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Objective: To address a gap in understanding of verbal exchange (oral and aural) health literacy by describing the systematic development of a verbal exchange health literacy (VEHL) definition and model which hypothesizes the role of VEHL in health outcomes.

Methods: Current health literacy and communication literature was systematically reviewed and combined with qualitative patient and provider data that were analyzed using a grounded theory approach. Results: Analyses of current literature and formative data indicated the

importance of verbal exchange in the clinical setting and revealed various factors associated with the patient-provider relationship and their characteristics that influence decision making and health behaviors. VEHL is defined as the ability to speak and listen that facilitates exchanging, understanding, and interpreting of health information for health-decision making, disease management and navigation of the healthcare system. A model depiction of mediating and influenced factors is presented.

Conclusion: A definition and model of VEHL is a step toward addressing a gap in health literacy knowledge and provides a foundation for examining the influence of VEHL on health outcomes.

Practice Implications: VEHL is an extension of current descriptions of health literacy and has implications for patient-provider communication and health decision making.

HARRINGTON, Kathleen F a Melissa A VALERIO. A conceptual model of verbal exchange health literacy. In: Patient Education And Counseling [online]. 2014, 94(3) s. 403-410 [cit. 2017-12-27] ISSN 1873-5134. PMID 24291145. Dostupné z: https://doi.org/10.1016/j.pec.2013.10.024

Objective: A person’s health literacy, i.e., their ability to seek, understand and use health information, is a critical determinant of whether they are able to actively participate in their healthcare. The objective of this study was to conceptualise health literacy from the patient perspective.

Methods: Using comprehensive qualitative methods 48 individuals were interviewed across three distinct groups in Australia: those with a chronic condition, the general community and individuals who had recently presented to a metropolitan public hospital emergency department. Purposeful sampling was employed to ensure a range of experiences was captured.

Results: Seven key abilities were identified: knowing when to seek health information; knowing where to seek health information; verbal communication skills; assertiveness; literacy skills; capacity to process and retain information; application skills.

Conclusion: This study identifies key abilities patients identified as critical to seek, understand and utilise information in the healthcare setting. These abilities are not reflected in existing measures for health literacy. Future measures of health literacy could consider

incorporating abilities identified in this study and may provide guidance in developing health interventions to assist patients to participate effectively in their health.

Practice Implications: More comprehensive measures to assess patient’s health literacy are needed.

JORDAN, Joanne E., Rachelle BUCHBINDER a Richard H. OSBORNE. Conceptualising health literacy from the patient perspective. In: Patient Education And Counseling [online]. 2010, 79(1), s. 36-42 [cit. 2017-12-27]. ISSN 1873-5134. PMID 19896320. Dostupné ze systému ScienceDirect (DOI): https://dx.doi.org/10.1016/j.pec.2009.10.001

‚Research literacy‘ is proposed as a key concept for advancing societal health. To examine whether improvements in research literacy would affect knowledge of and ethical participation in research, parents of young children received a brief educational intervention designed to enhance their understanding of child research. Results demonstrated that the intervention improved research-related knowledge and increased parents‘ comfort with their research participation decisions. Moreover, enhanced understanding of child volition increased parents‘ willingness to enrol their children in research. The proposed research literacy model identifies methods to enhance population knowledge and appreciation of research, strengthening links between scientific advancement and health.

BRODY, Janet L et al. Conceptualizing the Role of Research Literacy in Advancing Societal Health. In: Journal of Health Psychology [online]. 2012, 17(5), s. 724-730 [cit. 2017-12-27]. ISSN 1461-7277. PMID 22021275. Dostupné z (DOI): https://dx.doi.org/10.1177/1359105311425273

Though there has been a considerable expansion of interest in the health literacy concept worldwide, there has also been criticism that this concept has been poorly defined, that it stretches the idea of „literacy“ to an indefensible extent and more specifically, that it adds little to the existing concerns and intervention approaches of the better established discipline of health promotion. This paper takes as a starting point the expanded model of health literacy advanced by Nutbeam (2000) and addresses these concerns by interrogating the concept of „critical health literacy“ in order to draw conclusions about its utility for advancing the health of individuals and communities. The constituent domains of critical health literacy are identified; namely information appraisal, understanding the social determinants of health, and collective action, and as far as possible each are clearly delineated, with links to related concepts made explicit. The paper concludes that an appreciation of work undertaken in a range of different disciplines, such as media studies, medical sociology, and evidence-based medicine can enhance our understanding of the critical health literacy construct and help us understand its usefulness as a social asset which helps individuals towards a critical engagement with health information. There is some evidence that aspects of critical health literacy have indeed been found to be a resource for better health outcomes, but more research is needed in this area, both to develop quantitative and qualitative approaches to evaluating health literacy skills, and to offer convincing evidence that investment in programmes designed to enhance critical health literacy are worthwhile.

CHINN, Deborah. Critical Health Literacy: A Review and Critical Analysis. In: Social Science & Medicine [online]. 2011, 73(1), s. 60-67 [cit. 2017-12-27]. ISSN 1873-5347. PMID 21640456. Dostupné ze systému ScienceDirect (DOI): https://dx.doi.org/10.1016/j.socscimed.2011.04.004

When the antecedents of health-promoting behavior are explored, the concept of health literacy is deemed a factor of major influence. Originally defined as reading, writing and numeracy skills in the health domain, health literacy is now considered a multidimensional concept. The ongoing discussion on health literacy reveals that no agreement exists about which dimensions to include in the concept. To contribute to the development of a consistent and parsimonious concept of health literacy, we conducted a critical review of concepts in other literacy domains. Our review was guided by two research questions: (i) Which dimensions are included in the concepts of other literacy domains? (ii) How can health literacy research profit from other literacy domains? Based on articles collected from PubMed, PsycINFO, Communication & Mass Media Complete, CINAHL, SAGE Full-Text Collection, Cochrane Library and Google Scholar as well as selected monographs and editions, we identified seven distinct dimensions. Some of the dimensions recur across all reviewed literacy domains and first attempts have been made to operationalize the dimensions. Expanding upon these dimensions, the paper discusses how they can prove useful for elaborating a consistent and parsimonious concept of health literacy and foster the development of a more holistic measure.

FRISCH, Anne-Linda et al. Defining and Measuring Health Literacy: How Can We Profit from Other Literacy Domains? In: Health Promotion International [online]. 2012, 27(1), s. 117-126 [cit. 2017-12-27]. ISSN 1460-2245. PMID 21724626. Dostupné z: https://doi.org/10.1093/heapro/dar043

NUTBEAM, Don. Defining and Measuring Health Literacy: What Can We Learn from Literacy Studies? In: International Journal of Public Health [online]. 2009, 54(5), s. 303-305 [cit. 2017-12-27]. ISSN 1661-8564. PMID 1964184. Dostupné ze systému SpringerLink (DOI): https://dx.doi.org/10.1007/s00038-009-0050-x

Caregivers play a vital role in caring for people diagnosed with cancer. However, little is understood about caregivers‘ capacity to find, understand, appraise and use information to improve health outcomes. The study aimed to develop a conceptual model that describes the elements of cancer caregiver health literacy. Six concept mapping workshops were conducted with 13 caregivers, 13 people with cancer and 11 healthcare providers/policymakers. An iterative, mixed methods approach was used to analyse and synthesise workshop data and to generate the conceptual model. Six major themes and 17 subthemes were identified from 279 statements generated by participants during concept mapping workshops. Major themes included: access to information, understanding of information, relationship with healthcare providers, relationship with the care recipient, managing challenges of caregiving and support systems. The study extends conceptualisations of health literacy by identifying factors specific to caregiving within the cancer context. The findings demonstrate that caregiver health literacy is multidimensional, includes a broad range of individual and interpersonal elements, and is influenced by broader healthcare system and community factors. These results provide guidance for the development of: caregiver health literacy measurement tools; strategies for improving health service delivery, and; interventions to improve caregiver health literacy.

YUEN, Eva YN et al. Development of a Conceptual Model of Cancer Caregiver Health Literacy. In: European Journal of Cancer Care [online]. 2016, 25(2), s. 294-306 [cit. 2017-12-27]. ISSN 1365-2354. PMID 25630765. Dostupné z: https://dx.doi.org/10.1111/ecc.12284

Background: Health information has become readily accessible through mass media, and people are playing a more active and autonomous role in their health. Much of the health information that was previously only available to health professionals is now directly accessible to the public. Consequently, people often navigate vast amounts of health information on their own, typically with little knowledge about how to evaluate it or the need to do so. Health information remains essentially unregulated, and widespread problems and concerns with the quality of health information have been noted. In addition to the variable quality of health information, inconsistent and/or inappropriate use of related terminology (e.g. ‚evidence-based‘ and ‚clinically proven‘) can be confusing to the public, who are ill-prepared to critically examine claims. The general public are not trained in the fundamentals of health research and do not typically possess the knowledge and skills to evaluate the accuracy and completeness of information about health interventions. Without this, the public are vulnerable to acting on inaccurate or incomplete health information and making ill-informed health decisions. With this review, we intend to identify and assess educational interventions which have been designed to improve people’s ability to understand key concepts relevant to evaluating claims about the effects of health interventions.

Methods/design: This systematic review of the literature will use a search strategy that has been developed in conjunction with a Health Sciences Librarian who has expertise in systematic review searching to identify relevant studies. Databases to be searched include the following: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and ERIC. Attempts to identify unpublished studies and ongoing trials will also be made. Two review authors will independently screen search results and assess studies for eligibility. Studies which aim to improve participants‘ understanding of the key concepts relevant to evaluating the effects (or the interpretation of results) of health interventions will be included. Randomised trials, non-randomised trials, controlled before and after studies, controlled studies with only post-test measures, and interrupted time series studies will be eligible for inclusion. We will contact study authors to clarify any missing details/data. Due to the nature of the systematic review question and the expectation of heterogeneity in study design, interventions, and outcomes, we intend to take a narrative approach to data synthesis.

CUSACK, Leila et al. Educational Interventions to Improve People’s Understanding of Key Concepts in Assessing the Effects of Health Interventions: A Systematic Review Protocol. In: Systematic Reviews [online]. 2016, 5, s. 37 [cit. 2017-12-27]. ISSN 2046-4053. PMID 26915734. Dostupné z: https://dx.doi.org/10.1186/s13643-016-0213-9.

As the use of eHealth grows and diversifies globally, the concept of eHealth literacy – a foundational skill set that underpins the use of information and communication technologies (ICT) for health – becomes more important than ever to understand and advance. EHealth literacy draws our collective attention to the knowledge and complex skill set that is often taken for granted when people interact with technology to address information, focusing our attention on learning and usability issues from the clinical through to population health level. Just as the field of eHealth is dynamic and evolving, so too is the context where eHealth literacy is applied and understood. The original Lily Model of eHealth literacy and scale used to assess it were developed at a time when the first generation of web tools gained prominence before the rise of social media. The rapid shifts in the informational landscape created by Web 2.0 tools and environments suggests it might be time to revisit the concept of eHealth Literacy and consider what a second release might look like.

NORMAN, Cameron. Ehealth Literacy 2.0: Problems and Opportunities with an Evolving Concept. In: Journal of Medical Internet Research [online]. 2011, 13(4), s. e125 [cit. 2017-12-27]. ISSN 1438-887. PMID 22193243. Dostupné z: http://dx.doi.org/10.2196/jmir.2035.

Background: Two types of studies have been conducted around the concept of health literacy, which in the last years has gained widespread acceptance in the field of Communication and Medicine: on the one side, empirical research on the different aspects of health literacy and their relationship with health outcomes (DeWalt et al. 2004; Paasche-Orlow et al. 2006; Sudore et al. 2006), and on the other side studies aimed at discussing and implementing new and existing theoretical definitions of the concept (Nutbeam 2008; Schulz & Nakamoto 2005). The present study is a tentative endeavour to contribute to the conceptual work around health literacy, i.e. to specify the concept with regard to the limited area of cancer. The main idea is that of elaborating and operationally defining a concept of cancer literacy. A key issue in this endeavor is the question of what to include in the concept, and what to omit. Material and Methods: It is hard to know which features of laity communication competence are important to operationally define health literacy in general and cancer literacy in particular, without taking the knowledge and experience of health care providers into account. To achieve an operational definition of cancer literacy in the general population, building upon the professional experience of health care providers (oncologists, GPs, nurses from oncology wards, social workers, public health professionals), a Delphi study among cancer experts (N = 50) from the three linguistic regions of Switzerland has been conducted. Results: The paper presents the main results of the three waves of the Delphi study that was the first to operationally define the concept of cancer literacy, highlighting its main aspects, their relative importance and the degree of agreement among the participants. Conclusions: The study is the first step of a larger research project funded by Oncosuisse and carried out by a Swiss university, which foresees other studies in this area, such as a content analysis of the Swiss newspaper coverage of the aspects that have emerged as crucial constituents of cancer literacy, and the development of a measuring instrument that will help define the most health illiterate and cancer illiterate segments of the population and produce information on which aspects of health and cancer literacy are most in need of improvement. This will help designing information campaigns and public policies that are targeted to where the deficiencies are. Institution (Diviani, Schulz) Universita della Svizzera italiana, Institute of Communication and Health, Lugano, Switzerland Publisher Elsevier Ltd Emtree Heading *neoplasm; *reading; *Delphi study; *oncology; health; health care personnel; interpersonal communication; population; Switzerland; university; content analysis; empirical research; publication; types of study; policy; nurse; oncology ward; social worker; public health; health practitioner; competence.

DIVIANI, Nicola a SCHULZ Peter J. Establishing a concept of cancer literacy – A delphi study among Swiss oncology experts. In: European Journal of Cancer Supplements [online]. 2009, 7(2-3), s. 211[cit. 2017-12-28]. Dostupné ze systému ScienceDirect (DOI): http://dx.doi.org/10.1016/S1359-6349(09)70722-0

Background and Aim: A growing responsibility on the part of individuals to make decisions in health issues implies the need of access to health information and personal skills to comprehend the information. Health literacy comprises skills in obtaining, understanding and acting on information about health issues in ways that promote and maintain health. A lack of health literacy may have effects at both the individual and societal levels. There are thus reasons for health care professionals to gain a comprehensive understanding of health literacy. The aim of this review was to explore how health literacy is described in the scientific literature and to give a synthesis of its different meanings. Methods: The review was based on approximately 200 scientific articles published 2000-2008. The analysis process was inspired by the methods of narrative literature review. Findings and Conclusions: Two different approaches to health literacy became visible, one in which health literacy is expressed as a polarized phenomenon, focusing on the extremes of low and high health literacy. The definitions of health literacy in this approach are characterized by a functional understanding, pointing out certain basic skills needed to understand health information. The other approach represents a complex understanding of health literacy, acknowledging a broadness of skills in interaction with the social and cultural contexts, which means that an individual’s health literacy may fluctuate from one day to another according to the context. The complex approach stresses the interactive and critical skills needed to use information or knowledge as a basis for appropriate health decisions. We conclude that health literacy is a heterogeneous phenomenon that has significance for both the individual and society. Future research will aim at the development of assessments that capture the broadness of skills and agents characteristic for health literacy as a complex phenomenon.

MÅRTENSSON, Lena a Gunnel HENSING. Health Literacy — a Heterogeneous Phenomenon: A Literature Review. In: Scandinavian Journal of Caring Sciences [online]. 2012, 26(1), s. 151-160 [cit. 2017-12-27]. ISSN 1471-6712. PMID 21627673. Dostupné z: http://dx.doi.org/10.1111/j.1471-6712.2011.00900.x

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.

SØRENSEN, Kristine et al. Health Literacy and Public Health: A Systematic Review and Integration of Definitions and Models. In: BMC Public Health [online]. 2012, 12, s.80 [cit. 2017-12-27]. ISSN 1471-2458. PMID 22276600. Dostupné z: http://dx.doi.org/10.1186/1471-2458-12-80

Health literacy, ‚the personal characteristics andsocial resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health‘, is key to improving peoples‘ control over modifiable social determinants of health (SDH). This study listened to adult learners to understand their perspectives on gathering, understanding and using information for health. This qualitative project recruited participants from community skills courses to identify relevant ‚health information‘ factors. Subsequently different learners put these together to develop a model of their ‚Journey to health‘. Twenty-seven participants were recruited; twenty from community health literacy courses and seven from an adult basic literacy and numeracy course. Participants described health as a ‚journey‘ starting from an individual’s family, ethnicity and culture. Basic (functional) health literacy skills were needed to gather and understand information. More complex interactive health literacy skills were needed to evaluate the importance and relevance of information in context, and make health decisions. Critical health literacy skills could be used to adapt negative external factors that might inhibit health- promotion. Our model is an iterative linear one moving from ethnicity, community and culture, through lifestyle, to health, with learning revisited in the context of different sources of support. It builds on existing models by highlighting the importance of SDH in the translation of new health knowledge into healthy behaviours, and the importance of health literacy in enabling people to overcome barriers to health.

ROWLANDS, Gillian et al. Health Literacy and the Social Determinants of Health: A Qualitative Model from Adult Learners. In: Health Promotion International [online]. 2017, 32(1), s. 130-138 [cit. 2017-12-27]. ISSN 0957-4824. Dostupné z: http://dx.doi.org/10.1093/heapro/dav093

There is no consensus on how best to assess the health literacy demands of health information materials. Comprehensive, reliable, and valid assessment tools are needed. The authors report on the development, refinement, and testing of Health Literacy INDEX, a new tool reflecting empirical evidence and best practices. INDEX is comprised of 63 indicators organized into 10 criteria: plain language, clear purpose, supporting graphics, user involvement, skill-based learning, audience appropriateness, user instruction, development details, evaluation methods, and strength of evidence. In a sample of 100 materials, intercoder agreement was high: 90% or better for 52% of indicators, and above 80% for nearly all others. Overall scores generated by INDEX were highly correlated with average ratings from 12 health literacy experts (r = 0.89, p < .0001). Additional research is warranted to examine the association between evaluation ratings generated by INDEX and individual understanding, behaviors, and improved health. Health Literacy INDEX is a comprehensive tool with evidence for reliability and validity that can be used to evaluate the health literacy demands of health information materials. Although improvement in health information materials is just one aspect of mitigating the effects of limited health literacy on health outcomes, it is an essential step toward a more health literate public.

KAPHINGST, Kimberly A. et al. Health Literacy INDEX: Development, Reliability, and Validity of a New Tool for Evaluating the Health Literacy Demands of Health Information Materials. In: Journal of Health Communication [online]. 2012, 17(3), s. 203-221 [cit. 2017-12-27]. ISSN 1087-0415. PMID 23030571. Dostupné z: http://dx.doi.org/10.1080/10810730.2012.712612

Objective: To systematically review current health literacy (HL) instruments for use in consumer-facing and mobile health information technology screening and evaluation tools.Design: The databases, PubMed, OVID, Google Scholar, Cochrane Library and Science Citation Index, were searched for health literacy assessment instruments using the terms „health“, „literacy“, „computer-based,“ and „psychometrics“. All instruments identified by this method were critically appraised according to their reported psychometric properties and clinical feasibility.Results: Eleven different health literacy instruments were found. Screening questions, such as asking a patient about his/her need for assistance in navigating health information, were evaluated in seven different studies and are promising for use as a valid, reliable, and feasible computer-based approach to identify patients that struggle with low health literacy. However, there was a lack of consistency in the types of screening questions proposed. There is also a lack of information regarding the psychometric properties of computer-based health literacy instruments.Limitations: Only English language health literacy assessment instruments were reviewed and analyzed.Conclusions: Current health literacy screening tools demonstrate varying benefits depending on the context of their use. In many cases, it seems that a single screening question may be a reliable, valid, and feasible means for establishing health literacy. A combination of screening questions that assess health literacy and technological literacy may enable tailoring eHealth applications to user needs. Further research should determine the best screening question(s) and the best synthesis of various instruments‘ content and methodologies for computer-based health literacy screening and assessment.

COLLINS, Sarah A. et al. Health Literacy Screening Instruments for Ehealth Applications: A Systematic Review. In: Journal of Biomedical Informatics [online]. 2012, 45(3), s. 598-607. [cit. 2017-12-27] ISSN 1532-0464. PMID 22521719. Dostupné ze systému ScienceDirect (DOI): https://doi.org/10.1016/j.jbi.2012.04.001

CONTEXT: Patients with the greatest health care needs may have the least ability to read and comprehend information needed to function successfully as patients. OBJECTIVE: To examine the scope and consequences of poor health literacy in the United States, characterize its implications for patients and physicians, and identify policy and research issues. PARTICIPANTS: The 12 members of the Ad Hoc Committee on Health Literacy, American Medical Association Council on Scientific Affairs, were selected by a key informant process as experts in the field of health literacy from a variety of backgrounds in clinical medicine, medical and health services research, medical education, psychology, adult literacy, nursing, and health education. EVIDENCE: Literature review using the MEDLINE database for January 1966 through October 1, 1996, searching Medical Subject Heading (MeSH) reading combined with text words health or literacy in the title, abstract, or MeSH. A subsequent search using reading as a search term identified articles published between 1993 and August 1998. Authors of relevant published abstracts were asked to provide manuscripts. Experts in health services research, health education, and medical law identified proprietary and other unpublished references. CONSENSUS PROCESS: Consensus among committee members was reached through review of 216 published articles and additional unpublished manuscripts and telephone and Internet conferencing. All committee members approved the final report. CONCLUSIONS: Patients with inadequate health literacy have a complex array of communications difficulties, which may interact to influence health outcome. These patients report worse health status and have less understanding about their medical conditions and treatment. Preliminary studies indicate inadequate health literacy may increase the risk of hospitalization. Professional and public awareness of the health literacy issue must be increased, beginning with education of medical students and physicians and improved patient-physician communication skills. Future research should focus on optimal methods of screening patients to identify those with poor health literacy, effective health education techniques, outcomes and costs associated with poor health literacy, and the causal pathway of how poor health literacy influences health.

Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs (American Medical Association). Health Literacy Report of the Council on Scientific Affairs. In: JAMA [online]. 1999, 281(6), s. 552–557 [cit. 2017-12-26]. Dostupné z: https://dx.doi.org/10.1001/jama.281.6.552

OSBORNE, Richard H., Alison BEAUCHAMP a Roy BATTERHAM. Health literacy: a concept with potential to greatly impact the infectious diseases field. In: International Journal Of Infectious Diseases: IJID: Official Publication Of The International Society For Infectious Diseases [online]. 2016, 43, s. 101-102 [cit. 2017-12-27]. ISSN 1878-3511. PMID 26724772. Dostupné z: http://dx.doi.org/10.1016/j.ijid.2015.12.012

The terms ‚health‘ and ‚literacy‘ form a powerful concept that has evolved from the 1970s to one that has garnered the attention of a wide range of disciplines; most notably, education and health care, but also library science, public health, and the mental health arena. There are many definitions of health literacy, but none that encompass the totality by which the concept is constructed. This paper presents an analysis of the concept of health literacy using the technique of concept/dimensional analysis. A clear understanding of the concept is essential as health literacy has implications that are far-reaching and impact both the individual and society.

MANCUSO, Josephine M. Health literacy: a concept/dimensional analysis. In: Nursing & Health Sciences [online]. 2008, 10(3), s. 248-255 [cit. 2017-12-28]. ISSN 1441-0745. PMID 18786068. Dostupné také z: http://onlinelibrary.wiley.com/doi/10.1111/j.1442-2018.2008.00394.x/full

The concept of ‚health literacy‘ refers to the personal and relational factors that affect a person’s ability to acquire, understand and use information about health and health services. For many years, efforts in the development of the concept of health literacy exceeded the development of measurement tools and interventions. Furthermore, the discourse about and development of health literacy in public health and in clinical settings were often substantially different. This paper provides an update about recently developed approaches to measurement that assess health literacy strengths and limitations of individuals and of groups across multiple aspects of health literacy. This advancement in measurement now allows diagnostic and problem-solving approaches to developing responses to identified strengths and limitations. In this paper, we consider how such an approach can be applied across the diverse range of settings in which health literacy has been applied. In particular, we consider some approaches to applying health literacy in the daily practice of health-service providers in many settings, and how new insights and tools–including approaches based on an understanding of diversity of health literacy needs in a target community—can contribute to improvements in practice. Finally, we present a model that attempts to integrate the concept of health literacy with concepts that are often considered to overlap with it. With careful consideration of the distinctions between prevailing concepts, health literacy can be used to complement many fields from individual patient care to community-level development, and from improving compliance to empowering individuals and communities.

BATTERHAM, Roy W. et al. Health Literacy: Applying Current Concepts to Improve Health Services and Reduce Health Inequalities. In: Public Health [online]. 2016, 132, s. 3-12 [cit. 2017-12-28]. ISSN 1476-5616. PMID 26872738. Dostupné ze systému ScienceDirect (DOI): https://doi.org/10.1016/j.puhe.2016.01.001

AIM: This paper reports an analysis of the concept of health literacy in order to clarify its meaning, reduce ambiguities associated with references to it, and promote consistency in using the concept in nursing dialogue and research. BACKGROUND: Health literacy is a relatively new concept in health promotion research. Only within the last decade have researchers identified the problems associated with health literacy, the role it plays in an individual’s ability to comprehend health and self-care information, and its relationship to health outcomes. Clarifying the concept is essential so that nurses develop an awareness of the phenomenon and its relationship to the outcomes of their communication and health education efforts. METHOD: The method used for this concept analysis was that of Walker and Avant (1995). FINDINGS: Health literacy empowers people to act appropriately in new and changing health-related circumstances through the use of advanced cognitive and social skills. The defining attributes of health literacy are reading and numeracy skills, comprehension, the capacity to use information in health care decision-making, and successful functioning as a healthcare consumer. Antecedents of health literacy are literacy and a health-related experience. Consequences of health literacy include improved self-reported health status, lower health care costs, increased health knowledge, shorter hospitalizations, and less frequent use of health care services. Empirical referents of the concept are the Test of Functional Health Literacy in Adults and the health literacy component of the National Assessment of Adult Literacy. CONCLUSIONS: An analysis of the concept of health literacy enhances nurses‘ ability to assess more accurately their clients‘ levels of health literacy, thus identifying those at risk for misunderstanding health care instructions, shame associated with inadequate reading skills, and inability to adhere to health care recommendations.

SPEROS, C. Health literacy: concept analysis. In: Journal Of Advanced Nursing [online]. 2005, 50(6), s. 633-640 [cit. 2017-12-28]. ISSN 0309-2402. PMID 15926968. Dostupné z: http://dx.doi.org/10.1111/j.1365-2648.2005.03448.x

Health literacy–the ability to read, understand, and act on basic health information–is a relatively new concept linked to health status. Recent reports indicate a national and international lack of health literacy skills, leaving many individuals vulnerable to poor health outcomes. Adequate health literacy is necessary for people to access health information, take control of their health management, and positively affect their overall health status. Health communication is an integral part of health literacy and is an essential skill in health promotion. We examine the concepts and definitions of health literacy and provide a framework for medical communicators to use in developing effective health communications.

LANNING, Beth A. a Eva I. DOYLE. Health literacy: developing a practical framework for effective health communication. In: AMWA Journal: American Medical Writers Association Journal [online]. 2010, 25(4) s. 155-161 [cit. 2017-12-28]. ISSN 1075-6361. Dostupné z: http://c.ymcdn.com/sites/www.amwa.org/resource/resmgr/journal/Issues/2010/2010v25n4_online.pdf

As societies grow more complex and people are increasingly bombarded with health information and misinformation, health literacy becomes essential. People with strong health literacy skills enjoy better health and well-being, while those with weaker skills tend to engage in riskier behaviour and have poorer health. With evidence from the recent European Health Literacy Survey, this report identifies practical and effective ways public health and other sector authorities and advocates can strengthen health literacy in a variety of settings, including educational settings, workplaces, marketplaces, health systems, new and traditional media and political arenas. The report can be used as a tool for spreading awareness, stimulating debate and research and, above all, for informing policy development and action.

KICKBUSCH, Ilona et al (ed.). Health literacy: the solid facts [online]. Copenhagen: World Health Organization Regional Office for Europe, 2013 [cit. 2017-12-27]. Solid facts (Series). ISBN 978-92-890-0015-4. Dostupné z: http://www.euro.who.int/__data/assets/pdf_file/0008/190655/e96854.pdf

The WHO Health Promotion Glossary was written to facilitate understanding, communication and cooperation among those engaged in health promotion at the local, regional, national and global levels. Two editions of the Glossary have been released, the first in 1986 and the second in 1998.

NUTBEAM Don. Health Promotion Glossary. In: Health Promotion International [online]. 1998, 13(4), s. 349–364 [cit. 2017-12-27]. Doi: 10.1093/heapro/13.4.349. Dostupné z: https://doi.org/10.1093/heapro/13.4.349

Background: The aim of this study is to make a critical analysis of the different definitions of health literacy to provide a framework of the concept. Methods: A literature search was conducted in PubMed, Embase, PsycINFO, ERIC, Health Evidence, Centre for Reviews and Dissemination and Cochrane Library. Google and OpenGrey were searched to find additional papers and unpublished works. Results: Among 7000 papers founded, we selected 26 works. During the 1990s, authors began to systematically study the relationship between health literacy and health status, according to a public health view. In the first decade of the new century, a new fundamental definition established three progressive degrees of health literacy: functional, interactive and critical health literacy. Sørensen (in 2012) provided a framework for the development of new assessment tools and interventions. Conclusion: The improvement of health literacy is a powerful tool for the development of a new type of relationship between individuals and the health system.

BONACCORSI, Guglielmo et al. Health Services and Health Literacy: From the Rationale to the Many Facets of a Fundamental Concept. A Literature Review. In: Annali Dell’Istituto Superiore Di Sanita [online]. 2016, 52(1), s. 114-118 [cit. 2017-12-28]. ISSN 0021-2571. PMID 27033626. Dostupné z: http:// dx.doi.org/10.4415/ANN_16_01_18.pdf

Increasing media use among adolescents and its significant influence on health behavior warrants in-depth understanding of their response to media content. This study developed the concept and tested a model of Media Health Literacy (MHL), examined its association with personal/socio-demographic determinants and reported sources of health information, while analyzing its role in promoting empowerment and health behavior (cigarette/water-pipe smoking, nutritional/dieting habits, physical/sedentary activity, safety/injury behaviors and sexual behavior). The school-based study included a representative sample of 1316 Israeli adolescents, grades 7, 9 and 11, using qualitative and quantitative instruments to develop the new measure. The results showed that the MHL measure is highly scalable (0.80) includes four sequenced categories: identification/recognition, critical evaluation of health content in media, perceived influence on adolescents and intended action/reaction. The findings suggest that as a determinant of adolescent health behavior, MHL identifies groups at risk and may provide a basis for health promotion among youth.  

LEVIN-ZAMIR, Diane, Dafna LEMISH a Rosa GOFIN. Media Health Literacy (MHL): Development and Measurement of the Concept among Adolescents. In: Health Education Research [online]. 2011, 26(2), s. 323-335 [cit. 2017-12-28]. Dostupné z: http://dx.doi.org/10.1093/her/cyr007

A report on health literacy, defined as ‚the ability to make sound health decisions in the context of everyday life.‘ It is a Call to Action to policymakers to make health literacy a central pillar in health policy discussions, research and action at a European, national and local level.

KICKBUSCH, Ilona, Suzanne WAIT a Daniela MAAG. Navigating health: the role of health literacy [online]. Alliance for Health and the Future, International Longevity Centre, 2006 [cit. 2017-12-27]. Dostupné z: http://www.ilcuk.org.uk/images/uploads/publication-pdfs/pdf_pdf_3.pdf

This study investigated predictors of and pathways to health literacy among Korean American immigrants residing in New York City (n = 407). Social Cognitive Theory guided the study and the Chew et al. 16-item health literacy screening scale was employed. Structural equation modeling using Mplus 4.21 tested the proposed conceptual model. Findings revealed that education and English proficiency were the most influential predictors of health literacy; education was directly associated with health literacy and indirectly through language proficiency. Predictors of greater English proficiency included higher levels of education, younger age, and unmarried status. The findings suggest that immigrants with minimal English abilities, little education, and no health insurance have particular intervention needs, perhaps best met by a patient-centered approach focusing on individual language needs and cultural health beliefs.

LEE, Hee Yun a Jeong-Kyun CHOI. Pathway to Health Literacy in Korean American Immigrants: The Mediating Role of English Proficiency. In: Journal of Human Behavior in the Social Environment [online]. 2012, 22(3), s. 255-269 [cit. 2017-12-28]. ISSN 1091-1359. Dostupné z: http://dx.doi.org/10.1080/10911359.2012.655568

Background: It has been argued that only 12% of adults have the necessary health literacy to manage their health care effectively, which can lead to difficulties in self-care activities, such as medication adherence. Prior research suggests that health literacy may influence knowledge, self-efficacy and self-care, but this has not been fully examined. Objective: To test a model to explain the relationships between health literacy, heart failure knowledge, self-efficacy, and self-care. Methods: Prior to receiving clinic-based education, newly referred patients to 3 heart failure clinics completed assessments of health literacy, heart failure knowledge, self-efficacy, self-care, and demographics. Structural equation modeling was completed to examine the strength of the inter-variable relationships. Results: Of 81 participants recruited, data from 63 patients were complete. Health literacy was independently associated with knowledge (P < 0.001). Health literacy was not related to self-care. Self-efficacy was independently-associated with self-care adherence (P = 0.016). No other relationships were statistically significant. The model had good fit (comparative fit index = 1.000) and explained 33.6% of the variance in knowledge and 27.6% in self-care. Conclusions: Health literacy influences knowledge about heart failure but not self-care adherence. Instead, self-efficacy influenced self-care adherence. Future research should incorporate additional factors that may better model the relationships between health literacy, knowledge, self-efficacy, and self-care.

CHEN, Aleda M. H. et al. Relationships between Health Literacy and Heart Failure Knowledge, Self-Efficacy, and Self-Care Adherence. In: Research in Social & Administrative Pharmacy: RSAP [online]. 2014, 10(2), s. 378-386 [cit. 2017-12-28]. ISSN 1934-8150. PMID 23953756. Dostupné ze systému ScienceDirect (DOI): http://dx.doi.org/10.1016/j.sapharm.2013.07.001

Health literacy is a relatively new concept that has been evolving at a rapid pace over the past decade. As recently as 2004, nursing researchers were contributing only a small portion of the existing body of knowledge as it related to the concept of health literacy. But in the last 4 to 5 years, this trend has changed. More interest demonstrated by nursing scholars has caused an exponential increase in the literature being produced. The research to date has shown a direct correlation between low health literacy and poor health. Older adults have been identified as a vulnerable population with an estimated two-thirds of US adults aged 60 and older having inadequate or marginal literacy skills. A concept analysis of health literacy in the older adult population is warranted at this time to further clarify the concept and provide standard terminology and definitions for future holistic nursing practice and research, leading to better identification of health-literacy deficits and intervention within vulnerable populations.

OLDFIELD, Scott R. a H. M. DREHER. The Concept of Health Literacy within the Older Adult Population. In: Holistic Nursing Practice [online]. 2010, 24(4), s. 204-21 [cit. 2017-12-28]. ISSN 1550-5138. PMID 20588129. Dostupné z: http://dx.doi.org/10.1097/HNP.0b013e3181e90253

Background: Inadequate health literacy has been associated with poor management of long-term health conditions and has been identified as a key social determinant of health outcomes. However, little is understood about how health literacy might develop over time or the processes by which people may become more health literate. Our objectives were to describe how patients with a long-term condition practice health literacy in the management of their health and communication with health professionals, how they become more health literate over time and their experience of using health services. We also sought to identify and describe the motivations, facilitators and barriers in the practice of health literacy in healthcare consultations. Methods: We designed a longitudinal qualitative study using seriál interviews with 18 participants to explore their experiences of learning to manage their condition and their experiences of health literacy when participating in healthcare processes. Participants were recruited from patient education programmes and were interviewed three times over a period of 9 months. A framework approach was used to analyse data. Results: A model is presented that illustrates the development of health literacy along a trajectory that includes the development of knowledge, health literacy skills and practices, health literacy actions, abilities in seeking options and informed and shared decision making opportunities. Motivations and barriers to developing and practising health literacy skills partly reflected participants‘ characteristics but were also influenced by health professionals. Some participants developed their health literacy to a point where they became more involved in healthcare processes (including informed and shared decision-making). Conclusions: Patients with a long-term condition can develop health literacy skills over time and put their skills into practice in becoming more active in healthcare consultations. Our findings have implications for developing health literacy interventions aimed at patient involvement in healthcare processes and improved self-management of long-term conditions.

EDWARDS, Michelle et al. The Development of Health Literacy in Patients with a Long-Term Health Condition: The Health Literacy Pathway Model. In: BMC Public Health [online]. 2012, 12, s. 130 [cit. 2017-12-28]. ISSN 1471-2458. PMID 22332990. Dostupné z: http://dx.doi.org/10.1186/1471-2458-12-130

Background: Health literacy (HL) is seen as an increasingly relevant issue for global public health and requires a reliable and comprehensive operationalization. By now, there is limited evidence on how the development of tools measuring HL proceeded in recent years and if scholars considered existing methodological guidance when developing an instrument. Methods: We performed a systematic review of generic measurement tools developed to assess HL by searching PubMed, ERIC, CINAHL and Web of Knowledge (2009 forward). Two reviewers independently reviewed abstracts/ full text articles for inclusion according to predefined criteria. Additionally we conducted a reporting quality appraisal according to the survey reporting guideline SURGE. Results: We identified 17 articles reporting on the development and validation of 17 instruments measuring health literacy. More than two thirds of all instruments are based on a multidimensional construct of health literacy. Moreover, there is a trend towards a mixed measurement (self-report and direct test) of health literacy with 41% of instruments applying it, though results strongly indicate a weakness of coherence between the underlying constructs measured. Overall, almost every third instrument is based on assessment formats modeled on already existing functional literacy screeners such as the REALM or the TOFHLA and 30% of the included articles do not report on significant reporting features specified in the SURGE guideline. Conclusions: Scholars recently developing instruments that measure health literacy mainly comply with recommendations of the academic circle by applying multidimensional constructs and mixing up measurement approaches to capture health literacy comprehensively. Nonetheless, there is still a dependence on assessment formats, rooted in functional literacy measurement contradicting the widespread call for new instruments. All things considered, there is no clear „consensus“ on HL measurement but a convergence to more comprehensive tools. Giving attention to this finding can help to offer direction towards the development of comparable and reliable health literacy assessment tools that effectively respond to the informational needs of populations.

ALTIN, Sibel Vildan et al. The Evolution of Health Literacy Assessment Tools: A Systematic Review. In: BMC Public Health [online]. 2014, 14, s. 1207 [cit. 2017-12-28]. ISSN 1471-2458. PMID 25418011. Dostupné z: http://dx.doi.org/10.1186/1471-2458-14-1207

Objective: Health literacy refers to an individual’s ability to seek, understand, and use health information. This paper describes the development and psychometric testing of the health literacy management scale (HeLMS). Methods: Content areas were identified from a conceptual Framework derived from interviews and concept mapping. Items were generated from statements from concept mapping participants. Construction (N=333) and replication (N=350) samples were participants in chronic disease self-management programs and emergency department attendees. Factor analysis was used to refine constructs and define psychometric properties. Results: Consultations generated 8 scales each with 4-5 items: Understanding health information, Accessing GP healthcare services, Communication with health professionals, Being proactive and Using health information, Patient attitudes towards their health, Social support, and Socioeconomic considerations. Confirmatory factor analyses indicated good fit of the data with the model (RMSEA=0.07, SRMR=0.05, CFI=0.97) and all domains had high internal consistency (Cronbach alpha>0.82). Conclusion: The HeLMS has acceptable psychometric properties and assesses a range of health literacy constructs important to patients when seeking, understanding and using health information within the healthcare system. Practice Implications: The HeLMS presents a new approach to assessing health literacy in healthcare settings.

JORNAN, Joanne E. et al. The health literacy management scale (HeLMS): a measure of an individual’s capacity to seek, understand and use health information within the healthcare setting. In: Patient Education And Counseling [online]. 2013, 91(2), s. 228-235 [cit. 2017-12-28]. ISSN 1873-5134. PMID 23419326. Dostupné z: http://dx.doi.org/10.1016/j.pec.2013.01.013

Although there are a variety of models and frameworks that describe factors that are associated with health literacy skills, few illustrate the full pathway from development and moderators of health literacy skills, their application, and the outcomes that result all in one framework or model. This article introduces the Health Literacy Skills conceptual framework that does encompass this full continuum. To develop the framework, the authors reviewed and built upon existing health literacy frameworks. The Health Literacy Skills framework hypothesizes the relations between health literacy and health-related outcomes and depicts how health literacy functions at the level of the individual. The framework also reflects how factors external to the individual (e.g., family, setting, community, culture, and media) influence the constructs and relations represented in the framework. The framework is organized into 4 primary components: (a) factors that influence the development and use of health literacy skills; (b) health-related stimuli; (c) health literacy skills needed to comprehend the stimulus and perform the task; and (d) mediators between health literacy and health outcomes. Previous theoretical frameworks lend support to the proposed causal pathways it illustrates. The authors hope this conceptual framework can serve as a springboard for further discussion and advancement in operationalizing this complex construct. The Health Literacy Skills framework could also be used to guide the development of interventions to improve health literacy. Future research should be conducted to fully test the relations in the framework.

SQUIERS, Linda et al. The Health Literacy Skills Framework. In: Journal of Health Communication [online]. 2012, 17(3), s. 30-54 [cit. 2017-12-28] ISSN 1087-0415. PMID 23030560. Dostupné z: http://dx.doi.org/10.1080/10810730.2012.713442

This article aims to present and describe a model of complementary and alternative medicine (CAM) health literacy. The model is the conceptual basis for CAM health literacy, which is operationally defined as the information about CAM needed to make informed self-management decisions regarding health. Improving health literacy is a national priority, and widespread use of CAM has added to the complexity of this task. There are no currently available models or measures of health literacy regarding CAM. The authors developed the model using an iterative process of deriving concepts, constructs, and empirical indicators from the literature and the author’s prior work, review and critique by experts, and revision. The model of CAM health literacy can serve as the basis for future research on the use and efficacy of CAM and the constructs and concepts within it can be used to identify points of intervention for research or for clinical practice. It is anticipated that the model will have scientific and clinical application for assessing health literacy in other self care decision-making situations.

SHREFFLER-GRANT, Jean, et al. The Montana State University conceptual model of complementary and alternative medicine health literacy. In: Journal Of Health Communication [online]. 2013, 18(10), s. 1193-200 [cit. 2017-12-28]. ISSN 1087-0415. PMID 23889542. Dostupné z: http://dx.doi.org/10.1080/10810730.2013.778365

Health literacy tools that provide reliable information about healthy living can be found at Healthfinder.gov. Healthfinder.gov, which is a federal government Web site, is financially supported by the U.S. government rather than paid advertisements. The content is written in a plain, easy-to-read language, which makes this an ideal tool for those with limited literacy skills. The tools at Healthfinder.gov may increase the likelihood of users understanding the connection between a healthy lifestyle and healthy outcomes. This may empower users to make informed decisions regarding health issues, improve health literacy rates, improve health outcomes, and decrease health care costs.

MILLICAN, Kim P. U.S. Government Health Literacy Tools. In: Journal Of Consumer Health On The Internet [online]. 2014, 18(4), s. 385-395 [cit. 2017-12-28]. ISSN 1539-8285. Dostupné z: http://dx.doi.org/10.1080/15398285.2014.953000

Background: Interest in and debates around health literacy have grown over the last two decades and key to the discussions has been the distinction made between basic functional health literacy, communicative/interactive health literacy and critical health literacy. Of these, critical health literacy is the least well developed and differing interpretations of its constituents and relevance exist. The aim of this study is to rigorously analyse the concept of critical health literacy in order to offer some clarity of definition upon which appropriate theory, well grounded practice and potential measurement tools can be based. Method: The study uses a theoretical and colloquial evolutionary concept analysis method to systematically identify the features associated with this concept. A unique characteristic of this method is that it practically combines an analysis of the literature with in depth interviews undertaken with practitioners and policy makers who have an interest in the field. The study also analyses how the concept is understood across the contexts of time, place, discipline and use by health professionals, policy makers and academics. Results: Findings revealed a distinct set of characteristics of advanced personal skills, health knowledge, information skills, effective interaction between service providers and users, informed decision making and empowerment including political action as key features of critical health literacy. The potential consequences of critical health literacy identified are in improving health outcomes, creating more effective use of health services and reducing inequalities in health thus demonstrating the relevance of this concept to public health and health promotion. Conclusions: While critical health literacy is shown to be a unique concept, there remain significant contextual variations in understanding particularly between academics, practitioners and policy makers. Key attributes presented as part of this concept when it was first introduced in the literature, particularly those around empowerment, social and political action and the existence of the concept at both an individual and population level, have been lost in more recent representations. This has resulted in critical health literacy becoming restricted to a higher order cognitive individual skill rather than a driver for political and social change. The paper argues that in order to retain the uniqueness and usefulness of the concept in practice efforts should be made to avoid this dilution of meaning.

SYKES, Susie et al. Understanding critical health literacy: a concept analysis. In: BMC Public Health [online]. 2013, 13, s. 150 [cit. 2017-12-28]. ISSN 1471-2458. PMID 23419015. Dostupné z: http://dx.doi.org/10.1186/1471-2458-13-150

Objective: To examine whether theories and/or models are used in interventions geared towards improving health-related outcomes for individuals with limited literacy skills. Methods: Intervention studies (n=52) published between 1980 and 2009 that met inclusion criteria were reviewed to assess the topic addressed, type of theory and/or model used, and the extent of theory use. Results: Twenty-one (40.4%) interventions were based on a theory or model. Most of those 21 interventions were either „informed by“ (n=15, 71.4%) or „applied“ (n=4, 19.1%) theory whereas 2 (9.5%) „tested“ theory. Conclusions: Most low-literacy intervention research is not based on any educational, behavioral, or social science theory or model.

WALLACE, Lorraine S. et al. Use of theory in low-literacy intervention research from 1980 to 2009. In: American Journal Of Health Behavior [online]. 2012, 36(2), s. 145-52 [cit. 2017-12-28] ISSN 1945-7359. PMID 22370253. Dostupné z (DOI): http://dx.doi.org/10.5993/AJHB.36.2.1