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Capsule vidéo illustrant le concept de littératie en santé

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Capsule vidéo illustrant le concept de littératie en santé

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Promosanté

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Illustration du concept de littératie en santé au travers d'un exemple

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Outil d'analyse de la lisibilité : analyse le niveau de difficulté d'un texte

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Scolarius est un outil gratuit d’analyse de la lisibilité. Il analyse le niveau de difficulté d’un texte en fonction de la longueur des mots, des phrases et des paragraphes. Il s’agit d’un outil qui permet à l’utilisateur de savoir si le niveau de difficulté de son texte correspond au niveau de comp…

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Littératie en santé - De l'accès à l'utilisation de l'information en santé

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Littératie en santé - De l'accès à l'utilisation de l'information en santé

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PromoSanté Iles-de-France

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Ce dossier a été construit par l'Équipe de PromoSanté IdF, avec la collaboration de plus de 40 contributeurs : acteurs de la promotion de la santé appartenant à différents types de structures.

Le concept de littératie en santé est en France un champ récent de recherches et de pratiques, qui ne fait pas encore l'objet d'un consensus sur toutes ses dimensions. Malgré des points de vue et approches parfois différents, les professionnels s'accordent toutefois sur la plupart des grands principes et enjeux de la littératie en santé.

Agir en matière de littératie en santé : pourquoi ?
Pour mieux comprendre : commentaire de l'infographie
La littératie en santé agit comme un " déterminant de déterminants " de la santé. C'est-à-dire que le niveau de littératie en santé des personnes influence certains déterminants de santé tels que les comportements de santé, l'utilisation des services de santé, la participation des personnes et des groupes, ou encore l'équité en santé. Ce concept transversal représente ainsi un levier d'action pour les professionnels des secteurs sanitaire, médico-social, social et éducatif.

Par ailleurs, le lien entre littératie en santé et inégalités sociales de santé a été démontré. Certaines personnes ont en effet plus de risques de présenter un niveau faible de littératie en santé (personnes âgées ou en situation de handicap, issues de l'immigration et ne maîtrisant pas la langue ou la culture, faiblement scolarisées...). Néanmoins, près de la moitié des adultes ne dispose pas d'un niveau suffisant de littératie en santé [HLS-EU, 2015]. Se poser la question de la littératie en santé, quelle que soit la personne avec laquelle on est amené à travailler, prend donc tout son sens.

Ce qu'en disent les professionnels

Au cours de la 4ème journée régionale " La littératie en santé " organisée pas le Collectif Santé ville Ile-de-France, les participants ont défini en quelques mots la littératie en santé.

Cette journée, qui a eu lieu le 28 mai 2019 dans les locaux de la Cité de la santé, était destinée aux coordinateurs des Ateliers Santé Ville (ASV), des Contrats locaux de santé (CLS) et Contrats locaux de santé mentale (CLSM), ainsi qu'aux acteurs franciliens de la promotion de la santé.

Monter un projet centré sur la littératie en santé : que vous apporte ce dossier Comprendre & Agir ?

Les dossiers thématiques de PromoSanté IdF vous permettent d'approfondir vos connaissances et vous donnent les ressources utiles au montage de projets. Des ressources pour...

COMPRENDRE LES ENJEUX : concepts, enjeux et politiques publiques

MONTER UN PROJET : méthodologies, facteurs d'efficacité, réflexions éthiques, expériences, outils d'animation et formations

Découvrir les autres dossiers
Bibliographies et autres ressources

Bibliographies sélectives

Littératie et littératie en santé

Littératie numérique en santé

Dossiers documentaires et techniques

Autres ressources en éducation thérapeutique du patient

L'Education Thérapeutique du Patient (ETP) et la littératie en santé utilisent des concepts et un vocabulaire communs tels que l'autonomie, la motivation, les compétences et la qualité de vie. Les deux visent à développer les compétences en santé, l'autonomisation et la préservation du capital santé des individus.

Comme toute action de santé, l'ETP peut contribuer à aggraver les inégalités sociales de santé si elle ne prend pas en compte le contexte de vie de la personne, son expérience et la littératie en santé.

La littératie en santé - Dossier dans la revue Le Chaînon (revue des associations de patients et de proches). Ligue des usagers des services de santé (Belgique), 2022

Comment mieux prendre en compte la littératie en santé des personnes en éducation thérapeutique ? Comité Régional d'Education pour la santé Provence-Alpes-Côte d'Azur (CRES PACA), 2021

3 définitions de la littératie, séminaire " Vous avez dit littératie ? ". Pôle ETP Ile-de-France, 2017
Ressourçothèque du Pôle ETP Ile-de-France

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LITTERATIE EN SANTE - De l'accès à l'utilisation de l'information santé

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Ce dossier a été construit par l'Équipe de PromoSanté IdF, avec la collaboration de plus de 40 contributeurs : acteurs de la promotion de la santé appartenant à différents types de structures.Le concept de littératie en santé est en France un champ récent de recherches et de pratiques, qui ne fait pas encore l'objet d'un consensus sur toutes ses dimensions.

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Un outil pour expliquer avec des images et des mots simples la consultation et les soins.

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Des outils pédagogiques expliquant la santé avec des dessins et des mots simples, pour mieux comprendre la santé, avoir moins peur pendant les consultations et mieux communiquer durant les consultations médicales.

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La littératie en santé : d'un concept à la pratique

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La littératie en santé : d'un concept à la pratique

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Cultures&Santé

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A l'attention du personnel de la santé pour faciliter la communication avec les patients.

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Carnet santé: outil d'aide à la consultation pour les médecins

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Carnet santé: outil d'aide à la consultation pour les médecins

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Un outil pour ouvrir le dialogue sur la santé sexuelle entre médecins généralistes et personnes migrantes vivant avec le VIH. L'outil a été conçu de manière participative avec le public cible en tenant compte de la littératie en santé.

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Revue Chainon: focus sur la littératie en santé

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Revue Chainon: focus sur la littératie en santé

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Enquête de santé sur la Littératie santé 2018

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Enquête de santé sur la Littératie santé 2018

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Outil de dialogue sous forme de jeu de cartes illustré pour cerner les priorités du patient. Disponible en téléchargement ou en prêt au CLPS.

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Aide à la consultation : BabbelBoost - Brusano

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Le BabbelBoost a été élaboré avec des professionnels de la santé et du social, des chercheurs ainsi que des patients et leurs proches. Il vise à ouvrir le dialogue, à prendre un temps pour identifier ce qui est important pour la personne que vous accompagnez et à cibler les dimensions auxquelles accorder une attention particulière pour améliorer sa qualité de vie.

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Promouvoir la littératie en santé dans la 1ère ligne: les leçons de 24 pratiques en Belgique- FRB

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Promouvoir la littératie en santé dans la 1ère ligne: les leçons de 24 pratiques en Belgique- FRB

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La littératie en santé- synthèse du rapport KCE

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La littératie en santé- synthèse du rapport KCE

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Séance 1: Power Point de présentation par les Dr Joanne Herman et Dr Gilles Henrard

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Séance 1: Power Point de présentation par les Dr Joanne Herman et Dr Gilles Henrard

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Séance 2: compte-rendu des échanges par la technique du World Café 

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Séance 2: compte-rendu des échanges par la technique du World Café 

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Information en santé _ retour des tables ok

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Elles sont au nombre de 8 et permettent de soutenir la Littératie pour la santé de manière concrète. Disponible en téléchargement ou en prêt au CLPS.

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La majorité de nos outils est disponible en téléchargement. Les kits d'animation sont également disponibles en location dans notre centre de documentation. Vous pouvez vous procurez certains outils gratuitement selon quelques conditions et dans la limite des stocks disponibles.

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Guide d'apprentissage du raisonnement éthique en situation difficile

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Guide d'apprentissage du raisonnement éthique en situation difficile

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Capsule vidéo - "Simple comme bonjour : Comment adapter une communication claire et simple entre les professionnel.les et la population"

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Capsule vidéo - "Simple comme bonjour : Comment adapter une communication claire et simple entre les professionnel.les et la population"

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Imagier pour la communication soignant-soigné

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Imagier pour la communication soignant-soigné

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Disponible en prêt au CLPS.

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Avant de continuer...

Vous prendrez bien quelques cookies ? Sur le site PIPSa, nous les utilisons pour nos statistiques de visites et pour vous permettre les partages sur les réseaux sociaux. Pas de pub, promis ! Cliquez sur "accepter" et on s'occupe de tout, ou configurez-les vous-même si vous préférez.

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Imagier pour la communication soignant-soigné - Germes de parole

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Avant de continuer... Vous prendrez bien quelques cookies ? Sur le site PIPSa, nous les utilisons pour nos statistiques de visites et pour vous permettre les partages sur les réseaux sociaux. Pas de pub, promis ! Cliquez sur "accepter" et on s'occupe de tout, ou configurez-les vous-même si vous préférez.

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Application GSM gratuite pour communiquer avec les patients ayant des difficultés à s'exprimer. Disponible en 16 langues.

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Application gratuite pour les soignants et pour les patients
Mode d'emploi MediPicto en vidéo téléchargeable sur Google Play Store pour les Android et Apple Store pour les IPhone
Des pictogrammes pour favoriser les échanges entre patients et soignants traduits en 16 langues

De quoi s'agit-il ?

MediPicto est une application gratuite destinée à favoriser le dialogue entre les soignants et les patients ayant des difficultés d'expression et/ou de compréhension. Ces difficultés peuvent être liées à une situation de handicap temporaire ou définitif, à une fatigue extrême, à l'âge, à une maladie évolutive, à une situation de soins, à un accident..., ou encore une barrière linguistique (pictogrammes traduits en 16 langues).

POURQUOI UTILISER MEDIPICTO ?

POUR LES SOIGNANTS et professionnels hospitaliers, elle permet de :

Dialoguer à l'aide de pictogrammes sur les principales situations, douleur, prise de médicament, diagnostic mais aussi de poser des questions administratives

Sélectionner l'une des 16 langues si le patient n'est pas francophone

Construire des scénarios personnalisés, avec les pictogrammes les plus souvent utilisés ou sur des thèmes précis - ex : Interrogatoire urgence obstétrique (avez-vous de contractions, depuis quand,avez-vous perdu les eaux...) de les enregistrer et les partager avec leurs collègues.

POUR LES PATIENTS, elle permet :

Aux patients en difficulté de communication d'utiliser les pictogrammes,

Aux patients étrangers de sélectionner leur langue pour dialoguer avec les soignants

A tous patients, de préparer à l'avance un entretien et de l'enregistrer seuls ou avec un proche (patients en difficulté de communication, avec déficience intellectuelle, personne sourde, non francophones, migrants...)

A tous, de voyager dans des pays étrangers et de dialoguer grâce aux traductions utiles en 16 langues

A tous patients d'être acteurs de leur santé quelles que soient leurs limitations

Dès l'écran d'accueil, l'utilisateur renseigne son profil :
COMMENT ÇA MARCHE ?

Le patient ou le soignant télécharge gratuitement l'application sur Google Play Store pour les Android et Apple Store pour les IPhone. Elle peut être utilisée en mode déconnecté

Je suis patient OU Je suis soignant

Sa langue (16 choix)

Homme/Femme/Garçon/Fille /Bébé

Application Interactive :
Un dialogue peut s'engager entre soignant et patient en sélectionnant les pictogrammes. Les pictogrammes sont également classés par thème.

Une barre d'outils permet d'apporter des informations complémentaires : Echelle (douleur/émotion, graduation) -Anatomie (face/dos/type de douleur) - Calendrier (date, horaire, période journée) -Posologie (formes pharmaceutiques, quantité) - Clavier de saisie.

Le patient et le soignant peuvent dialoguer : poser des questions, répondre, apporter des précisions.

A tout moment l'un et l'autre peuvent " reprendre la main " en cliquant en bas de l'écran sur l'icône , pour le soignant et sur l'îcone pour le patient

L'ensemble des échanges (questions, réponses, précisions) est enregistré temporairement dans l'historique

L'onglet scénario permet d'enregistrer une succession de pictogrammes :
- Les soignants peuvent bâtir et enregistrer des " scénarios personnalisés ". Un QR Code peut être généré pour être flashé par un autre soignant afin de partager le même scénario de prise en charge.
- Les patients disposent des mêmes fonctionnalités et peuvent ainsi préparer et enregistrer à l'avance un " entretien personnalisé " avant une consultation, une rencontre avec un professionnel de santé.

COMMENT L'OBTENIR ?

L'application est téléchargeable gratuitement sur Google Play Store pour les Android et Apple Store pour les IPhone. MediPicto est également sur l'application AP-HP Pro.

" SantéBD " projet porté par CoActis Santé, héberge sur son site www.santebd.org à compter de juillet 2023, les pictogrammes de l'application MediPicto de l'AP-HP, ouvrant sur de nouvelles fonctionnalités de cette application, en particulier l'impression des images.

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MédiPicto AP-HP : Mieux communiquer pour Mieux soignerApplication gratuite pour les soignants et pour les patientstéléchargeable sur Google Play Store pour les Android et Apple Store pour les IPhone

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Des soins intégrés pour une meilleure santé

Chronilux doit permettre d'expérimenter une nouvelle organisation de notre système de soins. Celle-ci est basée sur la coopération et la coordination du réseau avec le patient. Elle favorisera le partage des ressources, des compétences, de l'information et devra déboucher sur des objectifs communs de qualité, d'efficacité et d'effcience.

Le modèle mis en place par ce projet doit être généralisable à d'autres pathologies chroniques. Il pourra ainsi contribuer à l'élaboration d'une nouvelle prise en charge des malades chroniques.

Le périmètre d'action concerne les 44 communes de la province de Luxembourg.

Les affections ciblées dans la première phase du projet sont les personnes présentant un syndrome métabolique, les personnes souffrant de diabètede type 2 et/ou de maladies cardiovasculaires.

Chronilux fait partie d'un ensemble de 12 projets-pilotes financés par les autorités fédérales pour une durée de 4 ans (2018-2021). Il existe 5 autres projets en Wallonie, 6 en Flandre et un à Bruxelles, regroupés sous l'intitulé " Des soins intégrés pour une meilleure santé ".

Pour plus d'information sur les soins intégrés pour une meilleure santé : www.integreo.be

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Chronilux - Des soins intégrés pour une meilleure santé

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Chronilux doit permettre d'expérimenter une nouvelle organisation de notre système de soins. Celle-ci est basée sur la coopération et la coordination du réseau avec le patient. Elle favorisera le partage des ressources, des compétences, de l'information et devra déboucher sur des objectifs communs de qualité, d'efficacité et d'effcience.

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Le site du Centre d’Éducation du Patient asbl.

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Centre Local de Promotion de la Santé en province de Luxembourg (CLPS LUX)

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Centre Local de Promotion de la Santé en province de Luxembourg (CLPS LUX)

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Fédération des Maisons Médicales et Collectifs de Santé

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Fédération des Maisons Médicales et Collectifs de Santé

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Aidant proche, bénévole dans une association ou dans un groupe d'entraide, pair aidant, expert du vécu... Qu'est-ce qui pousse - qu'est-ce qui nous pousse - à un moment de notre vie à endosser un rôle de " soignant " ? Contre rémunération ou non, de plein gré ou par la force des choses, moyennant un statut ou en attente de reconnaissance, ces nouvelles figures de soins occupent une place de plus en plus importante dans notre système de santé. Que disent-elles de ce système ? À quels besoins répondent-elles ? Comment ces fonctions s'articulent-elles avec celles des acteurs conventionnels de la santé : médecin, infirmier, aide-soignant... quand tous se retrouvent au chevet d'un même patient ?

Santé conjuguée explore les nouvelles figures de soins dans son numéro n°94 (mars 2021). Lire en ligne.

Lire plus
Toutes les actualités

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Aidant proche, bénévole dans une association ou dans un groupe d'entraide, pair aidant, expert du vécu... Qu'est-ce qui pousse - qu'est-ce qui nous pousse - à un moment de notre vie à endosser un rôle de " soignant " ?

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Service d'interprétariat en milieu social

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Service d'interprétariat en milieu social

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Interprète en milieu social : le SeTIS wallon à votre service

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Besoin d'un interprète ou d'une traduction ? Le SeTIS wallon est l'interlocuteur n°1 en matière d'interprétariat en milieu social en wallonie.

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Service pour rendre l’information accessible à tous: traduction, formation et promotion

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Service pour rendre l’information accessible à tous: traduction, formation et promotion

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Le Règlement Général sur la Protection des Données est entré en vigueur le 25 mai 2018. Cette législation introduit de nouvelles règles qui visent à protéger les données personnelles des citoyens européens.

A qui s'applique ce règlement ?

Ce règlement s'applique au traitement des données personnelles :

Des personnes qui se sont inscrites à une formation FALC

Des prestataires

Des relecteurs

Des formateurs

Des demandeurs

Qui est le responsable du traitement des données ?

Selon l'article 2 §2 de l'arrêté 2020/440 du Collège de la Commission communautaire française relatif aux services d'appui à la communication alternative pour les personnes présentant des difficultés de compréhension, le responsable des traitements des données à caractère personnel est le Conseiller-Chef du Service de l'Emploi et des Aides à l'intégration ou toute personne qu'il désigne à cet effet.

Quelles sont les données collectées par le Service et pour quelles raisons sont-elles collectées ?
Lors de l'inscription à une formation
Lorsqu'une personne s'inscrit à une formation FALC, les données suivantes sont collectées :

Identité de la personne (Nom et prénom)

Données de contact et de facturation (Email, téléphone, adresse postale, employeur, numéro de TVA)

Statut (étudiant, proche d'une personne en situation de handicap, professionnel, membre de l'asbl Inclusion)

Ces données sont récoltées pour les raisons suivantes :

Pouvoir contacter les personnes dans le cadre de l'organisation de la formation

Pouvoir proposer une réduction des frais en fonction du statut de la personne

Gérer la facturation et le suivi des payements

Lors de la demande de certification de la formation
A l'issue de la formation FALC, la personne peut demander une certification, qui consiste notamment en un examen d'aptitudes. Si la personne obtient la certification, elle figure de facto sur la liste des prestataires FALC.

Lors de cette demande de certification, le niveau d'études est collecté afin de vérifier si le prestataire entre dans les conditions définies par l'arrêté.

La liste des prestataires est remise au pouvoir subsidiant conformément à l'article 19 de l'arrêté 2020/440 du Collège de la Commission communautaire française relatif aux services d'appui à la communication alternative pour les personnes présentant des difficultés de compréhension.

Cette liste reprend nominativement les prestataires, relecteurs et formateurs de prestataires en distinguant pour les prestataires les prestations fournies.

Lors de la signature d'une convention de collaboration

Le service peut proposer aux prestataires de signer une convention de collaboration. Plusieurs données supplémentaires sont alors recueillies :

Le statut du prestataire (volontaire ou indépendant)

Les coordonnées bancaires

Ces données sont récoltées pour la raison suivante :

Pouvoir rémunérer ou défrayer les prestataires

Lors d'une demande de prestation par un demandeur

Lorsqu'un client fait une demande de prestation, les données suivantes sont conservées :

Identité du demandeur

Données de contact et de facturation

Données concernant la demande : textes à traduire, documents complémentaires remis éventuellement par le client, etc

Ces données sont récoltées pour les raisons suivantes :

Pouvoir contacter le demandeur

Pouvoir facturer la prestation

Pouvoir fournir un travail de qualité sur base des documents reçus du client

Lors de la signature du bon de commande, il est demandé au client s'il accepte que le travail réalisé (texte source et texte traduit) soit diffusé à des fins de promotion et de sensibilisation au FALC. Le client peut librement refuser cette diffusion. Seuls les travaux réalisés pour des clients qui auront

donné un accord de diffusion pourront être utilisés par le Service, par exemple en guise d'illustration sur leur site web ou les réseaux sociaux. Le client peut à tout moment retirer son accord de diffusion.

Un registre des prestations comportant au minimum l'identité du demandeur et les prestations réalisées peut être remis au pouvoir subsidiant dans le cadre d'un contrôle, conformément à l'article 28 de l'arrêté 2020/440 du Collège de la Commission communautaire française relatif aux services d'appui à la communication alternative pour les personnes présentant des difficultés de compréhension.

Comment sont conservées les données ?

Ces données sont conservées en version numérique au sein du service FALC et de l'asbl Inclusion. Elles figurent sur le disque dur des employés du service et sur le serveur de l'asbl Inclusion, sur un disque propre au service FALC.

Si une personne ne souhaite pas que ses données soient conservées, elle en fait la demande au service FALC et les données en question sont effacées. La collaboration avec le service cesse alors. Seules des données globalisées sont alors conservées, pour la rédaction du rapport d'activité.

Lors de l'organisation d'une formation, le service transmet au formateur les données de contact des participants, pour la bonne organisation de celle-ci.

Lors d'une demande de prestation, les données de contact et de contenu sont transmises par le service au prestataire qui va réaliser la prestation. En effet, un contact entre le prestataire et le demandeur est possible, dans un souci de travail de qualité.

Les données ne sont en aucun cas cédées à des tiers.

Quels sont les droits des personnes dont les données sont collectées ?

Ces personnes ont le droit, à tout moment, de :

Accéder aux données personnelles les concernant

Recevoir une copie des données personnelles les concernant

Faire corriger des données incorrectes les concernant

Compléter des données incomplètes les concernant

Faire effacer des données les concernant

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Le service FALC.be a été créé par l'asbl Inclusion. Il propose des formations pour apprendre à utilier le FALC (langage FAcile à Lire et à Comprendre). Il peut aussi traduire vos informations, pour les rendre accessibles à tous.

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Guide "communiquer pour tous" à l'attention de tous ceux qui souhaitent concevoir une information accessible à tous

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Guide "communiquer pour tous" à l'attention de tous ceux qui souhaitent concevoir une information accessible à tous

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Guide pratique à l'attention de tous ceux qui souhaitent concevoir une information accessible à tous. Le prix Prescrire 2021 a été décerné au Guide Communiquer pour tous.

Auteur : Allaire Cécile, Ruel Julie
Année de publication : 2021
Pages : 110 p.
Format/Durée : 21 X 29,7 cm
Ref : NS0411218L
Collection : Référentiels de communication en santé publique

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Communiquer pour tous : Guide pour une information accessible

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Guide pratique à l'attention de tous ceux qui souhaitent concevoir une information accessible à tous. Le prix Prescrire 2021 a été décerné au Guide Communiquer pour tous.

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FAIRE DIRE : communiquer avec son patient

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FAIRE DIRE : communiquer avec son patient

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Un outil pour améliorer la communication entre les professionnels de santé et les usagers - Haute Autorité de Santé

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Un outil pour améliorer la communication entre les professionnels de santé et les usagers.

Il s'inspire des outils internationaux existants nommés : Teach-back, Show-me ou Closing-the loop. C'est un outil de communication basé sur la reformulation par le patient de l'information donnée par le professionnel de santé. Son utilisation permet de s'assurer que les informations et les consignes reçues par le patient sont bien prises en compte et retenues. L'outil comporte 3 étapes successives : Expliquer - FAIRE DIRE - Réexpliquer si nécessaire ( Amalberti 2013).

En effet, il existe des difficultés pour les patients à comprendre les explications médicales. En France, selon l'observatoire des inégalités, 29 % de la population détient, au mieux, le niveau certificat d'études primaires, de même, aux États-Unis 20 % de la population a un niveau de lecture de type CM2 et la moyenne nationale correspond plutôt à un niveau équivalent à la 5 ème- 4 ème ( Rudd et al 2005, NPSF 2011). Or les termes médicaux réclament plutôt un niveau de seconde et les difficultés de compréhension peuvent encore être aggravées par le vieillissement et la dégradation des capacités sensorielles ( Rapport du Center for Health Policy Research 2007).

La littérature est abondante à propos de l'impact sur la santé de l'aptitude des patients à lire et à comprendre les informations et les documents médicaux afin de pouvoir les utiliser et les appliquer à leur propre situation ( health literacy).

L'explication simple, l'adhésion, la participation et la reformulation sont des outils essentiels pour lutter contre ces difficultés.

Faire plus simple, plus court, et demander systématiquement une reformulation pour évaluer la compréhension sont les trois facteurs de succès préconisés par les programmes qui améliorent l'adhésion du patient et luttent contre les inégalités sociales ( Sheridan et al 2011).

Il a été montré que les patients à qui on expliquait et demandait de reformuler ce qu'ils avaient compris, avaient une bien meilleure mémorisation des informations essentielles, par rapport à ceux qui n'en avaient pas bénéficié ( Bertakis et al 1977).

En 2001, un rapport de l' Agency for Healthcare Research and Quality ( AHRQ) a porté sur les actions qui devaient être priorisées pour la sécurité du patient. L'explication et l'information au patient constituaient une des 11 priorités retenues par les auteurs du rapport comme ayant reçu le plus d'évidence scientifique dans la littérature.
Par ailleurs, il existe un outil de communication pour les patients développé par la National Patient Safety Foundation, il s'agit de l'outil Ask Me , qui a le même objectif d'amélioration de la communication que FAIRE DIRE. Mais alors que FAIRE DIRE s'adresse aux professionnels de santé, Ask Me incite le patient à poser des questions aux professionnels. En effet, la peur des patients de poser des questions, de ne pas comprendre, et parfois tout simplement l'angoisse de la réponse peuvent constituer un obstacle à une bonne communication avec les professionnels de santé. L'outil est basé sur trois questions posées par le patient au professionnel de santé qui permet au patient de s'interroger sur : ce qu'il a, ce qu'il doit faire et l'importance de le faire.
Vous pouvez choisir, en téléchargement ci-dessous, la brochure et/ou l'affiche avec l'illustration qui vous parait la plus adaptée à votre activité (le contenu reste identique).

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Autorité publique indépendante à caractère scientifique, la Haute Autorité de santé (HAS) vise à développer la qualité dans le champ sanitaire, social et médico-social, au bénéfice des personnes.

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Health literacy and public health: A systematic review and integration of definitions and models

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Health literacy and public health: A systematic review and integration of definitions and models

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Research article

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BMC Public Health 12, Article number: 80 (2012) Cite this article

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Abstract

Background

Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy.

Methods

A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model.

Results

The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively.

Conclusions

Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

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Background

Health literacy is a term introduced in the 1970s [ 1] and of increasing importance in public health and healthcare. It is concerned with the capacities of people to meet the complex demands of health in a modern society [ 2]. Health literate means placing one's own health and that of one's family and community into context, understanding which factors are influencing it, and knowing how to address them. An individual with an adequate level of health literacy has the ability to take responsibility for one's own health as well as one's family health and community health [ 3].

It is important to distinguish health literacy from literacy in general. According to the United Nation Education, Science and Culture Organization (UNESCO) during its history in English, the word 'literate' mostly meant to be 'familiar with literature' or in general terms 'well educated, learned'. While maintaining its broader meaning of being knowledgeable or educated in a particular area, during the late nineteenth century it has also come to refer to the abilities to read and write text. In recent years four understandings of literacy have appeared from the debate of the notion: 1) Literacy as an autonomous set of skills; 2) literacy as applied, practiced and situated; 3) literacy as a learning process; and 4) literacy as text. The focus is furthermore broadening so that literacy is not only referring to individual transformation, but also to contextual and societal transformation in terms of linking health literacy to economic growth and socio-cultural and political change [ 4].

The same development can be traced in the realm of health literacy. For some time most emphasis was given to health literacy as the ability to handle words and numbers in a medical context, and in recent years the concept is broadening to also understanding health literacy as involving the simultaneous use of a more complex and interconnected set of abilities, such as reading and acting upon written health information, communicating needs to health professionals, and understanding health instructions [ 5]. American studies in the 1990s linked literacy to health, showing an association between low literacy and decreased medication adherence, knowledge of disease and self-care management skills [ 6]. The 2003 National Assessment of Adult Literacy (NAAL), which measured the English literacy of American adults (people age 16 and older) included questions related to health, and revealed the consequences of limited literacy on health and healthcare [ 7].

A report from the Institute of Medicine indicates that nearly half of the American adult population may have difficulties in acting on health information [ 8]. This finding has been referred to as the "health literacy epidemic" [ 9]. In response, measures have been taken to ensure better health communication through establishing health literacy guidelines [ 10], and a trans-disciplinary approach has been encouraged to improve health literacy [ 11]. To support this approach, the American Medical Association recommends four areas for research: health literacy screening; improving communication with low-literacy patients; costs and outcomes of poor health literacy; and causal pathways of how poor health literacy influences health [ 12, 13]. The research literature on health literacy has expanded exponentially, with nearly 5,000 PubMed-listed publications to date (Primo November 2011), the majority of which have been published since 2005 [ 5, 14] and is evident that health literacy is being explored within different disciplines and with different approaches, e.g. looking at the role of health educators in promoting health literacy [ 15]; public health literacy for lawyers [ 16], health communication [ 17], the prevalence of limited health literacy [ 18], and health literacy as an empowerment tool for low-income mothers [ 19].

While until recently the interest in health literacy was mainly concentrated in the United States and Canada, it has become more internationalized over the past decade [ 20]. Research on health literacy has taken place in e.g. Australia [ 21, 22], Korea [ 23], Japan [ 24], the UK [ 25], the Netherlands [ 26], and Switzerland [ 27]. Although the EU produced less than a third of the global research on health literacy between 1991 and 2005 [ 28, 29], the importance of the issue is increasingly recognized in European health policies. As a case in point, health literacy is explicitly mentioned as an area of priority action in the European Commission's Health Strategy 2008-2013 [ 30]. It is linked to the core value of citizen empowerment, and the priority actions proposed by the European Commission include the promotion of health literacy programs for different age groups.

However, with the proliferation of health literacy research and policy measures, it becomes clear that there is no unanimously accepted definition of the concept. Moreover, the constituent dimensions of health literacy remain disputed, and attempts to operationalize the concept vary widely in scope, method and quality. As a result, it is very difficult to compare findings with regard to health literacy emerging from research in different countries.

The current article aims to address this issue by offering a systematic review of existing definitions and concepts of health literacy as reported in the international literature, by identifying the central health literacy dimensions, the target group as well as antecedents and consequences if explained. in order to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy.

Method

A systematic review in Medline, Pubmed and Web of Science was performed by two independent research teams in autumn 2009 and spring 2010 and the results compared and combined to obtain information regarding two research questions: (1) How is health literacy defined? and (2) How can health literacy be conceptualized? To retrieve studies, 17 keywords (definition, model, concept, dimension, framework, conceptual framework, theory, analysis, qualitative, quantitative, competence, skill, "public health", communication, information, functional, critical) were combined (using the Boolean operator and) with the search terms "health literacy", "health competence", and health competence (without quotes). Combinations of the keywords with health literacy (without quotes) produced a list of studies that was too wide for the purpose of this study, and therefore not used for the review. From the resulting list, studies were selected for inclusion in the review on the basis of their abstracts. Eligible studies were included which met the following inclusion criteria: (1) written in English; (2) concerned with health literacy in a developed country; and (3) offering relevant content with regard to the definition or conceptualization of health literacy, or a combination of these issues.

The eligible literature was scanned for definitions, and a content analysis was performed in three steps: Firstly, the definitions were coded and condensed by two research teams working independently. Secondly the analysis was discussed with a panel of health experts from the European Health Literacy Consortium. In a third step, the feedback was elaborated by the original research team and integrated in a final analysis yielding a condensed 'all-inclusive' definition of health literacy capturing the different meanings and dimensions presented in the literature. In addition, an overview of all models from the eligible literature was conducted, the models were compared according to dimensions, target groups and antecedents as well as consequences if explained, and as a result a new conceptual model was drafted capturing the most comprehensive core dimensions of health literacy identified as well as its antecedents and consequences.

Results

The combination of the key words with the three search terms resulted in the initial identification of 170 publications. Additional publications were found by reference tracking and included in the review. Based on the application of the inclusion criteria to the abstracts, 19 publications were retrieved which explicitly dealt with the definition of health literacy, and 12 with conceptual frameworks of health literacy.

Definitions of health literacy

From the 19 publications focusing specifically on definitions of health literacy 17 explicit definitions could be derived (Table 1). Of these definitions, the ones by the American Medical Association [ 12], the Institute of Medicine [ 8] and WHO [ 31] are cited most frequently in the eligible literature. A shared characteristic of these definitions is their focus on individual skills to obtain, process and understand health information and services necessary to make appropriate health decisions. However, recent discussions on the role of health literacy highlight the importance of moving beyond an individual focus, and of considering health literacy as an interaction between the demands of health systems and the skills of individuals. In fact the Institute of Medicine report already alluded that "health literacy is a shared function of social and individual factors, which emerges from the interaction of the skills of individuals and the demands of social systems" [ 8]. More recently, Kwan [ 32] and Pleasant [ 33] underscored the importance of skills and abilities on the part of all parties involved in communication and decisions about health, including patients, providers, health educators, and lay people. This broader view is presented in the definition proposed by Zarcadoolas, Pleasant and Greer [ 34], who state that a health literate person is able to apply health concepts and information to novel situations, and to participate in ongoing public and private dialogues about health, medicine, scientific knowledge, and cultural beliefs. Freedman and her collegues [ 35] argue that the medical perspective on factors influencing people's health should be shifted towards a societal level, and that a distinction must be made between public and individual health literacy. Public health literacy can be found when the conceptual foundations of health literacy are in place in a group or community.

The content analysis on the definitions yielded six clusters representing: (1) competence, skills, abilities; (2) actions; (3) information and resources; (4) objective; (5) context; and (6) time as outlined in Table 2. Accordingly each cluster was carefully examined, discussed and condensed by the research team and the resulting chosen terms and notions were combined to yield a new 'all inclusive' comprehensive definition capturing the essence of the 17 definitions identified in the literature:

Health literacy is linked to literacy and entails people's knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course.

This definition encompasses the public health perspective and can easily be specified to accommodate an individual approach by substituting the three domains of health "healthcare, disease prevention and health promotion" with "being ill, being at risk and staying healthy".

Concepts of health literacy

Table 3 lists the publications which provide a conceptual model of health literacy. From this overview, two issues become apparent. Firstly, health literacy is a multidimensional concept and consists of different components. Secondly, most conceptual models not only consider the key components of health literacy, but also identify the individual and system-level factors that influence a person's level of health literacy, as well as the pathways that link health literacy to health outcomes.

Dimensions of health literacy

The distinction between medical and public health literacy [ 35] is reflected in the identification of different dimensions. Within the definition of health literacy as individual capacities, the Institute of Medicine [ 8] consider cultural and conceptual knowledge, listening, speaking, arithmetical, writing, and reading skills as the main components of health literacy. Speros [ 48] also identifies reading and numeracy skills as the defining attributes, but adds comprehension, the capacity to use health information in decision making, and successful functioning in the role of healthcare consumer as dimensions. Baker [ 49] divides health literacy into health related print literacy and health related oral literacy, while Paashe-Orlow and Wolf [ 40] distinguish between listening, verbal fluency, memory span and navigation. Lee et al. [ 47] identify four interrelated factors: (1) disease and self-care knowledge; (2) health risk behavior; (3) preventive care and physician visits; and (4) compliance with medication. While these defining elements of health literacy vary considerably they all concern cognitive capabilities, skills and behaviors which reflect an individual's capacity to function in the role of a patient within the healthcare system.

Proponents of the population health literacy view, on the other hand, extend the concept to include dimensions which go beyond individual competences and the medical context. The prototypical model is that of Nutbeam [ 36], which distinguishes between three typologies of health literacy: (1) Functional health literacy refers to the basic skills in reading and writing that are necessary to function effectively in everyday situations, broadly comparable with the content of "medical" health literacy referred to above; (2) Interactive health literacy refers to more advanced cognitive and literacy skills which, together with social skills, can be used to actively participate in everyday situations, extract information and derive meaning from different forms of communication, and apply this to changing circumstance; and (3) Critical health literacy refers to more advanced cognitive skills which, together with social skills, can be applied to critically analyze information and use this to exert greater control over life events and situations. The different typologies represent levels of knowledge and skills that progressively support greater autonomy and personal empowerment in health related decision-making, as well as engagement with a wider range of health knowledge that extends from personal health management to the social determinants of health [ 52]. Manganello [ 50] adds media literacy as the ability to critically evaluate media messages. Zarcadoolas et al. [ 38] distinguish between fundamental literacy (skills and strategies involved in reading, speaking, writing and interpreting numbers); science literacy (the levels of competence with science and technology); civic literacy (abilities that enable citizens to become aware of public issues and become involved in the decision-making process); and cultural literacy (the ability to recognize and use collective beliefs, customs, world-view and social identity in order to interpret and act on health information). In a similar vein, Freedman et al. [ 35] identify three dimensions of public health literacy, each of which involves corresponding competences: (1) Conceptual foundations includes the basic knowledge and information needed to understand and take action on public health concerns; individuals and groups should be able to discuss core public health concepts, public health constructs and ecologic perspectives. (2) Critical skills relates to the skills necessary to obtain, process, evaluate, and act upon information that is needed to make public health decisions that benefit the community; an individual or group should be able to obtain, evaluate, and utilize public health information, identify public health aspects of personal and community concerns, and access who is naming and framing public health problems and solutions. (3) Civic orientation includes the skills and resources necessary to address health concerns through civic engagement; an individual or group should be able to articulate the uneven distribution of burdens and benefits of the society, evaluate who benefits and who is harmed by public health efforts, communicate current public health problems, and address public health problems through civic action, leadership, and dialogue. Mancuso [ 43] emphasizes that health literacy is a process that evolves over a person's lifetime and identify the attributes of health literacy to be capacity, comprehension and communication. (1) The Capacity skills related to health literacy include gathering, analyzing, and evaluating health information for credibility and quality, working together, managing resources, seeking guidance and support, developing and expressing a sense of self, creating and pursuing a vision and goals, and keeping pace with change. Oral language skills are also considered essential. Social skills and credentials such as reading, listening, analytical, decision-making, and numerical abilities are important as well to advocate for oneself, to act on health information, and to negotiate and navigate within the health-care system. (2) Comprehension is a complex process based on the effective interaction of logic, language, and experience and is crucial to the accurate interpretation of a myriad of information that is provided to the modern patient, such as discharge instructions, consent forms, patient education materials, and medication directions. (3) Communication is how thoughts, messages or information are exchanged through speech, signals, writing or behavior. Communication involves inputs, decoding, encoding output, and feedback. Essential communication skills are reading with understanding, conveying ideas in writing, speaking so others can understand, listening actively, and observing critically.

In conclusion, the range of factors that are considered as key components of health literacy is extensive, and there is a wide variation between conceptual models. However, this diversity of views can to a large extent be reduced to two dimensions, notably the core qualities of health literacy (e.g., basic or functional, interactive, and critical health literacy), and its scope and area of application (e.g., as a patient in healthcare, as a consumer at the market, as a citizen in the political arena, or as a member of the audience in relation to the media).

Antecedents and consequences of health literacy

Apart from the dimensions of health literacy, the conceptual models summarized in Table 3 also give the main antecedents and consequences of health literacy outlined in the literature.

For the antecedents, most authors refer to demographic, psychosocial, and cultural factors, as well as to more proximal factors such as general literacy, individual characteristics and prior experience with illness and the healthcare system. Among the demographic and social factors which impact on health literacy one notes socioeconomic status, occupation, employment, income, social support, culture and language [ 40], environmental and political forces [ 35], and media use [ 50]. In addition, peer and parental influences may impact on the health literacy of adolescents. In terms of personal characteristics, health literacy is predicted by age, race, gender and cultural background [ 50]; as well as by competences such as vision, hearing, verbal ability, memory and reasoning [ 40], physical abilities and social skills [ 50], and meta-cognitive skills associated with reading, comprehension, and numeracy [ 4, 48, 50]. The latter refers to the level of overall literacy, defined as the capacity to use printed and written information to function in society, achieve one's goals, and develop one's knowledge and potential. Finally, Nutbeam [ 36] points out that health literacy is also a result of health promotion actions such as education, social mobilization and advocacy.

In terms of the consequences, a number of researchers pointed out that health literacy leads to improved self-reported health status, lower healthcare costs, increased health knowledge, shorter hospitalization, and less frequent use of healthcare services [ 43, 48, 50, 53]. According to Baker [ 49], these better health outcomes are caused by the acquisition of new knowledge, more positive attitudes, greater self-efficacy, and positive health behaviors associated with higher health literacy. Paashe-Orlow and Wolf [ 40] posit that health literacy influences three main factors which in turn have an impact on health outcomes: (1) navigation skills, self-efficacy and perceived barriers influence the access and utilization of healthcare; (2) knowledge, beliefs and participation in decision-making influence patient/provider interactions; and (3) motivation, problem-solving, self-efficacy, and knowledge and skills influence self care. The relationship of health literacy to health outcomes according to these authors must be conceived as a step function with a threshold effect, rather than in a simple linear fashion. People generally exist within a web of social relationships; and below a certain level of function, much of the day-to-day detail of chronic disease management often needs to be facilitated by others. While the interaction between health literacy and social support is likely to have complicated and subtle implications, the health impact of social effects has not been fully elucidated in the context of health literacy [ 54].

Nutbeam [ 36] distinguishes between individual and community or social benefits of health literacy. In terms of individual benefits, functional health literacy leads to an improved knowledge of risks and health services, and compliance with prescribed actions; interactive health literacy to an improved capacity to act independently, an improved motivation and more self-confidence; and critical health literacy to improved individual resilience to social and economic adversity. In terms of community and social benefits, functional health literacy increases the participation in population health programs; interactive health literacy enhances the capacity to influence social norms and interact with social groups; and critical health literacy improves community empowerment and enhances the capacity to act on social and economic determinants of health. Nutbeam's conceptual framework has been applied in case studies focusing on topics of diarrhea [ 55], self-management in diabetes [ 56] and health promoting schools [ 57].

Ratzan [ 58] links health literacy in the community to the concept of social capital, arguing that health literate people live longer and have stronger incentives to invest in developing their own and their children's knowledge and skills. Healthier populations tend to have higher labor market productivity contributing to, rather than withdrawing from, pension schemes. Similarly, healthier people use the health system less, and coupled with education and cognitive function, appropriately demand fewer health services.

An integrated conceptual model of health literacy

Whereas a number of conceptual models of health literacy have been presented in the literature, none of these can be regarded as sufficiently comprehensive to line up with the evolving health literacy definitions and with the competencies they imply [ 59]. This is probably due to the fact that attempts to conceptualize health literacy have thus far failed to integrate the existing knowledge encompassing different perspectives on health literacy. Firstly, most of the existing conceptual models are not sufficiently grounded in theory in terms of the notions and concepts included. Secondly, very few models have integrated the components included in "medical" and "public health" literacy models. The only models which explicitly try to bridge the difference between both views are Nutbeam's [ 36] and Manganello's [ 50], whose dimension of functional literacy corresponds with the cognitive skills of medical health literacy. Thirdly, while acknowledging that health literacy entails different dimensions, the majority of the existing models are rather static and do not explicitly account for the fact that health literacy is also a process, which involves the consecutive steps of accessing, understanding, processing and communicating information. Fourthly, while most conceptual models identify the factors that influence health literacy and mention its impact on health service use, health costs and health outcomes, the pathways linking health literacy to its antecedents and consequences are not very clear. Researchers could link conceptual models of health literacy more explicitly to established health promotion theories and models [ 59]. Finally, very few conceptual models of health literacy have been empirically validated. To address these shortcomings, we propose an integrated model of health literacy which captures the main dimensions of the existing conceptual models reviewed above (Figure 1).

Integrated model of health literacy--see separate file.

The model combines the qualities of a conceptual model outlining the main dimensions of health literacy (represented in the concentric oval shape in the middle of Figure 1), and of a logical model showing the proximal and distal factors which impact on health literacy, as well as the pathways linking health literacy to health outcomes.

The core of the model shows the competencies related to the process of accessing, understanding, appraising and applying health-related information. According to the 'all inclusive' definition this process requires four types of competencies: (1) Access refers to the ability to seek, find and obtain health information; (2) Understand refers to the ability to comprehend the health information that is accessed; (3) Appraise describes the ability to interpret, filter, judge and evaluate the health information that has been accessed; and (4) Apply refers to the ability to communicate and use the information to make a decision to maintain and improve health. Each of these competences represents a crucial dimension of health literacy, requires specific cognitive qualities and depends on the quality of the information provided [ 60]: obtaining and accessing health information depends on understanding, timing and trustworthiness; understanding the information depends on expectations, perceived utility, individualization of outcomes, and interpretation of causalities; processing and appraisal of the information depends on the complexity, jargon and partial understandings of the information; and effective communication depends on comprehension. The competences also incorporate the qualities of functional, interactive and critical health literacy as proposed by Nutbeam [ 36].

This process generates knowledge and skills which enable a person to navigate three domains of the health continuum: being ill or as a patient in the healthcare setting, as a person at risk of disease in the disease prevention system, and as a citizen in relation to the health promotion efforts in the community, the work place, the educational system, the political arena and the market place. Going through the steps of the health literacy process in each of these three domains equips people to take control over their health by applying their general literacy and numerical skills as well as their specific health literacy skills to acquire the necessary information, understanding this information, critically analyzing and appraising it, and acting independently to engage in actions overcoming personal, structural, social and economical barriers to health. As contextual demands change over time, and the capacity to navigate the health system depends on cognitive and psychosocial development as well as on previous and current experiences, the skills and competencies of health literacy develop during the life course and are linked to life long learning.

The frameworks associated with the three domains represent a progression from an individual towards a population perspective. As such, the model integrates the "medical" conceptualization of health literacy with the broader "public health" perspective. Placing greater emphasis on heath literacy outside of healthcare settings has the potential to impact on preventative health and reduce pressures on health systems.

The combination of the four dimensions referring to health information processing with the three levels of domains yields a matrix with 12 dimensions of health literacy as illustrated in Table 4.

Four dimensions of health literacy in the domain of healthcare, i.e., the ability to access information on medical or clinical issues, to understand medical information, to interpret and evaluate medical information, and to make informed decisions on medical issues and comply with medical advice.

Four dimensions of health literacy in the domain of disease prevention, notably the ability to access information on risk factors for health, to understand information on risk factors and derive meaning, to interpret and evaluate information on risk factors, and to make informed decisions on risk factors for health.

Four dimensions in the domain of health promotion, notably the ability to regularly update oneself on determinants of health in the social and physical environment, to comprehend information on determinants of health in the social and physical environment and derive meaning, to interpret and evaluate information on determinants, of health in the social and physical environment, and the ability to make informed decisions on health determinants in the social and physical environment.

Health literacy is in our understanding regarded an asset for improving people's empowerment within the domains of healthcare, disease prevention and health promotion.

In addition to the components of health literacy proper, the model in Figure 1 also shows the main antecedents and consequences of health literacy. Among the factors which impact on health literacy, a distinction is made between more distal factors, including societal and environmental determinants (e.g., demographic situation, culture, language, political forces, societal systems), and proximal factors, which are more concerned with personal determinants (e.g., age, gender, race, socioeconomic status, education, occupation, employment, income, literacy) and situational determinants (e.g. social support, family and peer influences, media use and physical environment). Health literacy is strongly associated with educational attainment [ 50], as well as with overall literacy [ 34, 38, 39]. Fundamental literacy affects a wide range of cognitive, behavioral, and societal skills and abilities. It should be distinguished from other specific literacy, such as science literacy (i.e., the ability to comprehend technical complexity, understanding of common technology, and an understanding that scientific uncertainty is to be expected), cultural literacy (i.e., recognizing and using collective beliefs, customs, world-views, and social identity relationships) and civic literacy (i.e., knowledge about sources of information and about agendas and how to interpret them, enabling citizens to engage in dialogue and decision-making). According to Mancuso [ 43], an individual must have certain skills and abilities to obtain competence in health literacy, and identifies six dimensions that are considered as necessary antecedents of health literacy, namely operational, interactive, autonomous, informational, contextual, and cultural competence.

Health literacy in turn influences health behavior and the use of health services, and thereby will also impact on health outcomes and on the health costs in society. At an individual level, ineffective communication due to poor health literacy will result in errors, poor quality, and risks to patient safety of the healthcare services [ 61]. At a population level, health literate persons are able to participate in the ongoing public and private dialogues about health, medicine, scientific knowledge and cultural beliefs. Thus, the benefits of health literacy impact the full range of life's activities--home, work, society and culture [ 34, 38, 39]. Advancing health literacy will progressively allow for greater autonomy and personal empowerment, and the process of health literacy can be seen as a part of an individual's development towards improved quality of life. In the population, it may also lead to more equity and sustainability of changes in public health. Consequently, low health literacy can be addressed by educating persons to become more resourceful (i.e., increasing their personal health literacy), and by making the task or situation less demanding, (i.e., improving the "readability of the system").

Discussion

In this article we have we have presented a working definition of health literacy which represents the essence of the definitions of this concept as given in the literature. Furthermore a new conceptual model has been developed as a result of the review of existing health literacy concepts. While the literature indicates that health literacy refers to the competences of people to meet the complex demands of health in modern society [ 2, 3, 62] the exact nature of these competences is still debated. One perspective is that they refer to a series of individual cognitive skills and abilities applied in a medical context; the other perspective sees a broader range of competencies applied in the social realm. The first is referred to as "medical health literacy" [ 5], "patient health literacy" [ 14], or "clinical health literacy" [ 63]; the second as "public health literacy" [ 35]. Nutbeam [ 52] refers to the opposing medical and public health views on health literacy as respectively a "clinical risk", and a "personal asset" approach, and points out that they are rooted in the different traditions of clinical care, and adult learning and health promotion, respectively. As both perspectives are important and useful to enable a better understanding of health communication processes in clinical and community settings, any definition of health literacy needs to integrate both views. The proposed 'all inclusive' definition is adaptable and includes the public health perspective as well as the individual perspective.

While originating from the study of the reading and numerical skills that are necessary to function adequately in the healthcare environment, the concept of health literacy has expanded in meaning to include information-seeking, decision-making, problem-solving, critical thinking, and communication, along with a multitude of social, personal, and cognitive skills that are imperative to function in the health-system [ 49, 52, 59]. It has now diffused into the realm of culture, context, and language [ 49, 52, 59]. Although some authors have argued that health literacy is merely "new wine in old bottles", and is basically the repackaging of concepts central to the ideological theory and practice of health promotion [ 64], enhancing health literacy is increasingly recognized as a public health goal and a determinant of health. As new health literacy frameworks have emerged to clarify the deeper meaning of health literacy, its contribution to health, and the social, environmental, and cultural factors that influence health literacy skills in a variety of populations, there is a need for an integration of diverging definitions, conceptual frameworks and models of health literacy.

Conclusion

The conceptual framework presented in this paper provides this integration in the form of a comprehensive model. Based on a systematic review of existing definitions and conceptualizations of health literacy, it combines the qualities of a conceptual model outlining the most comprehensive dimensions of health literacy, and of a logical model, showing the proximal and distal factors which impact on health literacy as well as the pathways linking health literacy to health outcomes. Specifically, the model identifies 12 dimensions of health literacy, referring to the competencies related to accessing, understanding, appraising and applying health information in the domains of healthcare, disease prevention and health promotion, respectively.

By integrating existing definitions and conceptualizations of health literacy into an encompassing model outlining the main dimensions of health literacy as well as its determinants and the pathways to health outcomes, this model has a heuristic value in its own right. More importantly, however, it can also support the practice of healthcare, disease prevention and health promotion by serving as a conceptual basis to develop health literacy enhancing interventions. Moreover, it can contribute to the empirical work on health literacy by serving as a basis for the development of measurement tools. As currently available tools to measure health literacy do not capture all aspects of the concept as discussed in the literature, there is a need to develop new tools to assess health literacy, reflecting health literacy definitions and accompanying conceptual models for public health. By following a concept validation approach, scales can be developed to assess the dimensions outlined in the conceptual model presented in this paper. This will not only produce a comprehensive measure of health literacy, reflecting the state of the art of the field and applicable for social research and in public health practice, but also serve to validate the conceptual model and thus contribute to the understanding of health literacy.

References

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Acknowledgements

The authors thank all partners in the HLS-EU consortium for contributing to the development of the conceptual model and the content of this article.

HLS-EU Consortium members

Maastricht University, the Netherlands: Helmut Brand, Stephan van den Broucke and Kristine Sørensen

National School of Public Health, Greece: Demosthenes Agrafiodis, Elizabeth Ioannidis and Barbara Kondilis

University College of Dublin, National University of Ireland: Gerardine Doyle, James Fullam and Kenneth Cafferkey

Ludwig Boltzmann Gesellschaft GmbH, Austria: Jürgen Pelikan and Florian Röethlin

Instytut Kardiologii, Poland: Zofia Slonska

University of Murcia, Spain: Maria Falcon

Medical University - Sofia, Bulgaria: Kancho Tchamov and Alex Zhekov

National Institute of Public Health and the Environment, The Netherlands: Mariël Droomers, Jantine Schuit, Iris van der Heide and Ellen Uiters

NRW Centre for Health, Germany: Gudula Ward and Monika Mensing

Funding

The HLS-EU project and related research are supported by grant 2007-113 from the European Commission.

Author information

Author notes

Authors and Affiliations

1. Department of International Health, Research School of Primary Care and Public Health, Maastricht University, Maastricht, The Netherlands

Kristine Sørensen & Helmut Brand

2. Université Catholique de Louvain, Louvain-la-Neuve, Belgium

Stephan Van den Broucke

3. University College Dublin, National University of Ireland, Dublin, Ireland

James Fullam & Gerardine Doyle

4. Ludwig Boltzmann Institute Health Promotion Research, Vienna, Austria

Jürgen Pelikan

5. National Institute of Cardiology, Warsaw, Poland

Zofia Slonska

Consortia

(HLS-EU) Consortium Health Literacy Project European

Corresponding author

Correspondence to Kristine Sørensen.

Additional information

Competing interests

The authors are members of the European Health Literacy (HLS-EU) consortium and claim to have no competing interests.

Authors' contributions

Background: KS, SVDB, JF, GD. Methodology: KS, SVDB, JF. Results: KS, SVDB, HB, JF, GD, ZS and JP. Discussion: KS, SVDB, HB, JF, GD, ZS and JP. Conclusion: KS, SVDB, JF and GD. All authors read and approved the final manuscript.

Kristine Sørensen, Stephan Van den Broucke, James Fullam, Gerardine Doyle and Helmut Brand contributed equally to this work.

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Sørensen, K., Van den Broucke, S., Fullam, J. et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health 12, 80 (2012). https://doi.org/10.1186/1471-2458-12-80
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DOI: https://doi.org/10.1186/1471-2458-12-80

Keywords

Health Literacy

Functional Health Literacy

Health Literacy Skill

Public Health Literacy

Poor Health Literacy

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Health literacy and public health: A systematic review and integration of definitions and models - BMC Public Health

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Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison.