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Taking Health Literacy to the Next Level

Health literacy calls for self-regulation. Some extra help may be needed.

Key points

  • Health literacy includes knowledge, communication, and critical thinking.
  • Self-efficacy is a determining factor in successful self-management of health.
  • There are programs that can enable the actions that health literacy promotes.
Source: rudall30 / iStock
Source: rudall30 / iStock

Health literacy is a concept that addresses an individual’s ability to “find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” This is the latest definition from the Centers for Disease Control and Prevention (2020).

Putting it into an everyday context, health literacy can play out in many ways. Often treatment of chronic diseases like heart failure or diabetes involves compliance with medications and making lifestyle changes such as being more physically active and eating a healthier diet.

The same can be true for relatively healthy individuals. Getting people motivated to get more exercise and eat healthy foods can be an uphill battle in many different situations.

Health literacy also speaks to the issue that many individuals do not have much understanding of how their bodies work.

Fleshing out the scope of health literacy

According to a systematic review in 2020, health literacy is considered a very promising and effective way to deal with the rise of what they term “non-communicable diseases.” Our society is getting sicker with these diseases, and we are in dire need of being able to use health information to manage our health.

Lack of health literacy has been connected to poor health, high risk of mortality, and rising costs related to managing chronic diseases. Getting a grip on medical advances and new pharmaceuticals, and sorting out information presented on various forms of media are growing challenges in our modern society. Health literacy is more important than ever.

The 2020 systematic review presented research that filled in some critical elements of the concept of health literacy. It is not just about using knowledge to inform decisions. It is about knowing how to process that information and then taking actions to maintain health.

Other research cited in the review presented additional concepts. Health literacy can also include the ability to work with health providers to maintain health. In this context, it means being able to describe one’s situation and preferences.

The review article concluded that there needs to be a new definition of health literacy as the “ability of an individual to obtain and translate knowledge and information in order to maintain and improve health in a way that is appropriate to the individual and system contexts.”

This new definition refers to what each individual may be bringing to the table. Level of education, social support, beliefs about the importance of health, and previous experiences in the health care system can all play a part.

It's not always about literacy

Maintaining or improving health can be a tall order, even for someone who is considered health literate. There are other things that can influence an individual’s ability to manage their health.

For example, two studies of groups experiencing heart failure were concerned with the connection between health literacy and the ability to manage the disease. One study (2018) concluded that effective patient actions were not related to health literacy or knowing about heart failure. The other one (2014) found that health literacy was associated with knowledge, but that self-efficacy was associated with being able to initiate self-care for the disease.

Going beyond health literacy

As noted in the studies of patients with heart failure, self-efficacy was a determining factor in successful self-management. People need to have a belief in their ability to organize and manage a complex situation like maintaining health.

To that aim, there are some processes that can create a solid framework for building confidence, competency, and feelings of empowerment:

1. Mindset

Growth mindset is spelled out in Carol Dweck's book, Mindset. She explains that growth mindset is the ability to convert challenges into learning experiences. It is a way to use creative thinking to solve problems or address barriers in a productive way. A growth mindset can create confidence in the individual’s ability to manage their own health. On the other hand, having a “fixed mindset” means that a person may become locked into a self-perception that stifles exploration of new actions or solutions. As Dweck notes, it is possible to teach and nurture a growth mindset. Some aspects of the research have been challenged, but the concepts can be helpful.

2. Motivational interviewing

Motivational Interviewing involves empathetic listening and making sure the conversation is about the individual. It is a process of asking open-ended questions that gently steer that conversation to change. Using this process, clients come to their own conclusions about what they are willing to change about their health and why. It is a supportive process that can work in concert with the constructs of health literacy.

Importantly, research tells us that motivation to adopt sustained health behaviors often comes from being committed to a deep personal value. Motivational interviewing can help to uncover what that is and link it to specific actions that contribute to healthy changes.

3. Exploration

My book The End of Try Try Again and its accompanying Action Workbook address health behavior change or maintenance using many of the concepts mentioned above. Answering questions increases self-awareness, lets the person individualize their strategies, and helps them build the skills they need to make healthy changes.

These methods can be used effectively to expand and successfully implement what health literacy is hoping to achieve.


Liu, C., Wang, D., Liu, C., Jiang, J., Wang, X., Chen, H., Ju, X., Zhuang, X. (2020). What is the meaning of health literacy? A systematic review and qualitative synthesis. Fam Med Com Health. 8:e000351.

Jacobson, A.F., et al. (2018). Patient activation, knowledge, and health literacy association with self-management behaviors in persons with heart failure. Heart and Lung. (47) 5: 447–451.

Chen, A.M.H., Yehle, K.S., Albert, N.M., Ferraro, K. F., Mason, H.L., Murawski, M.M., Plake, K.S. (2014). Relationships between health literacy and heart failure knowledge, self-efficacy, and self-care adherence. Research in Social and Administrative Pharmacy. (10) 2: 378–386.

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