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Table 6 Antecedents and consequences of health literacy in children and young people (models that did not state any are not shown)

From: Health literacy in childhood and youth: a systematic review of definitions and models

No Author Factors that influence the development and maintenance of HL Factors that are influenced by Health Literacy or impact on the relationship between HL & health outcomes
Children & Primary and Lower Secondary School Students
2 Paek et al. 2011 [28] Demographics & Environments
(Gender, Ethnicity, Residence (rural/urban), health status, environmental risk factors, access to health information.
Socialization Process:
- socialization agents a) interpersonal channel (parents, peer, school) vs. b) Media (push media: TV, Radio, Newspaper; pull media: Internet),
- health information behaviour, frequent consumption of health information, source of health information
(Health) behavioural outcomes
3 Schmidt et al. 2010 [25] n.m. health behaviour (as intermediate health outcome)
Young people & Secondary School Students
4 Manganello, 2008 [21] - individual traits/characteristics: such as age, ethnicity, gender, cultural background, cognitive and physical abilities and social skills;
- media use
- peer and parental influences: home setting, parental (health) literacy;
- systems: media, education and health care
Health behaviour: e.g. to be informed and skilled health care consumers,
Health service use: e.g. to effectively navigate the health care system & use health insurance benefits
Health costs
5 Massey et al. 2012 [33] n.m. - health environment requires individuals to be informed and skilled HC consumers,
- overcome environmental & interpersonal barriers when interacting with the HC system
6 Paakkari & Paakkari, 2012 [8] Learning process and learning environment/conditions:
teaching methods for health literacy need to be age-adjusted, pupil-focused, reflective, through discussion and negotiation
Empowerment, be able to understand oneself, others and the world, make sound health decisions, contribute to changing the factors that impact one’s own health and the health of other
7 Rask, Uusiautti, Määttä, 2013 [29] poverty, gender, cultural differences, level of education, social economic status knowledge & skills in maintaining their own health, ability to discuss health-related social issues
10 Wharf Higgins et al., 2009 [27] Mico context:- Internal influences: age, gender, beliefs, values, experiences, SES,- General literacy (ability to read/write, listen/speak, view/represent;
- other abilities, e.g. technological abilities with information mediaMeso Context: - School, family, and peer factors affecting health (e.g. family SES, peer norms and behaviour, safe/healthy schools etc.)- Health curricula: teaching, assignments, activities, testing, resources, etc.Macro context: - External influences: societal, community and neighbourhood factors affecting health (e.g. community-level SES, culture, media, government policies, etc.).
To establish and maintain an individual’s health-related goals (e.g. do not drink before driving, to exercise)
Different age groups or considering a life course perspective
12 Lenartz et al. 2014; 2012 [38, 69] n.m. Health behaviour and health
13 Mancuso, 2008 [34] Competences: Operational (ability to utilize tools, procedures, and techniques for handling language proficiently),
- Interactive (collaboration with others for individual improvement & enhancement through self-management.),
- Autonomous (personal empowerment & self-awareness),
- Informational (ability to determine authority and the currency of health information),
- Contextual (mastery of the (health care) environment),
- Cultural (ability to interpret the meaning system of social practices)
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, screening, and health-promoting behaviours
- Health status, defined as physical illness or perceptions of illness, disease or impairment
14 Martin & Chen, 2014 [24] - parental health literacy & parental SES, health and health behaviour influence children health, school readiness, and academic outcomes; informal home setting, with downstream effects in formal academic setting;
System influences and potential intervention point:
- health and education setting/system, culture and society,
child HL influences HL as parents, parental SES, health, and health behaviours
15 Nutbeam, 2000 [35] Health promotion actions:
- Education (e.g. patient & school education, broadcast media and print media communication),
- Social mobilization (e.g. community development, group facilitation, targeted mass communication),
- Advocacy (e.g. lobbying, political organization and activism, overcoming bureaucratic inertia)
Individual benefits
- Greater autonomy and personal empowerment
- Improved knowledge of risks and health services
- 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 programmes
- 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
16 Sanders et al. 2009 a [31] Family factors: income, education, language, culture, social support;
Social factors: geography, educational resources, public health support, environmental health
Different systems:
- Educational system (Preschool, K-12 curricula, adult education/job training),
- Community systems (after-school programmes, culture/language, public health programmes),
- Patient care environment (Provider skills, information tools),
- Health systems (delivery system, information system)
Family health behaviours, Child health outcomes
18 Sørensen et al.,2012 [10] Distal factors:
- Social and environmental determinants (e.g. demographic situation, culture, language, political forces, societal systems);
Proximal factors:
- personal determinants (age, gender, ethnicity, socioeconomic status, education, occupation, employment, income, literacy),
- situational determinants (e.g. social support, family and peer influences, media use and physical environment).
health service use, health costs, health outcomes, health behaviour, participation, empowerment, equity, sustainability
19 Wolf et al. 2009 [23] n.m. Health knowledge, health behaviour, health outcomes
20 Zarcadoolas et al., 2005/ 2003 [4] Health status; Demographic, socio-political, psychosocial
and cultural factors
Ability to apply information, to participate in public and private dialogues about health, medicine, scientific knowledge and cultural beliefs