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Selecting the concept
Health literacy shapes whether patients can follow a medication plan, recognize warning signs and take part in decisions. Advanced practice nurses use the term often, but it is defined in many different ways. This paper uses Walker and Avant's (2019) eight-step method to clarify it.
Aims of the analysis
To identify the defining attributes of health literacy so that it can be assessed consistently in primary care and used to plan patient teaching.
Uses of the concept
Early definitions treated health literacy as the ability to read and understand health materials, close to functional literacy in a clinical setting. Later definitions widened it. A systematic review identified 17 definitions and 12 conceptual models of health literacy. From these, the authors built an integrated model with 12 dimensions: the knowledge, motivation and competencies needed to access, understand, appraise and apply health information in three areas, health care, disease prevention and health promotion (Sørensen et al., 2012). This broader view treats health literacy as something people use to make everyday decisions about health, not only a reading skill.
Defining attributes
- Accessing health information: finding and obtaining it.
- Understanding it: making sense of spoken, written and numerical information.
- Appraising it: judging whether information is relevant and trustworthy.
- Applying it: using information to make decisions and act on them.
Cases
Model case. Mr. J., 58, is told he has prediabetes. He reads the clinic's handout, looks up the CDC's lifestyle program, notices that a website selling supplements is advertising rather than giving advice, and enrolls in a program at his community center. All four attributes are present.
Borderline case. Ms. K. understands her new blood pressure prescription and can explain it, but she relies on social media posts claiming that garlic can replace medication and stops taking her pills. She can access and understand information but doesn't appraise it.
Contrary case. Mr. L. is handed an inhaler with no explanation, can't read the printed instructions, and doesn't know who to ask. None of the attributes are present.
Antecedents and consequences
- Antecedents: basic literacy and numeracy, language and cultural fit of information, cognitive ability, and access to clear information from clinicians.
- Consequences: better self-management, safer medication use and more effective participation in shared decisions. Limited health literacy is associated with poorer health outcomes.
Empirical referents
The Newest Vital Sign is a quick screening test in which patients answer six questions about a nutrition label, taking about 3 minutes. In its validation study, fewer than 4 correct answers indicated possible limited literacy (Weiss et al., 2005). Screening tools like this measure mainly the understanding and applying attributes, so the advanced practice nurse should also ask how patients find and judge information.
Implications for advanced practice
Because limited health literacy is common and often hidden, the advanced practice nurse can use plain language and teach-back with every patient, while screening helps target extra support.
References
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., Brand, H., & (HLS-EU) Consortium Health Literacy Project European. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12, Article 80. https://doi.org/10.1186/1471-2458-12-80
Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Pearson.
Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., Mockbee, J., & Hale, F. A. (2005). Quick assessment of literacy in primary care: The Newest Vital Sign. Annals of Family Medicine, 3(6), 514–522. https://doi.org/10.1370/afm.405
