title: The causal pathways linking health literacy to health outcomes.
abstract: OBJECTIVE
  To provide an evidence-based review of plausible causal pathways that could best explain well-established associations between limited health literacy and health outcomes.
  
  
  METHODS
  Through analysis of current findings in medical and public health literature on health literacy we derived a conceptual causal model.
  
  
  RESULTS
  Health literacy should be viewed as both a patient and a system phenomenon. Three distinct points along a continuum of health care are suggested to be influenced by health literacy: (1) access and utilization of health care, (2) patient-provider relationship, and (3) self-care.
  
  
  CONCLUSIONS
  The conceptual model organizes what has been learned to date and underscores promising areas of future inquiry and intervention.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston University Medical Center, Boston, MA 02118, USA. mpo@bu.edu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D004522:Educational Status; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D011369:Professional-Patient Relations; D012648:Self Care