Table 3 Conceptual models of health literacy
From: Health literacy and public health: A systematic review and integration of definitions and models
| Reference | Dimensions | Antecedents | Consequences | |
|---|---|---|---|---|
| 1 | Nutbeam (2000) [36] |
- Functional health literacy - Interactive health literacy - Critical health literacy | Health promotion actions (education, social mobilization, advocacy) |
Individual benefits
- Improved knowledge of risks - Compliance with prescribed actions. Improved capacity to act independently on knowledge - Improved motivation and self-confidence - Improved individual resilience to adversity Community/social benefits - Increased participation in population health programs - Improved capacity to influence social norms and interact with social groups. - Improved capacity to act on social and economic determinants of health - improved community empowerment |
| 2 | Lee et al. (2004) [47] |
- Disease and self-care knowledge. - Health risk behavior - Preventive care and physician visits. - Compliance with medications. |
- Social-economic status - Gender - Ethnicity - Health insurance coverage - Disease severity - Income discrepancy - Ethnic composition of the community |
- Health status - Emergency care - Hospitalization |
| 3 | Institute of Medicine (2004) [8] |
- Cultural and conceptual knowledge - Listening - Speaking - Arithmetical skills - Writing skills - Reading skills |
- Education, culture and language. - Communication and assessment skills of people with whom individuals interact for health - Ability of the media, the marketplace, and governmental agencies to provide health information in an appropriate manner | Health outcomes and costs |
| 4 | Zarcadoolas et al. (2005) [38] |
- Fundamental literacy Science literacy - Civic literacy Cultural literacy |
- Health status - Demographic, sociopolitical, psychosocial and cultural factors |
- Ability to apply information to novel situations Ability to participate in public and private dialogues about health, medicine, scientific knowledge and cultural beliefs |
| 5 | Speros (2005) [48] |
- Reading/numeracy skills - Comprehension - Capacity to use health information in decision making - Successful functioning in healthcare consumer role |
- Literacy - Health-related experience. |
- Improved self-reported health status - Lower healthcare costs - Increased health knowledge - Shorter hospitalization Less frequent use of healthcare services |
| 6 | Baker (2006) [49] |
- Health-related print literacy - Health-related oral literacy. |
- Health-related reading fluency - Health-related vocabulary - Familiarity with health concepts Complexity and difficulty of the printed and spoken messages in the healthcare environment |
- Acquisition of new knowledge - More positive attitudes - Greater self-efficacy Positive health behaviors - Better health outcomes |
| 7 |
Paashe-Orlow & Wolf (2007) [40] |
- Listening - Verbal fluency - Memory span - Navigation. |
- Socioeconomic status Occupation - Employment status Income - Social support - Culture and language - Education - Age - Race/ethnicity Personal competences such as vision, hearing, verbal ability, memory and reasoning. |
- Access and utilization of healthcare (influenced by patients' navigation skills, self-efficacy and perceived barriers, and by system's complexity, acute care orientation and tiered delivery model). - Patient/provider interactions (influenced patients' knowledge, beliefs and participation in decision-making, and by providers' communication skills, teaching ability, time and patient-centered care). Self care (influenced by patients' motivation, problem-solving, self-efficacy, knowledge/skills, and by support technologies, mass media, health education and resources) |
| 8 | Kickbusch & Maag (2008) [2] |
- Functional - Interactive - Critical |
- Education system - Health-care system - Culture/home and community - Work - Politics Market | - Health outcomes and costs |
| 9 | Mancuso (2008) [43] |
- Capacity - Comprehension Communication |
- Operational competence - Interactive competence - Autonomous competence - Informational competence - Contextual competence - Cultural competence |
- Healthcare costs - Knowledge of diseases and treatments - Self-management skills - Ability to care for chronic conditions - Compliance - Medical or medication treatment errors - Access to and use of healthcare services. - Use of expensive services such as emergency care and inpatient admissions. Prevention and screening health-promoting behaviors Health status, defined as physical illness or perceptions of illness, disease or impairment |
| 10 | Manganello (2008) [50] |
- Functional health literacy - Interactive health literacy - Critical health literacy Media literacy |
- Individual traits (age, race, gender, cultural background, cognitive and physical abilities, social skills) - Media use - Peer and parent influences - Mass media, the education system and the health system |
- Health behavior - Health costs - Health service use |
| 11 | Freedman et al. (2009) [35] |
- Conceptual foundations - Critical skills Civic orientation | Social, environmental and political forces |
- Resolve some of society's more pressing health issues - Alleviate social injustices. |
| 12 | Von Wagner et al. (2009) [51] | - Ability to rely on literacy and numeracy skills when they are required to solve problems |
- Epidemiological or structural determinants - Individual influences - Reading and arithmetic skills - External influences |
- Access and use of healthcare - Patient-provider interaction - Management of health and illness |