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Health Expect. 2008 Jun;11(2):113-22. doi: 10.1111/j.1369-7625.2008.00497.x.

Patient health literacy and participation in the health-care process.

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Department of Medicine and Culture, Shiga University of Medical Science, Shiga, and Department of Public Health, Teikyo University School of Medicine, Tokyo, Japan.



Health information is an important resource for patients to understand and engage in the management of their health conditions. We discuss the role of health literacy (HL) in improving patient participation and propose future research in this field.


Literature searches were conducted to review existing definitions and measures of HL and identify empirical findings of its impact on patient health/illness-related behaviours. We searched MEDLINE using 'health literacy' as a keyword and retrieved 371 articles published in English between 1985 and 2006. We also hand-searched publications of leading researchers and related institutes and followed the reference lists of relevant articles.


The World Health Organization has defined HL as 'the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.' Based on this definition, three levels of HL have been described: functional, communicative and critical. Studies of HL have increased dramatically over the past few years, but there is a gap between the conceptual definition of HL and its application. Thus, empirical evidence of its impact on patient health/illness-related behaviours is still limited.


The prevalence and consequence of inadequate HL as fully defined have not been determined. Further research is needed to develop measures of HL beyond the functional level and that consider the interaction of the individual patient HL with the health and social contexts in which the patient lives.

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