Skip to main content

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