Health literacy, social support, and health: a research agenda

The Health Literacy Skills Framework

“…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).…”

“…Although their definition includes skills, it also includes concepts such as knowledge and motivation, which some researchers consider to be separate constructs from healthy literacy (Baker, 2006;Lee et al, 2004;Paasche-Orlow & Wolf, 2007;von Wagner et al, 2008). Because of this variation in conceptualizations and definitions of health literacy, we have limited our review of health literacy frameworks to those which focus on health literacy as a skill or set of skills.…”

“…Whereas some frameworks include morbidity and mortality as outcomes (Nutbeam, 2000), others only consider mediators such as health behaviors and use of health services as outcomes (Sørensen et al, 2012;von Wagner et al, 2009). However, some frameworks include both types of outcomes (Lee et al, 2004;Manganello, 2008;Rootman et al, 2002;Schillinger, 2001;Sørensen et al, 2012).…”

“…Sometimes they are included as moderators (e.g., Sørensen et al, 2012;von Wagner et al, 2009) and other times they are presented as mediators (e.g., Baker, 2006). Most frameworks demonstrate the effect of societal influences in both parts of the model (Lee et al, 2004;Paasche-Orlow & Wolf, 2007;Mancuso, 2008;Manganello, 2008;Nutbeam, 2000;Rootman et al, 2002;Sørensen et al, 2012). Societal factors likely exert an influence in both areas as they not only affect the extent and development of health literacy skills, but they also influence how they are applied in health care systems and interactions with health care providers.…”

“…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).…”