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Definitions and interpretations of 'health literacy' have important implications for the delivery of health care and for health policy-related initiatives. We conducted a systematic review and critical analysis to determine the extent to which definitions of health literacy differ in the academic literature, the similarities and differences across definitions, and possible interpretations for the most commonly used definitions. We identified 250 different definitions of health literacy and grouped them into three categories: (i) most commonly used definitions (n=6), (ii) modified versions of these most commonly used definitions (n=133), and (iii) 'other' definitions (n=111). We found the most commonly used definitions to be open to multiple interpretations and to reflect underlying assumptions that are not always justifiable. Attention is needed to the ways in which differing definitions and interpretations of health literacy may affect patient care and the delivery of health literacy-related policy initiatives.Journal of Public Health Policy advance online publication, 19 May 2016; doi:10.1057/jphp.2016.18.

Objectives This study asked: What is known from the existing literature about the empirical relationships between health literacy (HL) and the three stages of the treatment decision making (TDM) process: information exchange, deliberation, and deciding on the treatment to implement? Methods A scoping review of the literature was conducted. Four databases were searched and a total of 2772 records were returned. After de-duplication and three levels of relevance screening, 41 primary studies were included. Results Relationships between HL and information exchange were studied more often than relationships between HL and deliberation and deciding on the treatment to implement. Across the 41 studies, there was little overlap in terms the measure(s) of HL adopted, the aspect of TDM considered, and the characteristics of the study populations – making comparisons of the findings difficult. Multiple knowledge gaps and measurement-related problems were identified; including, the possibility that the process of TDM influences HL. Conclusion The importance of HL to the three stages of TDM is unclear because of the knowledge gaps and measurement-related problems that exist. Practice implications There are many uncertainties about how TDM, or the design and use of patient decision aids, should respond to patients with different levels of HL.

Purpose: To obtain and document public health nurses’ thoughts about health literacy in, and related communication practices with, adolescent patients. Methods: Using a qualitative descriptive approach, we conducted semi-structured interviews with a purposeful sample of public health nurses working with adolescents, either part- or full-time. Emerging themes were identified using content analysis and confirmed by two health literacy researchers and a public health nurse. Results: Nurses ascribed different meanings to the term health literacy, the most common being an understanding of one’s health or health-related information. They provided various types of health information to adolescent patients, used more than one mode of communication, and assessed adolescents’ understanding primarily by asking questions. Tailored approaches employed by nurses to communicate information to adolescents included the use of peer educators in schools; business cards with information on where to seek more information; and text messaging. These approaches, however, were not uniformly adopted and some nurses expressed concerns about the lack of security associated with the use of text messaging. Anxiety/fear in adolescents emerged as a prominent patient-related barrier to effective communication and stemmed, in some cases, from adolescents’ lack of understanding about confidentiality policies. Major provider-related barriers to effective communication included hours and locations of services that were inconvenient for adolescents, and limited time to spend with adolescent patients. Conclusions: Attention is needed to patient- and provider-related barriers that may limit or impeded efforts by public health nurses to promote health literacy in adolescent patients.

Purpose: The goal of this study is to examine the role of educational and learning practices and resources enabling an adequate level of health literacy in older Canadians. Design and Methods: A secondary analysis of data derived from the 2003 IALSS (Canadian version) was performed. Using the Andersen-Newman model as a framework, a set of predisposing, enabling and need factors were tested as predictors of an adequate level of health literacy in older Canadians (n=2,979). Results: The educational enabling factors exhibited the most robust associations with an adequate level of health literacy. These included education level; self-study in the form of reading manuals, reference books and journals; computer/Internet use, use of the library; leisure reading of books; reading letters, notes and emails; and volunteerism. Implications: Programs and policies that encourage access to, and the uptake of, lifelong educational resources and practices by older persons are needed. Longitudinal research is required to further understand the associations found between educational practices and health literacy over the life course.