Table 3.

Conceptual models of health literacy

	Reference	Dimensions	Antecedents	Consequences
1	Nutbeam (2000) [36]	- Functional health literacy - Interactive health literacy - Critical health literacy	Health promotion actions (education, social mobilization, advocacy)	Individual benefits - Improved knowledge of risks - Compliance with prescribed actions. Improved capacity to act independently on knowledge - Improved motivation and self-confidence - Improved individual resilience to adversity Community/social benefits - Increased participation in population health programs - Improved capacity to influence social norms and interact with social groups. - Improved capacity to act on social and economic determinants of health - improved community empowerment
2	Lee et al. (2004) [47]	- Disease and self-care knowledge. - Health risk behavior - Preventive care and physician visits. - Compliance with medications.	- Social-economic status - Gender - Ethnicity - Health insurance coverage - Disease severity - Income discrepancy - Ethnic composition of the community	- Health status - Emergency care - Hospitalization
3	Institute of Medicine (2004) [8]	- Cultural and conceptual knowledge - Listening - Speaking - Arithmetical skills - Writing skills - Reading skills	- Education, culture and language. - Communication and assessment skills of people with whom individuals interact for health - Ability of the media, the marketplace, and governmental agencies to provide health information in an appropriate manner	Health outcomes and costs
4	Zarcadoolas et al. (2005) [38]	- Fundamental literacy Science literacy - Civic literacy Cultural literacy	- Health status - Demographic, sociopolitical, psychosocial and cultural factors	- Ability to apply information to novel situations Ability to participate in public and private dialogues about health, medicine, scientific knowledge and cultural beliefs
5	Speros (2005) [48]	- Reading/numeracy skills - Comprehension - Capacity to use health information in decision making - Successful functioning in healthcare consumer role	- Literacy - Health-related experience.	- Improved self-reported health status - Lower healthcare costs - Increased health knowledge - Shorter hospitalization Less frequent use of healthcare services
6	Baker (2006) [49]	- Health-related print literacy - Health-related oral literacy.	- Health-related reading fluency - Health-related vocabulary - Familiarity with health concepts Complexity and difficulty of the printed and spoken messages in the healthcare environment	- Acquisition of new knowledge - More positive attitudes - Greater self-efficacy Positive health behaviors - Better health outcomes
7	Paashe-Orlow & Wolf (2007) [40]	- Listening - Verbal fluency - Memory span - Navigation.	- Socioeconomic status Occupation - Employment status Income - Social support - Culture and language - Education - Age - Race/ethnicity Personal competences such as vision, hearing, verbal ability, memory and reasoning.	- Access and utilization of healthcare (influenced by patients' navigation skills, self-efficacy and perceived barriers, and by system's complexity, acute care orientation and tiered delivery model). - Patient/provider interactions (influenced patients' knowledge, beliefs and participation in decision-making, and by providers' communication skills, teaching ability, time and patient-centered care). Self care (influenced by patients' motivation, problem-solving, self-efficacy, knowledge/skills, and by support technologies, mass media, health education and resources)
8	Kickbusch & Maag (2008) [2]	- Functional - Interactive - Critical	- Education system - Health-care system - Culture/home and community - Work - Politics Market	- Health outcomes and costs
9	Mancuso (2008) [43]	- Capacity - Comprehension Communication	- Operational competence - Interactive competence - Autonomous competence - Informational competence - Contextual competence - Cultural competence	- Healthcare costs - Knowledge of diseases and treatments - Self-management skills - Ability to care for chronic conditions - Compliance - Medical or medication treatment errors - Access to and use of healthcare services. - Use of expensive services such as emergency care and inpatient admissions. Prevention and screening health-promoting behaviors Health status, defined as physical illness or perceptions of illness, disease or impairment
10	Manganello (2008) [50]	- Functional health literacy - Interactive health literacy - Critical health literacy Media literacy	- Individual traits (age, race, gender, cultural background, cognitive and physical abilities, social skills) - Media use - Peer and parent influences - Mass media, the education system and the health system	- Health behavior - Health costs - Health service use
11	Freedman et al. (2009) [35]	- Conceptual foundations - Critical skills Civic orientation	Social, environmental and political forces	- Resolve some of society's more pressing health issues - Alleviate social injustices.
12	Von Wagner et al. (2009) [51]	- Ability to rely on literacy and numeracy skills when they are required to solve problems	- Epidemiological or structural determinants - Individual influences - Reading and arithmetic skills - External influences	- Access and use of healthcare - Patient-provider interaction - Management of health and illness