informational (ability to determine authority and the currency of health information), - Contextual (mastery of the (health care) environment), - Cultural (ability to interpret the meaning system of social practices) | Healthcare costs, knowledge of diseases and treatments, self-management skills, ability to care for chronic conditions, compliance, medical or medication treatment errors - Access to and use of healthcare services - Use of expensive services such as emergency care and inpatient admissions - Prevention, screening, and health-promoting behaviours - Health status, defined as physical illness or perceptions of illness, disease or impairment |
14 | Martin & Chen, 2014 [24] | - parental health literacy & parental SES, health and health behaviour influence children health, school readiness, and academic outcomes; informal home setting, with downstream effects in formal academic setting; System influences and potential intervention point: - health and education setting/system, culture and society, | child HL influences HL as parents, parental SES, health, and health behaviours |
15 | Nutbeam, 2000 [35] | Health promotion actions: - Education (e.g. patient & school education, broadcast media and print media communication), - Social mobilization (e.g. community development, group facilitation, targeted mass communication), - Advocacy (e.g. lobbying, political organization and activism, overcoming bureaucratic inertia) | Individual benefits - Greater autonomy and personal empowerment - Improved knowledge of risks and health services - Compliance with prescribed actions. - Improved capacity to act independently on knowledge - Improved motivation and self-confidence - Improved individual resilience to adversity Community/social benefits - Increased participation in population health programmes - Improved capacity to influence social norms and interact with social groups. - Improved capacity to act on social and economic determinants of health - Improved community empowerment |
16 | Sanders et al. 2009 a [31] | Family factors: income, education, language, culture, social support; Social factors: geography, educational resources, public health support, environmental health Different systems: - Educational system (Preschool, K-12 curricula, adult education/job training), - Community systems (after-school programmes, culture/language, public health programmes), - Patient care environment (Provider skills, information tools), - Health systems (delivery system, information system) | Family health behaviours, Child health outcomes |
18 | Sørensen et al.,2012 [10] | Distal factors: - Social and environmental determinants (e.g. demographic situation, culture, language, political forces, societal systems); Proximal factors: - personal determinants (age, gender, ethnicity, socioeconomic status, education, occupation, employment, income, literacy), - situational determinants (e.g. social support, family and peer influences, media use and physical environment). | health service use, health costs, health outcomes, health behaviour, participation, empowerment, equity, sustainability |
19 | Wolf et al. 2009 [23] | n.m. | Health knowledge, health behaviour, health outcomes |
20 | Zarcadoolas et al., 2005/ 2003 [4] | Health status; Demographic, socio-political, psychosocial and cultural factors | Ability to apply information, to participate in public and private dialogues about health, medicine, scientific knowledge and cultural beliefs |