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Int. J. Environ. Res. Public Health 2018, 15(8), 1676; https://doi.org/10.3390/ijerph15081676

Beyond Reading and Understanding: Health Literacy as the Capacity to Act

1
Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands
2
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
*
Author to whom correspondence should be addressed.
Received: 9 May 2018 / Revised: 11 July 2018 / Accepted: 24 July 2018 / Published: 7 August 2018
(This article belongs to the Special Issue Health Literacy in Context—Settings, Media, and Populations)
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Abstract

Many health literacy interventions have a limited focus on functional/cognitive skills. In psychosocial models, the capacity to act however is seen as a major driver of behavioural change. This aspect is often lacking in health literacy concepts. In this study, we examine the impact of both aspects of health literacy (functional/cognitive and capacity to act) on specific healthcare outcomes (healthcare use, experiences with patient-centered care, shared-decision making, and self-management). In a sample of a national panel of people with a chronic disease (NPCD), questions about health literacy, patient activation, and outcomes were asked. The results indicated that 39.9% had limited HL levels and 36.9% had a low activation score. Combined, 22.7% of the sample scored low on both aspects, whereas 45.8% had adequate levels on both. Patients who score low on both use more healthcare and have less positive experiences with patient-centered care, shared decision making, and self-management. Patients who have adequate competency levels in both respects have the best outcomes. Both cognitive and non-cognitive aspects of health literacy are important, and they enhance each other. The capacity to act is especially important for the extent to which people feel able to self-manage. View Full-Text
Keywords: health literacy; health determinants; health competencies; health outcomes; patient-centered care; definitions; conceptual models health literacy; health determinants; health competencies; health outcomes; patient-centered care; definitions; conceptual models
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Rademakers, J.; Heijmans, M. Beyond Reading and Understanding: Health Literacy as the Capacity to Act. Int. J. Environ. Res. Public Health 2018, 15, 1676.

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