This article explores the concept and measurement of health literacy in the context of shared health decision-making. It draws upon a series of qualitative and quantitative studies undertaken in the development and evaluation of a bowel cancer screening decision aid for low literacy populations. The findings indicate that different types of health literacy (functional, interactive and critical) are required in decision-making and present a set of instruments to assess and discriminate between higher level health literacy skills required for engagement in decision-making. It concludes that greater sophistication in both the definition and measurement of health literacy in research is needed.
AbelT (2008) Measuring health literacy: Moving towards a health promotion perspective. International Journal of Public Health53: 169–170.
2.
Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association (1999) Health literacy: Report of the Council on Scientific Affairs. JAMA281: 552–557.
3.
BakerDW (2006) The meaning and the measure of health literacy. Journal of General Internal Medicine21: 878–883.
4.
BarryMJEdgman-LevitanS (2012) Shared decision making – The pinnacle of patient-centered care. The New England Journal of Medicine366: 780–781.
5.
BerkmanNDSheridanSLDonahueKE. (2011) Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine155: 97–107.
6.
BuchbinderRBatterhamRCicirielloS. (2011) Health literacy: What is it and why is it important to measure?The Journal of Rheumatology38: 1791–1797.
7.
CharlesCGafniAWhelanT (1997) Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine44: 681–692.
8.
ChinnD (2011) Critical health literacy: A review and critical analysis. Social Science & Medicine73: 60–67.
9.
ClerehanRBuchbinderRMoodieJ (2005) A linguistic framework for assessing the quality of written patient information: Its use in assessing methotrexate information for rheumatoid arthritis. Health Education Research20: 334–344.
10.
CoulterAEllinsJ (2007) Effectiveness of strategies for informing, educating, and involving patients. BMJ335: 24–27.
11.
DavisTCCrouchMALongSW. (1991) Rapid assessment of literacy levels of adult primary care patients. Family Medicine23: 433–435.
12.
DegnerLFKristjansonLJBowmanDSloanJACarriereKCO’NeilJ. (1997) Information needs and decisional preferences in women with breast cancer. JAMA277(18): 1485–92.
DoakCCDoakLGFriedellGH. (1998) Improving comprehension for cancer patients with low literacy skills: Strategies for clinicians. CA: A Cancer Journal for Clinicians48: 151–162.
15.
EdwardsMWoodFDaviesM. (2012) The development of health literacy in patients with a long-term health condition: The health literacy pathway model. BMC Public Health12: 130.
16.
HirshDClerehanRStaplesM. (2009) Patient assessment of medication information leaflets and validation of the Evaluative Linguistic Framework (ELF). Patient Education and Counseling77: 248–254.
17.
HoutsPSDoakCCDoakLG. (2006) The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Education and Counseling61: 173–190.
18.
Institute of Medicine (2004) Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press.
19.
IshikawaHYanoE (2011) The relationship of patient participation and diabetes outcomes for patients with high vs. low health literacy. Patient Education and Counseling84: 393–397.
20.
IshikawaHTakeuchiTYanoE. (2008) Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care31(5): 874–9.
21.
JordanJEBuchbinderROsborneRH (2010) Conceptualising health literacy from the patient perspective. Patient Education and Counseling79: 36–42.
22.
KickbuschI (2009) Health literacy: Engaging in a political debate. International Journal of Public Health54: 131–132.
23.
Levin-ZamirDPeterburgY (2001) Health literacy in health systems: Perspectives on patient self-management in Israel. Health Promotion International16: 87–94.
24.
MarteauTMDormandyEMichieS. (2001) A measure of informed choice. Health Expect4(2): 99–108.
25.
MartenssonLHensingG. (2012) Health literacy – a heterogeneous phenomenon: a literature review. Scand J Caring Sci26(1): 151–60.
26.
MogfordEGouldLDevoghtA (2011) Teaching critical health literacy in the US as a means to action on the social determinants of health. Health Promotion International26: 4–13.
27.
NutbeamD. Health Promotion Glossary (1998) World Health Organization, Oxford University Press, Great Britain.
28.
NutbeamD (2000) Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International15: 259–267.
29.
NutbeamD (2008) The evolving concept of health literacy. Social Science & Medicine67:2072–2078.
30.
NutbeamD (2009) Defining and measuring health literacy: What can we learn from literacy studies?International Journal of Public Health54: 303–305.
31.
O’ConnorA (1995) Validation of a decisional conflict scale. Med Decis Making15(1): 25–30.
32.
ParkerRMBakerDWWilliamsMV. (1995) The test of functional health literacy in adults: A new instrument for measuring patients’ literacy skills. Journal of General Internal Medicine10: 537–541.
33.
Pizur-BarnekowKDarraghAJohnstonM (2011) ‘I Cried Because I Didn’t Know if I Could Take Care of Him’: Toward a taxonomy of interactive and critical health literacy as portrayed by caregivers of children with special health care needs. Journal of Health Communication16: 205–221.
34.
PleasantAKuruvillaS. (2008) A tale of two health literacies: public health and clinical approaches to health literacy. Health Promot Int23(2): 152–9.
35.
PleasantAMckinneyJRikardRV (2011) Health literacy measurement: A proposed research agenda. Journal of Health Communication16: 11–21.
36.
RubinDLParmerJFreimuthV. (2011) Associations between older adults’ spoken interactive health literacy and selected health care and health communication outcomes. Journal of Health Communication16: 191–204.
37.
SainfortFBooskeBC. (2000) Measuring post-decision satisfaction. Med Decis Making20(1): 51–61.
38.
SmithS.KTrevenaLNutbeamDBarrattA, K.J. M. (2008) Information needs and preferences of low and high literacy consumers for decisions about colorectal cancer screenings: utilizing a linguistic model. Health Expectations11(2): 123–36.
39.
SmithSKTrevenaLBarrattADixonANutbeamDSimpsonJM. (2009a) Development and preliminary evaluation of a bowel cancer screening decision aid for adults with lower literacy. Patient Educ Couns Nov89(2): 330–6.
40.
SmithSKDixonATrevenaLNutbeamD, KJ. M. (2009b) Exploring patient involvement in healthcare decision making across different education and functional health literacy groups. Social Science & Medicine69(12): 1805–12.
41.
SmithSKTrevenaLSimpsonJMBarrattANutbeamDMcCafferyKJ. (2010) A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial. British Medical Journal341(c5370).
42.
SmithSKKearneyPTrevenaLBarrattANutbeamDMcCafferyKJ. (2012) Informed choice in bowel cancer screening: a qualitative study to explore how adults with lower education use decision aids. Health Expect E pub ahead of print.
43.
SorensenKVan Den BrouckeSFullamJ. (2012) Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health12: 80.
44.
St LegerL (2001) Schools, health literacy and public health: Possibilities and challenges. Health Promotion International16: 197–205.
45.
Von WagnerCSteptoeAWolfMS. (2009) Health literacy and health actions: A review and a framework from health psychology. Health Education & Behavior36: 860–877.
46.
WangR (2000) Critical health literacy: A case study from China in schistosomiasis control. Health Promotion International15: 269–274.
47.
WeissBDMaysMZMartzW. (2005) Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine3: 514–522.
