Table 3 Conceptual models of health literacy
From: Health literacy and public health: A systematic review and integration of definitions and models
| 听 | 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 |