Health literacy is on the public health agenda. The goal to "improve the health literacy of the population" was included as an objective in Healthy People 2010 and 2020 Objectives. In 2004, the Institute of Medicine released Health Literacy: A Prescription to End Confusion, which recommended that "the Department of Health and Human Services and other government and private funders should support research leading to the development of causal models explaining the relationship among health literacy, the education system, the health system, and relevant social and cultural systems" (Nielsen-Bohlman, Panzer & Kindig, 2004, p. 55). The U.S. Department of Health and Human Services' 2010 National Action Plan to Improve Health Literacy reinforces the need for conceptual advances in the field by calling for the development and implementation of health literacy Health Literacy Skills Framework 31interventions on the basis of theories and models, drawing from such related disciplines as communication, education, cognitive science, and medical sociology (p. 44).Pleasant, McKinney, and Rickard (2011) indicated that there is a lack of true theoretical frameworks that explain health literacy. Theory should be the foundation for developing reliable and valid measures of health literacy, which will allow the field to better study and understand the role of health literacy in health behavior change. This lack of theory has caused researchers to define health literacy in many different ways (Peerson & Saunders, 2009) and, thus, studies vary significantly depending on the definition and measures used (DeWalt, Berkman, Sheridan, Lohr, & Pignone, 2004;Peerson & Saunders, 2009;Pignone, DeWalt, Sheridan, Berkman, & Lohr, 2005).The absence of a common definition and understanding of health literacy may have slowed the field's progress in developing measures and conducting solid methodological research. There are a variety of models and frameworks that describe factors associated with health literacy skills (Baker, 2006;Mancuso, 2008;Nutbeam, 2000;Paasche-Orlow & Wolf, 2007;von Wagner, Steptoe, Wolf & Wardle, 2009). A comprehensive health literacy theory or framework may spur more professional discussions to help lay the foundation for a new era of theory-driven research.The majority of these frameworks illustrate the effects that health literacy has on health-related outcomes (Lee, Arozullah, & Cho, 2004;Manganello, 2008;Nutbeam, 2000;Paasche-Orlow & Wolf, 2007;Rootman et al., 2002; Schillenger, 2001;von Wagner et al., 2009). However, few illustrate the full continuum of relations among predictors, moderators, mediators, and outcomes of health literacy all in one theory or framework (Pleasant, 2011). PurposeThe purpose of this article is to introduce a framework for conceptualizing health literacy that builds on existing theoretical frameworks. We undertake three activities in the article:1. First, we review and synthesize the several existing theoretical frameworks for health literacy and describe their strengths and weaknesses. 2. Se...

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Although many health communication researchers use the terms “shame” and “guilt” interchangeably, arguably these constructs are distinct and have widely divergent psychological consequences. The purpose of this study was to explore distinct cognitive and emotional outcomes resulting from shame relative to guilt appeals. Specifically, this paper provides empirical evidence that negative outcomes such as anger and perceived manipulative intent are more likely to be associated with shame than guilt. Using an experimental design, participants were randomly assigned to view either a shame or a guilt appeal about getting tested for STDs and completed an online questionnaire. Shame was correlated with both anger and perceived manipulative intent whereas guilt was not. Participants who viewed the shame appeal reported higher levels of shame, anger, and perceived manipulative intent. Tactics for creating shame‐free guilt appeals and future research are discussed.

Presenting numeric information appears to improve understanding of risks and benefits relative to non-numeric presentation; presenting both numeric and non-numeric information when possible may be best practice. No single specific format or graphical approach emerged as consistently superior. Numeracy and health literacy also deserve more empirical attention as moderators.

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