The relevance of context in understanding health literacy skills: Findings from a qualitative study

BACKGROUND: Conceptualizing health literacy as a relational concept, which involves how individuals interact with complex health and social systems, requires a greater understanding of the context of people's health experiences. OBJECTIVES: To describe individuals’ experiences of accessing, understanding, appraising and applying health information; explore the barriers and facilitators to using these skills; and to describe the experience of information exchange in health consultations. DESIGN: A longitudinal qualitative methodology with thematic analysis of interviews was used. Health literacy levels were assessed using the HLS‐EU‐47–Item Questionnaire. Findings are presented from the first round of data collection. SETTING AND PARTICIPANTS: Twenty‐six participants purposefully selected from a CVD risk reduction programme at three separate time points. RESULTS: Four key themes identified: using health literacy capacities for managing health; psychological and structural factors that impact on these capacities; and the relationship quality with the health‐care provider (HCP). Although limited health literacy was prevalent across the sample (65%), all individuals were very proactive in attempting to utilize health literacy skills. Findings emphasize the importance of contextual factors such as the quality of communication with the health‐care provider, perceptions of control, attitudes to family medical history, navigating structural barriers and being supported in managing treatment and medication side‐effects. DISCUSSION AND CONCLUSION: Findings are relevant for health‐care providers in order to enhance the patient‐provider relationship and to ensure optimum health outcomes for all individuals regardless of health literacy levels.