Special Issue: Adjustment to Chronic Illness Original Articles and Reviews
Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions A Systematic Review Efrat Neter and Esther Brainin Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel
Abstract: The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly (n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search (n = 26); (3) articles on eHealth literacy and its association with health outcomes (n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies. Keywords: health literacy, eHealth literacy, health service use, health outcomes, processes of care
Health Literacy and eHealth Literacy – Definition and Measurement Health literacy is defined by the World Health Organization 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” (World Health Organization, 1998, p. 20). A definition by the Institute of Medicine focuses on similar capacities that serve making “appropriate health decisions” (Cutilli, 2007; Parker, Ratzan, & Lurie, 2003). This concept is elaborated by Nutbeam (2000, 2008) as being comprised of three types. The first, functional literacy, involves reading, writing, and basic communication skills that allow functioning effectively in everyday situations. Critical literacy involves critically
European Psychologist (2019), 24(1), 68–81 https://doi.org/10.1027/1016-9040/a000350
analyzing information and using information to exert greater control over life events and situations. Lastly, interactive literacy comprises of extracting information and deriving meaning from different forms of communication and to apply new information to changing circumstances. Rudd, Kirsch, and Yamamoto (2004) explicate health tasks that depend on health literacy: The range encompasses activities related to health promotion (e.g., purchase food), health protection (e.g., decide among product options and use products), disease prevention (e.g., undergo screening or diagnostic tests), health care and maintenance (e.g., calculate timing for medicine), and system navigation (e.g., locate facilities or apply for benefits). Historically, the attending physician was the primary source supplying medical and medication-related information, but nowadays a wider range of information sources
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