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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 references 44

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      Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

       D Nutbeam (2000)
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        The evolving concept of health literacy.

         Don Nutbeam (2008)
        The relationship between poor literacy skills and health status is now well recognized and better understood. Interest in this relationship has led to the emergence of the concept of health literacy. The concept has emerged from two different roots - in clinical care and in public health. This paper describes the two distinctive concepts that reflect health literacy, respectively, as a clinical "risk", or a personal "asset". In the former case a strong science is developing to support screening for poor literacy skills in clinical care and this is leading to a range of changes to clinical practice and organization. The conceptualization of health literacy as an asset has its roots in educational research into literacy, concepts of adult learning, and health promotion. The science to support this conceptualization is less well developed and is focused on the development of skills and capacities intended to enable people to exert greater control over their health and the factors that shape health. The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness. These include more personal forms of communication and community based educational outreach. It recommends improved interaction between researchers working within the two health literacy perspectives, and further research on the measurement of health literacy. The paper also emphasizes the importance of more general strategies to promote literacy, numeracy and language skills in populations.
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          Health Promotion Glossary

           D Nutbeam (1998)
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            Author and article information

            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
            Contributors
            Journal
            BMC Public Health
            BMC Public Health
            BioMed Central
            1471-2458
            2012
            25 January 2012
            : 12
            : 80
            3292515
            1471-2458-12-80
            22276600
            10.1186/1471-2458-12-80
            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.

            Categories
            Research Article

            Public health

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