Background Current conceptual models of health literacy (HL) illustrate the link between HL and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into their framework. This article outlines the development of Chronic Airway Disease (CAD) Management and Health Literacy (CADMaHL) conceptual model that integrates the aforementioned elements and factors into a single framework. Methods Information obtained during the following stages informed the development of our model: (1) a systematic review of existing CAD HL measurement tools that apply core HL domains; (2) patient-oriented focus group sessions to understand HL barriers to CAD self-management practices; (3) key-informant interviews to obtain potential strategies to mitigate CAD management barriers, and validate disease self-management topics; (4) elicited the perspectives of Canadian respirologist’s on the ideal functional HL skills for asthma and COPD patients. Results Throughout the study process many stakeholders (i.e., patients, key-informants, and an international HL advisory panel) contributed to and reviewed the model. The process enabled us to organize the CADMaHL model into 6 primary modules, including: INPUT, consisting of four HL core components (access, understand, communicate, evaluate,) and numeracy skills; OUTPUT, including application of the obtained information; OUTCOME, covering patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, consisting of information about functionality and relevancy of CADMaHL; IMPACT, including mediators between HL and health outcomes; CROSSCUTTING FACTORS, consisting of diverse socio-demographics and health-system factors with applicability across the HL domains. Conclusions We developed the CADMaHL model, with input from key-stakeholders, which addresses a knowledge gap by integrating various disease management, health-system and socio-demographic factors absent from previous published frameworks. We anticipate that our model will serve as the backbone for the development of a comprehensive HL measurement tool, which may be utilized for future HL interventions for CAD patients. Trial registration NCT01474928- Date of registration: 11/26/2017.

INTRODUCTION The prevalence of smoking is high within Chinese-Canadian communities and there is a lack of culturally and linguistically appropriate smoking cessation resources and services. We aimed to ascertain factors affecting smoking and smoking cessation from the perspectives of current smokers and key informants. METHODS As part of a multistage mixed-methods study taking place from January 2013 to June 2014, a qualitative exploratory study design was conducted applying a community-based participatory research approach. Focus groups and interviews were conducted with adult (aged ≥19 years) Chinese-Canadian current smokers (≥5 cigarettes per day for the past 30 days) and interviews were held with key informants in Vancouver, Canada. A constant comparison method was applied to code data, and an inductive approach was used to identify emergent themes. RESULTS In all, 35 smokers from the target communities (11 female, 24 male) participated in 4 focus group sessions and 17 key informants (14 female, 3 male) were individually interviewed. Internal and external factors influencing smoking onset, continuation, and cessation from the perspectives of smokers and key informants were identified. Male smokers thought that the most influential factor influencing smoking initiation was social pressure, while female smokers thought that it was stress. Female smokers reported refraining from seeking cessation assistance due to a perceived negative image of female smokers within the community. Both key informants and participants indicated that involving friends and family in the quitting process may help to motivate smokers. CONCLUSIONS Smokers from Chinese-Canadian communities may benefit from linguistically appropriate and culturally relevant smoking cessation interventions that consider prevailing attitudes, perceptions, and beliefs. The knowledge gained may inform the development of future smoking cessation programs and resources for the target community, while our approach may be applicable to other ethnocultural or immigrant communities.

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Background: Current conceptual models of health literacy (HL) illustrate the link between HL skills and health outcomes. However, these models fail to recognize and integrate certain elements of disease management, health system factors, and socio-demographic factors into a comprehensive framework. This article summarizes the process of developing a Chronic Airway Disease Management and Health Literacy (CADMaHL) conceptual model.Methods: The proposed CADMaHL model is developed within the following six stages: (1) Systematic review of HL measurement tools. (2) Patient-oriented focus group sessions. (3) HL and health professions (key-informants) interviews. (4) Attain perspectives and feedback of respirologists. (5) Develop a HL measurement tool for chronic airway disease (CAD) patients (e.g., asthma and COPD), pilot test, and tool modification. (6) Tool validation with asthma and COPD patients. Results: Throughout the study process, patient population groups, an advisory panel of HL experts, clinician scientists, and researchers reviewed the information acquired. This review process enabled us to organize the CADMaHL model into 6 primary modules, including INPUT, consists of four HL core components (access, understand, communicate, evaluate) and numeracy skill; OUTPUT, includes use/application of the obtained information; OUTCOME, covers patient empowerment in performing self-management practices by applying HL skills; ASSESSMENT, comprises HL assessment tools and strategies; IMPACT, includes mediators between HL and health outcomes; and CROSSCUTTING FACTORS, consists of diverse socio-demographics and health-system factors with applicability across the HL domains.Conclusions: We developed and validated the proposed HL tool using the CADMaHL model. We anticipate that the model may inform development of interventions aiming to improve HL and disease management outcomes of CAD patients, by properly identifying and mitigating HL gaps among these patient population groups.