Background
Method
Results
Definitions of health literacy
1 | WHO (1998) | "The cognitive and social skills which determine the motivation and ability of individuals to gain access to understand and use information in ways which promote and maintain good health" [31] |
2 | American Medical Association's (1999) | "The constellation of skills, including the ability to perform basic reading and numeral tasks required to function in the healthcare environment" [12] |
3 | Nutbeam (2000) | "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" [36] |
4 | Institute of Medicine (2004) | "The individuals' capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions" [8] |
5 | Kickbusch, Wait & Maag (2005) | "The ability to make sound health decision(s) in the context of everyday life--at home, in the community, at the workplace, the healthcare system, the market place and the political arena. It is a critical empowerment strategy to increase people's control over their health, their ability to seek out information and their ability to take responsibility" [37] |
6 | Zarcadoolas, Pleasant & Greer (2003, 2005, 2006) | |
7 | Paasche-Orlow & Wolf (2006) | "An individual's possession of requisite skills for making health-related decisions, which means that health literacy must always be examined in the context of the specific tasks that need to be accomplished. The importance of a contextual appreciation of health literacy must be underscored" [40] |
8 | EU (2007) | "The ability to read, filter and understand health information in order to form sound judgments" [30] |
9 | Pavlekovic (2008) | "The capacity to obtain, interpret and understand basic health information and services and the competence to use such information to enhance health" [41] |
10 | Rootman & Gordon-Elbihbety (2008) | "The ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health in a variety of settings across the life course" [42] |
11 | Ishikawa & Yano (2008) | "The knowledge, skills and abilities that pertain to interactions with the healthcare system" [14] |
12 | Mancuso (2008) | "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" [43] |
13 | Australian Bureau of Statistics (2008) | "The knowledge and skills required to understand and use information relating to health issues such as drugs and alcohol, disease prevention and treatment, safety and accident prevention, first aid, emergencies, and staying healthy" [44] |
14 | Yost et al. (2009) | "The degree to which individuals have the capacity to read and comprehend health-related print material, identify and interpret information presented in graphical format (charts, graphs and tables), and perform arithmetic operations in order to make appropriate health and care decisions" [45] |
15 | Adams et al. (2009) | "The ability to understand and interpret the meaning of health information in written, spoken or digital form and how this motivates people to embrace or disregard actions relating to health" [22] |
16 | Adkins et al. (2009) | "The ability to derive meaning from different forms of communication by using a variety of skills to accomplish health-related objectives" [46] |
17 | Freedman et al. (2009) | "The degree to which individuals and groups can obtain process, understand, evaluate, and act upon information needed to make public health decisions that benefit the community" [35] |
Competence / skills / abilities | Action | Information | Objective | Context | Time |
---|---|---|---|---|---|
Skills Possession of requisite skills/Constellation of skills/Wide range of skills Cognitive skills Social skills Personal skills The ability The capacity The knowledge The competencies Motivation Comprehension Communication | To gain access To understand To use To perform basic reading and numerical tasks To obtain To process To seek out To comprehend To evaluate To read To filter To find To appraise To communicate To interpret To identify To perform arithmetic operations To embrace or disregard actions To derive meaning To act To make sound decisions/to make health-related decisions To take responsibility To pertain interactions To attain capacity, comprehension and communication | Information Health information Information relating to health Basic health information Health-related print-material Information presented in graphical form Health information in written, spoken or digital form Different forms of communication Concepts Services | Promote and maintain good health To function in the health care environment To make appropriate health decisions A critical empowerment strategy to increase people's control over their health To make informed choices Reduce health risks Increase quality of life To form sound judgments To engage in demands of different health contexts To promote health To enhance health To improve health To make appropriate health and care decisions To accomplish health-related objectives To make public health decisions that benefit the community | Variety of settings The health care environment Different health contexts Health care setting Health related contexts The everyday life at home, in the community, at the workplace, within the healthcare system, at the market place and within the political arena HL always related to the context of the specific tasks needed to be accomplished | Across the life course Evolves over lifetime |
Concepts of health literacy
Reference | Dimensions | Antecedents | Consequences | |
---|---|---|---|---|
1 | Nutbeam (2000) [36] | - Functional health literacy - Interactive health literacy - Critical health literacy | Health promotion actions (education, social mobilization, advocacy) |
Individual benefits
- Improved knowledge of risks - 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 programs - 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 |
2 | Lee et al. (2004) [47] | - Disease and self-care knowledge. - Health risk behavior - Preventive care and physician visits. - Compliance with medications. | - Social-economic status - Gender - Ethnicity - Health insurance coverage - Disease severity - Income discrepancy - Ethnic composition of the community | - Health status - Emergency care - Hospitalization |
3 | Institute of Medicine (2004) [8] | - Cultural and conceptual knowledge - Listening - Speaking - Arithmetical skills - Writing skills - Reading skills | - Education, culture and language. - Communication and assessment skills of people with whom individuals interact for health - Ability of the media, the marketplace, and governmental agencies to provide health information in an appropriate manner | Health outcomes and costs |
4 | Zarcadoolas et al. (2005) [38] | - Fundamental literacy Science literacy - Civic literacy Cultural literacy | - Health status - Demographic, sociopolitical, psychosocial and cultural factors | - Ability to apply information to novel situations Ability to participate in public and private dialogues about health, medicine, scientific knowledge and cultural beliefs |
5 | Speros (2005) [48] | - Reading/numeracy skills - Comprehension - Capacity to use health information in decision making - Successful functioning in healthcare consumer role | - Literacy - Health-related experience. | - Improved self-reported health status - Lower healthcare costs - Increased health knowledge - Shorter hospitalization Less frequent use of healthcare services |
6 | Baker (2006) [49] | - Health-related print literacy - Health-related oral literacy. | - Health-related reading fluency - Health-related vocabulary - Familiarity with health concepts Complexity and difficulty of the printed and spoken messages in the healthcare environment | - Acquisition of new knowledge - More positive attitudes - Greater self-efficacy Positive health behaviors - Better health outcomes |
7 | Paashe-Orlow & Wolf (2007) [40] | - Listening - Verbal fluency - Memory span - Navigation. | - Socioeconomic status Occupation - Employment status Income - Social support - Culture and language - Education - Age - Race/ethnicity Personal competences such as vision, hearing, verbal ability, memory and reasoning. | - Access and utilization of healthcare (influenced by patients' navigation skills, self-efficacy and perceived barriers, and by system's complexity, acute care orientation and tiered delivery model). - Patient/provider interactions (influenced patients' knowledge, beliefs and participation in decision-making, and by providers' communication skills, teaching ability, time and patient-centered care). Self care (influenced by patients' motivation, problem-solving, self-efficacy, knowledge/skills, and by support technologies, mass media, health education and resources) |
8 | Kickbusch & Maag (2008) [2] | - Functional - Interactive - Critical | - Education system - Health-care system - Culture/home and community - Work - Politics Market | - Health outcomes and costs |
9 | Mancuso (2008) [43] | - Capacity - Comprehension Communication | - Operational competence - Interactive competence - Autonomous competence - Informational competence - Contextual competence - Cultural competence | - 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 and screening health-promoting behaviors Health status, defined as physical illness or perceptions of illness, disease or impairment |
10 | Manganello (2008) [50] | - Functional health literacy - Interactive health literacy - Critical health literacy Media literacy | - Individual traits (age, race, gender, cultural background, cognitive and physical abilities, social skills) - Media use - Peer and parent influences - Mass media, the education system and the health system | - Health behavior - Health costs - Health service use |
11 | Freedman et al. (2009) [35] | - Conceptual foundations - Critical skills Civic orientation | Social, environmental and political forces | - Resolve some of society's more pressing health issues - Alleviate social injustices. |
12 | Von Wagner et al. (2009) [51] | - Ability to rely on literacy and numeracy skills when they are required to solve problems | - Epidemiological or structural determinants - Individual influences - Reading and arithmetic skills - External influences | - Access and use of healthcare - Patient-provider interaction - Management of health and illness |
Dimensions of health literacy
Antecedents and consequences of health literacy
An integrated conceptual model of health literacy
Access/obtain information relevant to health | Understand information relevant to health | Process/appraise information relevant to health | Apply/use information relevant to health | |
---|---|---|---|---|
Health care
| Ability to access information on medical or clinical issues | Ability to understand medical information and derive meaning | Ability to interpret and evaluate medical information | Ability to make informed decisions on medical issues |
Disease prevention
| Ability to access information on risk factors for health | Ability to understand information on risk factors and derive meaning | Ability to interpret and evaluate information on risk factors for health | Ability to make informed decisions on risk factors for health |
Health promotion
| Ability to update oneself on determinants of health in the social and physical environment | Ability to understand information on determinants of health in the social and physical environment and derive meaning | Ability to interpret and evaluate information on health determinants in the social and physical environment | Ability to make informed decisions on health determinants in the social and physical environment |