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

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          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.

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          Most cited references27

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          Health promotion glossary.

          D Nutbeam (1986)
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            Patient health literacy and participation in the health-care process.

            Health information is an important resource for patients to understand and engage in the management of their health conditions. We discuss the role of health literacy (HL) in improving patient participation and propose future research in this field. Literature searches were conducted to review existing definitions and measures of HL and identify empirical findings of its impact on patient health/illness-related behaviours. We searched MEDLINE using 'health literacy' as a keyword and retrieved 371 articles published in English between 1985 and 2006. We also hand-searched publications of leading researchers and related institutes and followed the reference lists of relevant articles. The World Health Organization has defined HL as '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.' Based on this definition, three levels of HL have been described: functional, communicative and critical. Studies of HL have increased dramatically over the past few years, but there is a gap between the conceptual definition of HL and its application. Thus, empirical evidence of its impact on patient health/illness-related behaviours is still limited. The prevalence and consequence of inadequate HL as fully defined have not been determined. Further research is needed to develop measures of HL beyond the functional level and that consider the interaction of the individual patient HL with the health and social contexts in which the patient lives.
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              Promoting health literacy.

              This report reviews some of the extensive literature in health literacy, much of it focused on the intersection of low literacy and the understanding of basic health care information. Several articles describe methods for assessing health literacy as well as methods for assessing the readability of texts, although generally these latter have not been developed with health materials in mind. Other studies have looked more closely at the mismatch between patients' literacy levels and the readability of materials intended for use by those patients. A number of studies have investigated the phenomenon of literacy from the perspective of patients' interactions in the health care setting, the disenfranchisement of some patients because of their low literacy skills, the difficulty some patients have in navigating the health care system, the quality of the communication between doctors and their patients including the cultural overlay of such exchanges, and ultimately the effect of low literacy on health outcomes. Finally, the impact of new information technologies has been studied by a number of investigators. There remain many opportunities for conducting further research to gain a better understanding of the complex interactions between general literacy, health literacy, information technologies, and the existing health care infrastructure.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2012
                25 January 2012
                : 12
                : 80
                Affiliations
                [1 ]Department of International Health, Research School of Primary Care and Public Health, Maastricht University, Maastricht, The Netherlands
                [2 ]Université Catholique de Louvain, Louvain-la-Neuve, Belgium
                [3 ]University College Dublin, National University of Ireland, Dublin, Ireland
                [4 ]Ludwig Boltzmann Institute Health Promotion Research, Vienna, Austria
                [5 ]National Institute of Cardiology, Warsaw, Poland
                [6 ]The HLS-EU Consortium, Maastricht University, Maastricht, the Netherlands
                Article
                1471-2458-12-80
                10.1186/1471-2458-12-80
                3292515
                22276600
                3ecd9e7c-e013-419a-967d-5428e050db76
                Copyright ©2012 Sorensen et al; BioMed Central Ltd..

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 25 November 2011
                : 25 January 2012
                Categories
                Research Article

                Public health
                Public health

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