Critical health literacy: conceptualization and settings-based development

BACKGROUND: Health literacy is conceptualized as a continuum of social practices spanning functional, interactive and critical domains. Critical health literacy enables individuals and communities to reflect on the wider health determinants and engage in social and political processes towards health equity. This project introduces the Oxford Bibliographies (OB) entry and illustrates through an empirical case study of critical health literacy in a community-based setting. METHODS: The OB entry provides a literature review of critical health literacy conceptualization, measurement and interventions. An institutional ethnography of critical health literacy in libraries, models a settings-based approach to critical health literacy development in children. RESULTS: Barriers to critical health literacy development include the lack of validated instruments and evaluation of interventions. Common settings for development with children are schools, but institutional settings face challenges in developing the political action element of critical health literacy. There is a need to move beyond single settings to consider multiple settings working in partnership where children can learn, live, and play. A coordinated supersetting approach leverages the strengths of different settings to promote critical health literacy. A model proposes four antecedents to a supersetting in which sub-settings collectively support (1) a determinants-based perspective, (2) open access to information and resources, (3) involvement of community stakeholders and (4) informed action on health. CONCLUSIONS: Although conceptualized over two decades ago, it is only recently that research on critical health literacy has normalized the consolidation of both its cognitive and social dimensions into a joint strategy of critical thinking and empowerment. A supersetting approach can combine community-based and school-based support to embed critical health literacy development opportunities early in the life course.