|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 ||1 Healthcare provider support ||1. Feeling understood and supported by healthcare providers ||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 ||2 Agency in relationships with healthcare providers ||6. Ability to actively engage with healthcare providers ||Difficulty|
|3. Skills of using health system||2 Dealing with outside world||3 Skills for using the health system ||3 Navigating the health system ||7. Navigating the health system ||Agree/ disagree|
|4. Practicalities of accessing health system||2 Dealing with outside world||4 Practicalities of accessing the health system ||[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 ||4 Critical appraisal ||5. Appraisal of health information ||Agree/ disagree|
|7. Skills/options for accessing information||1 About self||6 Ability to access information ||5 Ability to access information ||8. Ability to find good quality health information ||Difficulty|
|8. Having condition related information, information and knowledge adequacy||3 Being resourced||7 Perceived information adequacy ||6 Perceived information adequacy ||2. Having sufficient information ||Difficulty|
|9. Self management/ motivation/ prioritisation||2 Dealing with outside world||8 Taking responsibility for health ||7 Taking responsibility for health ||3. Actively managing my health ||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 ||8 Health focused ||Engagement in decisions. [Scale removed due to items not having sufficient difficulty range]|
|11. Social support||3 Being resourced||10 Social support ||9 Social support ||4. Social support for health ||Agree/ disagree|
|12. Literacy and numeracy||2 Dealing with outside world||11 Understanding health and healthcare ||10 Reading and writing health information ||9. Understand health information well enough to know what to do ||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