Table 1

Evolution of the constructs and scales to define health literacy
Initial construct descriptor Overarching theme Draft scales tested in calibration sample* Refined scales tested in replication sample** Final scale ** Response options
1. Characteristics of relationships with providers (regular, trust) 1 About self 1 Healthcare provider support [9] 1 Healthcare provider support [6] 1. Feeling understood and supported by healthcare providers [4] Agree/ disagree
2. Dealing with providers (2nd opinion/ assertiveness/ communication/ questions/ listens), difference between new and familiar providers 2 Dealing with outside world 2 Agency in relationships with providers [8] 2 Agency in relationships with healthcare providers [5] 6. Ability to actively engage with healthcare providers [5] Difficulty
3. Skills of using health system 2 Dealing with outside world 3 Skills for using the health system [6] 3 Navigating the health system [6] 7. Navigating the health system [6] Agree/ disagree
4. Practicalities of accessing health system 2 Dealing with outside world 4 Practicalities of accessing the health system [9] [Re-classified as checklist assessment] Difficulty
5. Cognitive barriers/strategies. memory; organisation; judgement; not getting overwhelmed and confused 1 About self [Subsumed into Critical appraisal]
6. Understanding and critical appraisal 3 Being resourced 5 Critical appraisal [7] 4 Critical appraisal [6] 5. Appraisal of health information [5] Agree/ disagree
7. Skills/options for accessing information 1 About self 6 Ability to access information [10] 5 Ability to access information [5] 8. Ability to find good quality health information [5] Difficulty
8. Having condition related information, information and knowledge adequacy 3 Being resourced 7 Perceived information adequacy [7] 6 Perceived information adequacy [7] 2. Having sufficient information [4] Difficulty
9. Self management/ motivation/ prioritisation 2 Dealing with outside world 8 Taking responsibility for health [10] 7 Taking responsibility for health [5] 3. Actively managing my health [5] Difficulty
10. Being health focused. Where your head is (psych/ emotional state/ self discipline/ will power/ acceptance of condition) 1 About self 9 Health focused [9] 8 Health focused [6] Engagement in decisions. [Scale removed due to items not having sufficient difficulty range]
11. Social support 3 Being resourced 10 Social support [7] 9 Social support [5] 4. Social support for health [5] Agree/ disagree
12. Literacy and numeracy 2 Dealing with outside world 11 Understanding health and healthcare [8] 10 Reading and writing health information [5] 9. Understand health information well enough to know what to do [5] Agree/ disagree
13. Beliefs and values 1 About self [Inventory style assessment]

* values in parenthesis indicates the number of items in the scale.

** number of surviving items in the scale.

Osborne et al.

Osborne et al. BMC Public Health 2013 13:658   doi:10.1186/1471-2458-13-658

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