The Health Literacy Skills Framework

Abstract

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...

Relationships of Health Literacy, Health Behavior, and Health Status Regarding Infectious Respiratory Diseases: Application of a Skill-Based Measure

“…Health knowledge has positive strong influence on health literacy as well. In this research, health knowledge is defined as an individual's knowledge at the time before reading, watching or listening to the health-related materials, which some researchers called prior knowledge (Baker, 2006;McCormack, 2009;Squiers et al, 2012). The present finding suggested that greater health knowledge leads to greater health literacy.…”

“…Several researches have focused on theoretical explanations of potential mechanisms among these variables (Baker, 2006;Paasche-Orlow & Wolf, 2007;Sorensen et al, 2012;Squiers, Peinado, Berkman, Boudewyns, & McCormack, 2012;von Wagner, Steptoe, Wolf, & Wardle, 2009). McCormack and colleagues established a conceptual framework for individual health literacy (McCormack, 2009;Squiers et al, 2012).…”

“…Several researches have focused on theoretical explanations of potential mechanisms among these variables (Baker, 2006;Paasche-Orlow & Wolf, 2007;Sorensen et al, 2012;Squiers, Peinado, Berkman, Boudewyns, & McCormack, 2012;von Wagner, Steptoe, Wolf, & Wardle, 2009). McCormack and colleagues established a conceptual framework for individual health literacy (McCormack, 2009;Squiers et al, 2012). The framework includes four primary elements: health-related stimulus; influencing factors such as sociodemographic characteristics, resources, prior knowledge and capabilities; health literacy skills needed to comprehend the stimulus and perform the task; and mediators between health literacy and health outcomes (health behaviors and health status).…”

Should We Be Afraid of Simple Messages? The Effects of Text Difficulty and Illustrations in People With Low or High Health Literacy

“…Health literacy is defined by Berkman, Davis, and McCormack (2010, p. 16) as "the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions." Although the current literature shows little agreement upon the precise definition and conceptualization of health literacy (for recent conceptual models, see Sørensen et al, 2012;Squiers, Peinado, Berkman, Boudewyns, & McCormack, 2012), people's understanding of health information is usually a key component. In the frameworks, health literacy is positively associated with people's ability to understand information about health.…”

The Association of Health Literacy with Physical Activity and Nutritional Behavior in Older Adults, and Its Social Cognitive Mediators

“…Insight into the mediators of this association would also be of great value because these might be targets for interventions. Potential mediators of the association between health literacy and health behaviors include attitude towards health behaviors, self-efficacy to perform health behaviors, and perception of the risk of not performing sufficient health behaviors (Adams et al, 2013;Squiers, Peinado, Berkman, Boudewyns, & McCormack, 2012), but evidence on the role of these social cognitive factors is scarce. Regarding attitudes, only one cross-sectional study is available, which suggests an association between inadequate health literacy and negative attitudes toward health and health care .…”