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

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

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.

The core of the model shows the competencies related to the process of accessing, understanding, appraising and applying health-related information. According to the ‘all inclusive’ definition this process requires four  (1) Access refers to the ability to seek, find and obtain health information; (2) Understand refers to the ability to comprehend the health information that is accessed; (3) Appraise describes the ability to interpret, filter, judge and evaluate the health information that has been accessed; and (4) Apply refers to the ability to communicate and use the information to make a decision to maintain and improve health.

Conclusion

The conceptual framework presented in this paper provides this integration in the form of a comprehensive model. Based on a systematic review of existing definitions and conceptualizations of health literacy, it combines the qualities of a conceptual model outlining the most comprehensive dimensions of health literacy, and of a logical model, showing the proximal and distal factors which impact on health literacy as well as the pathways linking health literacy to health outcomes.

Specifically, the model identifies 12 dimensions of health literacy, referring to the competencies related to accessing, understanding, appraising and applying health information in the domains of healthcare, disease prevention and health promotion, respectively.

By integrating existing definitions and conceptualizations of health literacy into an encompassing model outlining the main dimensions of health literacy as well as its determinants and the pathways to health outcomes, this model has a heuristic value in its own right.

More importantly, however, it can also support the practice of healthcare, disease prevention and health promotion by serving as a conceptual basis to develop health literacy enhancing interventions. Moreover, it can contribute to the empirical work on health literacy by serving as a basis for the development of measurement tools. As currently available tools to measure health literacy do not capture all aspects of the concept as discussed in the literature, there is a need to develop new tools to assess health literacy, reflecting health literacy definitions and accompanying conceptual models for public health. By following a concept validation approach, scales can be developed to assess the dimensions outlined in the conceptual model presented in this paper. This will not only produce a comprehensive measure of health literacy, reflecting the state of the art of the field and applicable for social research and in public health practice, but also serve to validate the conceptual model and thus contribute to the understanding of health literacy.