Defining, conceptualizing, and measuring health literacy as a necessary step towards improved health outcomes : a focus on skills needed to find health information

Health literacy is an individual’s ability to find, understand, use, and communicate about health information in an effort to make informed health decisions. Low health literacy is prevalent in the U.S., where an estimated one-third of adults are thought to have difficulty with health information; however, this is more prevalent among racial/ethnic minorities, those who did not finish high school, and older adults. Low health literacy is thought to predict poor health, which results in billions of dollars in healthcare expenditures annually. Despite the prevalence of and concerns related to low health literacy, existing frameworks and measures are incapable of capturing changes in health literacy. As such, the purpose of this dissertation was to develop a conceptual model based on an existing definition of health literacy. This four-facet approach depicts health literacy as a latent variable comprised of the four skill sets included in the definition. A two-phase study was created to determine the skills needed for an individual to successfully find health information, the first facet included in the four-facet approach. Patients and health professionals (N=40) were asked about the skills they thought were needed to find health information (Phase One). Through these interviews, seven skills themes emerged (Knowing When to Search, Credibility Assessments, Reading Ability, Finding Numerical Information, Interpersonal Seeking, Finding Health Information Online, and Spatial Navigation). Based on themes elicited in these interviews, a tool was created to measure items for each of these themes (Phase Two). This tool was administered through an online survey (N=331). Exploratory factor analysis was conducted to extract factors from Phase Two data. Phase Two factor data added that patients may need skills to scan paragraphical text (Text Within Text) and to extract information from nutrition labels (Labels) or from information with high amounts of medical jargon (Health Information Challenges). This two-phase methodological approach should be used in future studies to address the other three facets of health literacy. Ultimately, this will result in a measurement tool capable of reflecting changes in health literacy over time and areas in which intervention work is needed to produce improved health outcomes.