A Qualitative Study of the Development of Health Literacy Capacities of Participants Attending a Community-Based Cardiovascular Health Programme

Abstract

Health literacy is a critical determinant of health, which can empower individuals and lead to engagement in collective health promotion action and is also a crucial component in the self-management of illness. The current study moves beyond a focus on functional health literacy and presents findings from a longitudinal qualitative (LQ) study consisting of three phases. This paper presents findings from the second phase of the study, which assessed the development of health literacy capacities of individuals attending a structured cardiovascular risk reduction programme in Ireland. The study objectives were to: explore perceptions of changes in interactions and information exchange within health consultations; identify the facilitators associated with changes in health literacy capacities; assess developments in engagement with broader contexts for health literacy capacities. A LQ study design was undertaken, which employed repeat interview methodology with 19 participants (aged 36–76 years) 12 weeks after beginning a structured cardiovascular risk reduction programme. Health literacy levels were assessed using the HLS-EU 47 item instrument in phase 1 (68% limited health literacy (HL), 32% adequate health literacy). A semi-structured interview guide, (informed by Sørensen’s conceptual model of health literacy), was used to explore the development of health literacy and to identify changes in knowledge, attitudes and experiences over time. Thematic analysis was used, informed by aspects of Saldaña’s framework for longitudinal qualitative data analysis. All participants reported having acquired increased understanding of issues relevant to their health and self-care. Participants described health literacy capacities that incorporate aspects of all levels of health literacy (functional, interactive and critical). Core themes were identified corresponding to changes in these levels: re-engagement with health information and increased understanding of risk and protective factors (changes in functional health literacy); changes in interactions with healthcare providers (HCP) (changes in interactive health literacy); enhanced psychological insights and understanding the broader determinants of health (changes in critical health literacy). Findings support the development of health literacy capacities across the functional, interactive and critical health literacy domains. Participants are capable of locating responsibility for health beyond the individual level and are making sense of knowledge within their own social contexts. Individuals, regardless of their initial health literacy levels, are capable of engaging with broader issues that can impact on their health and can be supported to develop these critical health literacy capacities.

Development of health literacy in persons and caregivers living with dementia: A qualitative directed content analysis

“…A notable finding was the trend at diagnosis where they first were "seeking the expert," then as they moved from dependence and understood and appraised information, they were "becoming the expert," and finally as they applied health information they were "acting as the expert." These findings further validate the Integrated Model of Health Literacy (Sorenson et al, 2012), confirming previous reports of patients developing improved health literacy competencies reflected in their increased confidence to access, understand, appraise, and most importantly, to apply health information to make health care decisions (Mckenna et al, 2018).…”

“…All identified the fragmented healthcare system as a challenge to navigate which represented a barrier to developing health literacy (Stømer et al, 2020). In another study, McKenna et al (2018) used an interview guide informed by the Integrated Model of Health Literacy to describe the development of health literacy skills in patients attending a cardiovascular risk reduction program. Participants described active information seeking on the internet, attending talks and appraising information for relevancy to their situation; they increasingly understood and applied health information to make choices about their nutrition, exercise, and medications (McKenna et al, 2018).…”

Health Literacy in Context

“…The collection of papers published in this Special Edition includes some that focus on clinical issues (for example, McKenna et al [11], and Stein et al [12]), but we have also attracted a good range of papers that are community-based, give attention to the social context in which health decisions are made, and include communication content that improves our understanding of the wider social determinants of health. However, there remains a dearth of published papers that describe health literacy interventions.…”

Fostering Health Literacy Responsiveness in a Remote Primary Health Care Setting: A Pilot Study

“…Whilst health literacy is partly determined by an individual's personal, literary, cognitive, communicative, and technology skills and capabilities, it is also affected by the demands placed on them by their increasingly complex healthcare systems [3]. Studies have shown that primary healthcare organisations are often the first point of access into the healthcare system and thus play a central role in facilitating or impeding the health literacy skills of individuals [16][17][18]. Clinical and non-clinical staff within healthcare organisations play a vital role in alleviating health literacy as a barrier to accessing healthcare by ensuring that across their services, policies, programs, and health information are all responsive to the diverse health literacy needs and preferences of the population [19].…”