Influencing factors and determinants of health literacy

Abstract

Abstract Health literacy has demonstrable effects on health status and quality of life and is a prerequisite for health-promoting behavior. Thus, health literacy is naturally an Austrian health target. Actions to strengthen health literacy should specifically address its determinants and influencing factors. To provide the best available knowledge for this goal, we developed an impact model of how influencing factors (indirect influence) and determinants (direct influence) will lead to increased health literacy based on the best available evidence We conducted an umbrella review on systematic, narrative and scoping reviews that deal with concepts, models or definitions of health literacy. The systematic literature search in MEDLINE (Ovid/Epistemonikos) identified 256 relevant abstracts. Two authors checked the abstracts and included 32 in the full text assessment. Fourteen studies were ultimately included in the umbrella review. We extracted influencing factors, determinants, and outcomes and coded, summarized, and renamed them in an inductive approach to ensure uniform terminology. In total, we identified 10 specific influencing factors and 13 measurable determinants. A graphical impact model visualizes the causal relationships between influencing factors and determinants and how they affect the main dimensions of health literacy together: decision, appraisal, access & seek. The impact model illustrates that health literacy is prevalent when decisions are made and implemented and that strengthening health literacy is best achieved through approaches that influence the determinants at the individual and situational level. With the list of specific influencing factors and measurable determinants, the impact model presented differs from all health literacy models available to date. The impact model gives clear recommendations on which concrete influencing factors and determinants programs for strengthening health literacy should be used to aim for positive changes. Key messages Interventions to strengthen health literacy should aim to improve both situational and individual determinants. A key situational determinant is the availability of accessible, understandable and reliable health information.