Measuring Functional, Communicative, and Critical Health Literacy Among Diabetic Patients

Abstract

OBJECTIVE -Health literacy (HL), the capacity of individuals to access, understand, and use health information to make informed and appropriate health-related decisions, has been recognized as an important concept in patient education and disease management. This study examined the psychometric properties of newly developed scales for measuring three different levels of HL (i.e., functional, communicative, and critical) in patients with diabetes.RESEARCH DESIGN AND METHODS -The reliability and validity of the three HL scales were evaluated in a sample of 138 outpatients with type 2 diabetes. In addition, sociodemographic and clinical characteristics, knowledge of diabetes, information-seeking behaviors, and self-efficacy were assessed for each patient through a self-report questionnaire and review of electronic medical records.RESULTS -Scale items were constructed to directly reflect the definition of HL. Internal consistency of functional, communicative, and critical HL scales was adequately high (␣ ϭ 0.84, ␣ ϭ 0.77, and ␣ ϭ 0.65, respectively). Three interpretable factors were identified in exploratory factor analysis. Correlations between HL scales and other measures supported the construct validity of the scales. The three HL scales were only moderately correlated with each other, suggesting that each represents a different domain of HL abilities and skills.CONCLUSIONS -Our newly developed HL scales are reliable and valid measures of three types of HL in diabetic patients. Exploring a patient's HL levels may provide a better understanding of the patient's potential barriers to self-management of disease and health-promoting behaviors. Diabetes Care 31:874-879, 2008O ver the past few decades, patient participation in the health care process has been recognized as a critical determinant of successful disease management. This is especially true for diabetes, which requires extensive, ongoing patient self-care. Health information is an important resource for helping patients understand and engage in the management of a health condition. Although physicians have historically been the primary source of health and medical information, other sources are becoming more available to the general public with the increase in media reports and rapid diffusion of information via the Internet (1-4). Thus, a patient's skills in understanding and applying information about health issues may have a substantial impact on his/ her behavior and health (5). These skills have recently been conceptualized as health literacy (HL).The National Library of Medicine refers to HL as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (6). Similarly, the World Health Organization defines HL as "the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health" (7). Based on this premise, Nutbeam (8) propos...

The impact of health literacy on diabetes self-management education

“…-Diabetes specific health literacy was measured at baseline and at follow-up using the scale developed by (Ishikawa et al, 2008). This scale consists of 14 items assessing functional HL (e.g., abilities to read and understand instructions or leaflets from hospitals/pharmacies), communicative HL (e.g., abilities to collect diabetes-related information from various sources, capacities to extract the information and apply it in daily life), and critical HL (e.g., abilities to assess the credibility and reliability of health information, to judge whether the information is applicable to one's own situation).…”

“…Health literacy (HL) refers to individuals' knowledge, motivation and skills to obtain, understand, appraise, and apply health information in order to take health-related decisions in everyday life (Sørensen et al, 2012). Although the definition and conceptualisation of HL vary across studies, three dimensions are often distinguished: (1) functional HL, which refers to basic skills in writing and reading that are required to effectively function in everyday situations; (2) communicative/interactive HL, which refers to more advanced skills that are needed to extract and understand information from various sources; and (3) critical HL, which refers to advanced cognitive skills that allow the individual to critically assess information and apply it to make health-related decisions (Ishikawa, Takeuchi and Yano, 2008;Nutbeam, 2000).…”

Different Measures, Different Outcomes? A Systematic Review of Performance-Based versus Self-Reported Measures of Health Literacy and Numeracy

“…[8][9][10][11][12][13][14] Frequently used self-report measures include Chew et al's brief validated screening questions (BSQ), the Single Item Literacy Screener, and the Subjective Numeracy Scale. 8,9,13 All involve patients describing themselves and their preferences or skills.…”

Age- and Sex-Specific Impact of Health Literacy on Healthy Lifestyle Characteristics among Japanese Residents in a Rural Community

“…In addition, the ability to extract health-related information was significantly associated with a healthy lifestyle regardless of age or sex. Although several studies have examined HL characteristics of young and middle-aged participants [9], male participants [9], and patients with diabetes mellitus [16], there have been a few reports that broadly include elderly and female participants. To the best of our knowledge, the present study is the first to describe age-and sex-specific HL characteristics among Japanese community-dwelling residents, and to examine associations with healthy lifestyle characteristics.…”