Health literacy and public health: a systematic review and integration of definitions and models

Kristine Sørensen, Stephan Van den Broucke, James Fullam, Gerardine Doyle, Jürgen Pelikan, Zofia Slonska, Helmut Brand, (HLS-EU) Consortium Health Literacy Project European, Helmut Brand, Stephan van den Broucke, Kristine Sørensen, Demosthenes Agrafiodis, Elizabeth Ioannidi, Barbara Kondilis, Gerardine Doyle, James Fullam, Kenneth Cafferkey, Jürgen Pelikan, Florian Röethlin, Zofia Slonska, Maria Falcon, Kancho Tchamov, Alex Zhekov, Mariël Droomers, Jantine Schuit, Iris van der Heide, Ellen Uiters, Gudula Ward, Monika Mensing, Kristine Sørensen, Stephan Van den Broucke, James Fullam, Gerardine Doyle, Jürgen Pelikan, Zofia Slonska, Helmut Brand, (HLS-EU) Consortium Health Literacy Project European, Helmut Brand, Stephan van den Broucke, Kristine Sørensen, Demosthenes Agrafiodis, Elizabeth Ioannidi, Barbara Kondilis, Gerardine Doyle, James Fullam, Kenneth Cafferkey, Jürgen Pelikan, Florian Röethlin, Zofia Slonska, Maria Falcon, Kancho Tchamov, Alex Zhekov, Mariël Droomers, Jantine Schuit, Iris van der Heide, Ellen Uiters, Gudula Ward, Monika Mensing

Abstract

Background: Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy.

Methods: A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model.

Results: The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively.

Conclusions: Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

Figures

Figure 1
Figure 1
Integrated model of health literacy--see separate file.

References

    1. Simonds SK. Health education as social policy. Health Education Monograph. 1974;2:1–25.
    1. Kickbusch I, Maag D. In: International Encyclopedia of Public Health. Kris H, Stella Q, editor. Vol. 3. Academic Press; 2008. Health Literacy; pp. 204–211.
    1. McQueen D, KI Potvin L, Pelikan JM, Balbo L, Abel Th, editor. Health and modernity. Springer: The Role of Theory in Health Promotion; 2007.
    1. UNESCO. Literacy for all. Education for All Global Monitoring Report 2006. UNESCO Publishing; 2005.
    1. Peerson A, Saunders M. Health literacy revisited: what do we mean and why does it matter? Health Promot Int. 2009;24(3):285–296. doi: 10.1093/heapro/dap014.
    1. Parker R. Health literacy: a challenge for American patients and their health care providers. Health Promot Int. 2000;15(4):277–283. doi: 10.1093/heapro/15.4.277.
    1. Kutner M, Jin E, Paulsen C. The Health Literacy of America's Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006-483). National Center for Education. Washington DC: U.S. Department of Education; 2006.
    1. Institute of Medicine. Health literacy: a prescription to end confusion. Washington DC: The National Academies; 2004.
    1. Davis T, Wolf MS. Health literacy: implications for family medicine. Fam Med. 2004;36(8):595–598.
    1. Health Literacy Innovations. The Health Literacy & Plain Language Resource Guide. Health Literacy Innovations; n.d;
    1. Lloyd LLJ, Ammary NJ, Epstein LG, Johnson R, Rhee K. A transdisciplinary approach to improve health literacy and reduce disparities. Health Promot Pract. 2006;7(3):331–335. doi: 10.1177/1524839906289378.
    1. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs AMA. Health literacy: report of the council on scientific affairs. J Am Med Assoc. 1999;281(6):552–557. doi: 10.1001/jama.281.6.552.
    1. McCray A. Promoting health literacy. J Am Med Inform Assoc. 2004;12(2):152–163. doi: 10.1197/jamia.M1687.
    1. Ishikawa H, Yano E. Patient health literacy and participation in the health-care process. Health Expect. 2008;11(2):113–122. doi: 10.1111/j.1369-7625.2008.00497.x.
    1. Tappe MK, Galer-Unti RA. Health educators' role in promoting health literacy and advocacy for the 21 st century. J Sch Health. 2001;71(10):477–482. doi: 10.1111/j.1746-1561.2001.tb07284.x.
    1. Robbins A. Public health literacy for lawyers: teaching population-based legal analysis. Environ Health Perspect. 2003;111(14):744–745. doi: 10.1289/ehp.111-a744.
    1. Parker RM, Gazmararian JA. Health literacy: essential for health communication. J Health Commun. 2003;8(3):116–118.
    1. Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20:174–184.
    1. Porr Caroline, Drummond Jane, Richter Solina. Health Literacy as an Empowerment Tool for Low-Income Mothers. Family & Community Health. 2006;29(4):328–335.
    1. Paasche-Orlow MK. Bridging the international divide for health literacy research. Patient Educ Couns. 2009;75:293–294. doi: 10.1016/j.pec.2009.05.001.
    1. Barber MN, Staples M, Osborne RH, Clerehan R, Elder C, Buchbinder R. Up to a quarter of the Australian population may have suboptimal health literacy depending upon the measurement tool: results from a population-based survey. Health Promot Int. 2009;24(3):252–261. doi: 10.1093/heapro/dap022.
    1. Adams RJ, Stocks NP, Wilson DH, Hill CL, Gravier S, Kickbusch I, Beilby JJ. Health literacy. A new concept for general practice? Aust Fam Physician. 2009;38(3):144–147.
    1. Lee TW, Kang SJ, Lee HJ, Hyun SI. Testing health literacy skills in older Korean adults. Patient Educ Couns. 2009;75(3):302–307. doi: 10.1016/j.pec.2009.04.002.
    1. Ishikawa H, Nomura K, Sato M, Yano E. Developing a measure of communicative and critical health literacy: a pilot study of Japanese office workers. Health Promot Int. 2008;23(3):269–274. doi: 10.1093/heapro/dan017.
    1. Ibrahim SY, Reid F, Shaw A, Rowlands G, Gomez GB, Chesnokov M, Ussher M. Validation of a health literacy screening tool (REALM) in a UK population with coronary heart disease. Journal of Public Health (Oxf) 2008;30:449–455. doi: 10.1093/pubmed/fdn059.
    1. Twickler TB, Hoogstraten E, Reuwer AQ, Singels L, Stronks K, Essink-Bot M. Laaggeltetterdheid en beperkte gezondheidsvaardigheden vragen om een antwoord in de zorg. Nederlandse Tijdschrift Gennesskunde. 2009;153(A250):1–6.
    1. Wang J, Schmid M. Regional differences in health literacy in Switzerland. Zürich: University of Zürich. Institute of Social and Preventive Medicine; 2007.
    1. Kondilis BK, Soteriades ES, Falagas ME. Health literacy research in Europe: a snapshot. Eur J Public Health. 2006;16(1):113–113.
    1. Kondilis BK, Kiriaze IJ, Athanasoulia AP, Falagas ME. Mapping health literacy research in the European union: a bibliometric analysis. PLoS One. 2008;3(6):E2519. doi: 10.1371/journal.pone.0002519.
    1. European Commission. Together for health: a strategic approach for the EU 2008-2013. Com(2007) 630 final. 2007.
    1. Nutbeam D. Health Promotion Glossary. Health Promot Int. 1998;13:349–364. doi: 10.1093/heapro/13.4.349.
    1. Kwan B, Frankish J, Rootman I, Zumbo B, Kelly K, Begoray D, Kazanijan A, Mullet J, Hayes M. The Development and Validation of Measures of "Health Literacy" in Different Populations. UBC Institute of Health Promotion Research and University of Victoria Community Health Promotion Research; 2006.
    1. Pleasant A. Proposed Defintion. International Health Association Conference: 2008. 2008.
    1. Zarcadoolas C, Pleasant A, Greer DS. Elaborating a definition of health literacy: a commentary. J Health Commun. 2003;8(3):119–120.
    1. Freedman DA, Bess KD, Tucker HA, Boyd DL, Tuchman AM, Wallston KA. Public health literacy defined. Am J Prev Med. 2009;36(5):446–451. doi: 10.1016/j.amepre.2009.02.001.
    1. Nutbeam D. Health literacy as a public goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–267. doi: 10.1093/heapro/15.3.259.
    1. Kickbusch I, Wait S, Maag D, Banks I. Navigating health: the role of health literacy. Alliance for Health and the Future, International Longevity Centre, UK. 2006.
    1. Zarcadoolas C, Pleasant A, Greer DS. Understanding health literacy: an expanded model. Health Promot Int. 2005;20(2):195–203. doi: 10.1093/heapro/dah609.
    1. Zarcadoolas C, Pleasant A, Greer D. Advancing health literacy: A framework for understanding and action. Jossey Bass: San Francisco, CA. 2006.
    1. Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. Am J Health Behav. 2007;31(Suppl 1):19–26.
    1. Pavlekovic G, editor. Health Literacy. Programmes for Training on Research in Public Health for South Eastern Europe. Vol. 4 2008.
    1. Rootman I, Gordon-El-Bihbety D. A vision for a health literate Canada. Ottawa: Canadian Public Health Association; 2008.
    1. Mancuso JM. Health literacy: a concept/dimensional analysis. Nurs Health Sci. 2008;10:248–255. doi: 10.1111/j.1442-2018.2008.00394.x.
    1. Australian Bureau of Statistics. Adult literacy and life skills survey. Summary results. Vol. 88. Australia, Canberra: Australian Bureau of Statistics; 2008.
    1. Yost KJ, Webster K, Baker DW, Choi SW, Bode RK, Hahn EA. Bilingual health literacy assessment using the Talking Touchscreen/la Pantalla Parlanchina: development and pilot testing. Patient Educ Couns. 2009;75(3):295–301. doi: 10.1016/j.pec.2009.02.020.
    1. Adkins NR, Corus C. Health literacy for improved health outcomes: effective capital in the marketplace. J Consum Aff. 2009;43(2):199–222. doi: 10.1111/j.1745-6606.2009.01137.x.
    1. Lee SD, Arozullah AM, Choc YI. Health literacy, social support, and health: a research agenda. Soc Sci Med. 2004;58:1309–1321. doi: 10.1016/S0277-9536(03)00329-0.
    1. Speros C. Health literacy: concept analysis. J Adv Nurs. 2005;50:633–640. doi: 10.1111/j.1365-2648.2005.03448.x.
    1. Baker DW. The meaning and the measure of health literacy. J Intern Med. 2006;21:878–883.
    1. Manganello JA. Health literacy and adolescents: a framework and agenda for future research. Health Educ Res. 2008;23(5):840–847.
    1. von Wagner C, Steptoe A, Wolf MS, Wardle J. Health literacy and health actions: a review and a framework from health psychology. Health Education & Behaviour. 2009;36(5):860–877. doi: 10.1177/1090198108322819.
    1. Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67:2072–2078. doi: 10.1016/j.socscimed.2008.09.050.
    1. Nielson-Bohlman L, Panzer A, Kinding D, editor. Health literacy: a prescription to end confusion. 2004.
    1. Shoou-Yih D, Leea AMA, Choc Young Ik. Health literacy, social support, and health: a research agenda. Soc Sci Med. 2004;58:1309–1321. doi: 10.1016/S0277-9536(03)00329-0.
    1. Wang R. Critical health literacy: a case study from China in schistosimiasis control. Health Promot Int. 2000;15(3):269–274. doi: 10.1093/heapro/15.3.269.
    1. Levin-Zamir D. Health literacy in health systems: perspectives on patient self-management in Israel. Health Promot Int. 2001;16(1):87–94. doi: 10.1093/heapro/16.1.87.
    1. St Leger L. Schools, health literacy and public health: possibilities and challenges. Health Promotion International. 2001;16(2):197–205. doi: 10.1093/heapro/16.2.197.
    1. Ratzan S. Health literacy: communication for the public good. Health Promotion International. 2001;16(2):207–214. doi: 10.1093/heapro/16.2.207.
    1. Protheroe J, Wallace L, Rowlands G, DeVoe J. Health literacy: setting an international collaborative research agenda. BMC Fam Pract. 2009;10(1):51. doi: 10.1186/1471-2296-10-51.
    1. Magasi S, Durkin E, Wolf MS, Deutsch A. Rehabilitation consumers' use and understanding of quality information: a health literacy perspective. Arch Phys Med Rehabil. 2009;90(2):206–212. doi: 10.1016/j.apmr.2008.07.023.
    1. Schyve PM. Language differences as a barrier to quality and safety in health care: the joint commission perspective. J Gen Intern Med. 2007;22(Suppl 2):360–361.
    1. McQueen DV, Kickbusch I, Potvin L, Pelikan J, Balbo L, Abel T. Health and Modernity: the Role of Theory in Health Promotion. New York: Springer; 2007.
    1. Pleasant A, Kuruvilla SS. A tale of two health literacies: public health and clinical approaches to health literacy. Health Promot Int. 2008;23(2):152–159.
    1. Tones K. Health literacy: new wine in old bottles. Health Educ Res. 2002;17:187–189.

Source: PubMed

3
Abonnieren