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      Definitions and measurement of health literacy in health and medicine research: a systematic review

      systematic-review

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          Abstract

          Objectives

          The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments.

          Design

          Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

          Data sources

          The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019.

          Eligibility criteria

          We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years.

          Data extraction and synthesis

          Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam’s descriptions of the different health literacy levels.

          Results

          120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1).

          Conclusion

          Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies.

          PROSPERO registration number

          CRD42020179699.

          Related collections

          Most cited references151

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Health literacy and public health: A systematic review and integration of definitions and models

            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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              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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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2022
                14 February 2022
                : 12
                : 2
                : e056294
                Affiliations
                [1 ]departmentDepartment of Quality and Health Technology , University of Stavanger , Stavanger, Norway
                [2 ]departmentFaculty of Health Sciences , VID Specialized University , Oslo, Akershus, Norway
                [3 ]departmentDepartment of Interdisciplinary Health Sciences , University of Oslo , Oslo, Norway
                [4 ]departmentDepartment of Transplantation Medicine , Oslo University Hospital Rikshospitalet , Oslo, Norway
                [5 ]departmentDepartment of Behavioural Sciences in Medicine , University of Oslo , Oslo, Norway
                [6 ]Lovisenberg Diaconal University College , Oslo, Akershus, Norway
                [7 ]Lovisenberg Diakonale Hospital , Oslo, Norway
                [8 ]departmentFaculty of Health Scienes , Oslo Metropolitan University , Oslo, Norway
                [9 ]departmentDepartment of Health and Nursing Sciences , University of Agder , Kristiansand, Norway
                Author notes
                [Correspondence to ] Kristin Hjorthaug Urstad; kristin.h.urstad@ 123456uis.no
                Author information
                http://orcid.org/0000-0002-8830-4564
                Article
                bmjopen-2021-056294
                10.1136/bmjopen-2021-056294
                8845180
                35165112
                6480ddb3-d005-49b2-9046-94a5065a1abc
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 11 August 2021
                : 15 December 2021
                Funding
                Funded by: Centre for Advanced Study in Oslo;
                Categories
                Health Services Research
                1506
                1704
                Original research
                Custom metadata
                unlocked

                Medicine
                public health,general medicine (see internal medicine)
                Medicine
                public health, general medicine (see internal medicine)

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