Understanding critical health literacy: a concept analysis

Abstract

BackgroundInterest in and debates around health literacy have grown over the last two decades and key to the discussions has been the distinction made between basic functional health literacy, communicative/interactive health literacy and critical health literacy. Of these, critical health literacy is the least well developed and differing interpretations of its constituents and relevance exist. The aim of this study is to rigorously analyse the concept of critical health literacy in order to offer some clarity of definition upon which appropriate theory, well grounded practice and potential measurement tools can be based.MethodThe study uses a theoretical and colloquial evolutionary concept analysis method to systematically identify the features associated with this concept. A unique characteristic of this method is that it practically combines an analysis of the literature with in depth interviews undertaken with practitioners and policy makers who have an interest in the field. The study also analyses how the concept is understood across the contexts of time, place, discipline and use by health professionals, policy makers and academics.ResultsFindings revealed a distinct set of characteristics of advanced personal skills, health knowledge, information skills, effective interaction between service providers and users, informed decision making and empowerment including political action as key features of critical health literacy. The potential consequences of critical health literacy identified are in improving health outcomes, creating more effective use of health services and reducing inequalities in health thus demonstrating the relevance of this concept to public health and health promotion.ConclusionsWhile critical health literacy is shown to be a unique concept, there remain significant contextual variations in understanding particularly between academics, practitioners and policy makers. Key attributes presented as part of this concept when it was first introduced in the literature, particularly those around empowerment, social and political action and the existence of the concept at both an individual and population level, have been lost in more recent representations. This has resulted in critical health literacy becoming restricted to a higher order cognitive individual skill rather than a driver for political and social change. The paper argues that in order to retain the uniqueness and usefulness of the concept in practice efforts should be made to avoid this dilution of meaning.

Critical Health Literacy in 3D

“…Drawing on the work of Freebody and Luke (1990), Nutbeam (2000) developed a model for health literacy based on three levels of literacy: (i) functional health literacy; (ii) interactive health literacy and; (iii) critical health literacy. Sykes et al (2013) argue that Nutbeam's definition of critical health literacy has not been utilized widely. According to Wharf-Higgins et al (2009), health promotion researchers have not paid attention to context so they have not been able to convey knowledge that makes sense within the social spaces that people inhabit that also generate the conditions for health literacy.…”

“…This leads to a second reason for a lack of engagement in critical literacy due to an inability to measure health literacy against social and political skill sets. For critical health literacy to develop, Sykes et al (2013) argues that there is a need to "to locate responsibility beyond the individual level" (p. 159). Chinn (2011) has observed the significant expansion of health literacy since the mid 1990s, with only a few focused on critical health literacy (Sykes et al, 2013).…”

“…The past 20 years has seen health literacy emerge and become identified as a resource for health (Wilkinson and Marmot, 2003;Sykes et al, 2013). The Jakarta Declaration (World Health Organization, 1997) argues that participation and engagement in health literacy is an activity that supports health (Paasche-Orlow and Wolf, 2007;Renwick, 2014).…”

Data-driven maternal health literacy promotion and a postscript on its implications

“…To evaluate MHL and monitor improvement, the authors used the LSP measures of information seeking, use of health services and community resources, health behaviors, preventive practices, and maintenance of safe environments. In other words, they monitored changes in the degree to which mothers produced the theoretically identified consequences of increased health literacy: improvement in health services utilization, risk behaviors, and selfcare [36]. Two previously validated scales derived from the LSP assess different aspects of maternal health literacy [30,32].…”

Health literacy of Iraqi immigrant adults: pilot study

“…Literacy that is necessary to make informed health care decisions (critical health literacy), is the higher order process of evaluating available health information to reach health care decisions. [14] Critical health literacy is also interrelated with health status, public health, and health promotion. Informed health decisions can enhance an individual's health status by improving chronic disease management by properly using health services.…”