title: Health literacy -- a heterogeneous phenomenon: a literature review.
abstract: OBJECTIVE
  A growing responsibility on the part of individuals to make decisions in health issues implies the need of access to health information and personal skills to comprehend the information. Health literacy comprises skills in obtaining, understanding and acting on information about health issues in ways that promote and maintain health. A lack of health literacy may have effects at both the individual and societal levels. There are thus reasons for health care professionals to gain a comprehensive understanding of health literacy. The aim of this review was to explore how health literacy is described in the scientific literature and to give a synthesis of its different meanings.
  
  
  METHODS
  The review was based on approximately 200 scientific articles published 2000-2008. The analysis process was inspired by the methods of narrative literature review.
  
  
  CONCLUSIONS
  Two different approaches to health literacy became visible, one in which health literacy is expressed as a polarized phenomenon, focusing on the extremes of low and high health literacy. The definitions of health literacy in this approach are characterized by a functional understanding, pointing out certain basic skills needed to understand health information. The other approach represents a complex understanding of health literacy, acknowledging a broadness of skills in interaction with the social and cultural contexts, which means that an individual's health literacy may fluctuate from one day to another according to the context. The complex approach stresses the interactive and critical skills needed to use information or knowledge as a basis for appropriate health decisions. We conclude that health literacy is a heterogeneous phenomenon that has significance for both the individual and society. Future research will aim at the development of assessments that capture the broadness of skills and agents characteristic for health literacy as a complex phenomenon.
authors.affiliation: Social Medicine, Department of Public Health and Community Medicine, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden. lena.i.martensson@gu.se
authors.forename: Lena
authors.initials: L
authors.lastname: Mårtensson
authors.forename: Gunnel
authors.initials: G
authors.lastname: Hensing
mesh_terms: D003210:Concept Formation; D057220:Health Literacy; D006801:Humans; D010358:Patient Participation; D018802:Patient-Centered Care; D009626:Terminology as Topic