Table 3

Conceptual models of health literacy

Reference

Dimensions

Antecedents

Consequences


1

Nutbeam (2000) [36]

- Functional health literacy

- Interactive health literacy

- Critical health literacy

Health promotion actions (education, social mobilization, advocacy)

Individual benefits

- Improved knowledge of risks

- Compliance with prescribed actions. Improved capacity to act independently on knowledge

- Improved motivation and self-confidence

- Improved individual resilience to adversity

Community/social benefits

- Increased participation in population health programs

- Improved capacity to influence social norms and interact with social groups.

- Improved capacity to act on social and economic determinants of health

- improved community empowerment


2

Lee et al. (2004) [47]

- Disease and self-care knowledge.

- Health risk behavior

- Preventive care and physician visits.

- Compliance with medications.

- Social-economic status

- Gender

- Ethnicity

- Health insurance coverage

- Disease severity

- Income discrepancy

- Ethnic composition of the community

- Health status

- Emergency care

- Hospitalization


3

Institute of Medicine (2004) [8]

- Cultural and conceptual knowledge

- Listening

- Speaking

- Arithmetical skills

- Writing skills

- Reading skills

- Education, culture and language.

- Communication and assessment skills of people with whom individuals interact for health

- Ability of the media, the marketplace, and governmental agencies to provide health information in an appropriate manner

Health outcomes and costs


4

Zarcadoolas et al. (2005) [38]

- Fundamental literacy Science literacy

- Civic literacy

Cultural literacy

- Health status

- Demographic, sociopolitical, psychosocial and cultural factors

- Ability to apply information to novel situations

Ability to participate in public and private dialogues about health, medicine, scientific knowledge and cultural beliefs


5

Speros (2005) [48]

- Reading/numeracy skills

- Comprehension

- Capacity to use health information in decision making

- Successful functioning in healthcare consumer role

- Literacy

- Health-related experience.

- Improved self-reported health status

- Lower healthcare costs

- Increased health knowledge

- Shorter hospitalization

Less frequent use of healthcare services


6

Baker (2006) [49]

- Health-related print literacy

- Health-related oral literacy.

- Health-related reading fluency

- Health-related vocabulary

- Familiarity with health concepts

Complexity and difficulty of the printed and spoken messages in the healthcare environment

- Acquisition of new knowledge

- More positive attitudes

- Greater self-efficacy Positive health behaviors

- Better health outcomes


7

Paashe-Orlow

& Wolf (2007) [40]

- Listening

- Verbal fluency

- Memory span

- Navigation.

- Socioeconomic status Occupation

- Employment status Income

- Social support

- Culture and language

- Education

- Age

- Race/ethnicity Personal competences such as vision, hearing, verbal ability, memory and reasoning.

- Access and utilization of healthcare (influenced by patients' navigation skills, self-efficacy and perceived barriers, and by system's complexity, acute care orientation and tiered delivery model).

- Patient/provider interactions (influenced patients' knowledge, beliefs and participation in decision-making, and by providers' communication skills, teaching ability, time and patient-centered care).

Self care (influenced by patients' motivation, problem-solving, self-efficacy, knowledge/skills, and by support technologies, mass media, health education and resources)


8

Kickbusch & Maag (2008) [2]

- Functional

- Interactive

- Critical

- Education system

- Health-care system

- Culture/home and community

- Work

- Politics

Market

- Health outcomes and costs


9

Mancuso (2008) [43]

- Capacity

- Comprehension

Communication

- Operational competence

- Interactive competence

- Autonomous competence

- Informational competence

- Contextual competence

- Cultural competence

- Healthcare costs

- Knowledge of diseases and treatments

- Self-management skills

- Ability to care for chronic conditions

- Compliance

- Medical or medication treatment errors

- Access to and use of healthcare services.

- Use of expensive services such as emergency care and inpatient admissions. Prevention and screening health-promoting behaviors

Health status, defined as physical illness or perceptions of illness, disease or impairment


10

Manganello (2008) [50]

- Functional health literacy

- Interactive health literacy

- Critical health literacy

Media literacy

- Individual traits (age, race, gender, cultural background, cognitive and physical abilities, social skills)

- Media use

- Peer and parent influences

- Mass media, the education system and the health system

- Health behavior

- Health costs

- Health service use


11

Freedman et al. (2009) [35]

- Conceptual foundations

- Critical skills

Civic orientation

Social, environmental and political forces

- Resolve some of society's more pressing health issues

- Alleviate social injustices.


12

Von Wagner et al. (2009) [51]

- Ability to rely on literacy and numeracy skills when they are required to solve problems

- Epidemiological or structural determinants

- Individual influences

- Reading and arithmetic skills

- External influences

- Access and use of healthcare

- Patient-provider interaction

- Management of health and illness


Sørensen et al. BMC Public Health 2012 12:80   doi:10.1186/1471-2458-12-80

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