Facilitators and Barriers to the Development of Health Literacy Capacities Over Time for Self-Management

BACKGROUND: Health literacy is a dynamic construct that is content and context specific. An understanding of the facilitators and barriers involved in the development of health literacy over time can provide important insights for the health care providers (HCP) in supporting patients with chronic illness. OBJECTIVE: The study was conducted to expand an understanding of how health literacy development can be supported through exploration of the main facilitators and barriers in the process. METHODS: This study used a longitudinal qualitative study design involving repeat interviews at three separate time points over a 12-month period. A purposive sample of 26 participants attending a structured cardiovascular disease risk-reduction program participated in the study, 17 of whom completed all three interviews. The European Health Literacy Survey measure was used to determine health literacy levels at the beginning and end of the 12-month period. Employing qualitative thematic analysis and a longitudinal-specific question framework, a trajectory approach was applied to explore individual cases longitudinally. KEY RESULTS: Facilitators and barriers to health literacy capacity development were identified. Participants demonstrated increased perceptions of having control and being empowered over time. However, this was also found to be affected by external life events. Study participants were also found to be embedding health knowledge, motivation, and behaviors over time within the everyday contexts of their lives. The relationship with the HCP permeated all aspects of health literacy capacity development, including aspects of treatment decision-making. Participants identified the need for psychological supports and the increased importance of looking after their mental health. CONCLUSIONS: Positive developments in health literacy capacities are important for the self-management of illness. Longitudinal findings underscore the importance of the HCP in supporting the development of health literacy capacities over time. These findings lend support to the need to integrate health literacy into medical and other HCP curricula to raise awareness of the concept of health literacy. [HLRP: Health Literacy Research and Practice. 2020;4(2):e104–e118.] PLAIN LANGUAGE SUMMARY: Using a longitudinal qualitative study design, this study proposes that health literacy capacities develop over time and that the health care provider (HCP) plays a central role in this process. Findings from this study support the need to embed health literacy training into medical and other applied HCP curricula to raise awareness of the concept of health literacy.