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Empirically Tested Health Literacy Frameworks.

ABSTRACT: BACKGROUND:Health literacy is a significant determinant of health behaviors, but the pathways through which health literacy influences health behaviors are not completely clear nor consistent. The purpose of this systematic review is to critically appraise studies that have empirically tested the potential pathways linking health literacy to health behavior. METHODS:We performed searches of the electronic databases PubMed, Embase, and CINAHL to identify studies that proposed a conceptual framework and empirically tested the proposed mechanism through which health literacy influences certain health behaviors. Twenty eligible studies were included for analysis. KEY RESULTS:The 20 studies addressed various health behaviors: chronic disease self-management (n = 8), medication adherence (n = 2), overall health status (n = 4), oral care (n = 1), cancer screening (n = 1), shared decision-making (n = 1), health information sharing (n = 1), physical activity and eating behaviors (n = 1), and emergency department visits (n = 1). Most studies were conducted in the United States (n = 13) and used a cross-sectional design (n = 15). The Short Test of Functional Health Literacy in Adults was commonly used to assess health literacy levels. Selection of variables and their operationalization were informed by a theoretical model in 12 studies. Age, gender, race/ethnicity, and insurance status were reported antecedents to health literacy. The most commonly tested mediators were self-efficacy (n = 8) and disease knowledge (n = 4). Fit indices reported in the studies ranged from acceptable to excellent. DISCUSSION:Current evidence supports self-efficacy as a mediator between health literacy and health behavior. Further research is needed to identify how health literacy interplays with known psychosocial factors to inform people's use of preventive care services. Future studies should include more disadvantaged populations such as immigrants with high disease burden and those with low health literacy. Theory-based, empirically tested health literacy models can serve as the conceptual basis for developing effective health interventions to improve health behaviors and ultimately decrease the burden of disease in such vulnerable populations. [HLRP: Health Literacy Research and Practice. 2020;4(1):e21-e44.] PLAIN LANGUAGE SUMMARY: This review systemically compiles, and critically appraises 20 existing studies that test conceptual frameworks that propose potential pathways through which health literacy affects health behaviors. The findings from this review can help inform the development of health literacy-focused interventions to improve the health behaviors of populations with disease burdens.

SUBMITTER: Cudjoe J

PROVIDER: S-EPMC7015262 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Empirically Tested Health Literacy Frameworks.

Cudjoe Joycelyn J Delva Sabianca S Cajita Mia M Han Hae-Ra HR

Health literacy research and practice 20200201 1

<h4>Background</h4>Health literacy is a significant determinant of health behaviors, but the pathways through which health literacy influences health behaviors are not completely clear nor consistent. The purpose of this systematic review is to critically appraise studies that have empirically tested the potential pathways linking health literacy to health behavior.<h4>Methods</h4>We performed searches of the electronic databases PubMed, Embase, and CINAHL to identify studies that proposed a con ...[more]

PMID: 32053206

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Project description:Background:The National Action Plan to Improve Health Literacy makes the case that a wide range of organizations and professionals must work together to improve health information and services to achieve a health literate society. The context and framework for this collaboration and action, however, have yet to be well-articulated. We report on our use of a community health needs assessment model to describe county and state health literacy activities, gaps, assets, and opportunities. This approach combines the public health best practice of learning about communities through systematic assessments and the emerging health literacy best practice of studying organizational behaviors. Brief description of activity:A community health literacy assessment was implemented from January 2018 to April 2018. The purpose was to collect information about county and state-level health literacy activities, gaps, assets, and opportunities. We used this information to characterize the status of health literacy in Maryland and establish an initial baseline for county and state strategic planning work and future collaboration. Implementation:An environmental scan of each county in Maryland identified health indicators, community resources, and health organizations or professionals. Organizational representatives participated in interviews about their health literacy work. Interviews were analyzed to identify themes as well as summarize and quantify perspectives by county. We convened a forum, disseminated preliminary findings, and performed member checking to assess agreement with the results. Results:The team interviewed 56 individuals from 49 organizations. Themes of health literacy definitions as well as organizational ranking on the use of health literacy best practices are discussed in this article. Forty public health professionals, including 10 interview participants, attended the forum. Member checking assessed interview participants' agreement with results and interpretations, which were found to be accurate portrayals of their responses. Lessons learned:Lessons learned include being flexible with the interview approach, performing member checking, and allowing participants to self-define health literacy. Our experience shows a small team can perform a large-scale assessment that provides actionable information at state and county-levels. The results can influence future interventions, inform strategic planning and collaboration, and lead us toward a health literate society. [HLRP: Health Literacy Research and Practice. 2019;3(4):e216-e226.]. Plain Language Summary:A systematic community health needs assessment framework was used to collect information about health literacy activities, assets, gaps, and opportunities at the state and county level. Participant feedback showed the team accurately captured the activities, assets, gaps, and opportunities to improve health literacy practices. A needs assessment framework is feasible for describing community health literacy.

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Empirically Tested Health Literacy Frameworks.

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Empirically Tested Health Literacy Frameworks.

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