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Table 2 Themes, sub themes and categories

From: The development of health literacy in patients with a long-term health condition: the health literacy pathway model


Sub themes


   1. Health knowledge

Knowledge of health in general and own health concerns

Knowledge of science and health


Knowledge of condition


Knowledge of health service


Knowledge of patients' rights

   2. Self management skills

Managing medication

Organising medications and managing a medication regime (self-injecting, taking pills)



Self monitoring blood sugar/coagulation


Managing a diet

Managing diabetes with diet

   3. Active information seeking and use

Engaging with written materials

Reading medical reference books, dictionaries, leaflets, newspaper reports


Accessing online information

Health-related websites, health organisations


Using social media

Posting messages on discussion boards, web chat with other patients, using video sharing websites to view procedures


Engaging with research

Reading research papers


Critical appraisal of information and considering it within context

Assessing the reliability and quality of information and the source of information, assessing relevance of the information in context of own concerns

   4. Actively communicating with health professionals


Keeping a record of symptoms, preparing questions to ask in consultations


Exchanging information

Bringing information to a consultation, discussing results, medications


Expressing needs and concerns

Asking to change a medication, talking about problems, communicating preferences, asking for a referral to another service, asking for monitoring devices, asking to see results


Conveying information

Reiterating health information given by one health professional to another


Managing communication

Managing communication with multiple health professionals

   5. Seeking and negotiating treatment options

Seeking treatment options

Seeking alternative treatment options online


Negotiating medication or treatment

Asking doctor to try a new medication or alternative treatment method

   6. Decision making

Desire for involvement

Making informed decisions about treatment preferences


Opportunities for involvement

Taking part in shared decision making

   7. Influences on health literacy

Negative influences (personal and professional barriers)

Patients: poor acceptance, compliance, reliance on health professionals for information, emotional barriers (shock fear, anxiety), avoidance of information


Health professionals: poor communication styles, conflicting information


Positive influences (personal and professional motivators, facilitators)

Patients: manage emotions (reducing fear), make sense of symptoms


Friends and family: distributed health literacy skills


Health professionals: GP support information seeking, pharmacy support with understanding of medications, nurse support with self-management, access to services and mediate communications with doctors

   8. Health literacy outcomes

Develop knowledge, skills, understanding and coping


Active involvement in consultations