title: Improving low health literacy and patient engagement: A social ecological approach.
abstract: This article posits four principal objectives related to the overarching goal of broadening the conceptualization of health literacy. We propose a social ecological approach to health literacy and patient engagement by illustrating how this multilevel approach offers an array of strategic options for interventions.
  
  
  
  A social ecological approach supports a broader understanding of health literacy that aligns with increased patient engagement. The ecological model highlights the importance of context, demonstrates how health literacy and patient engagement are inextricably connected, and gives rise to strategies to enhance them both. We illustrate the five multilevel intervention strategies for addressing low health literacy and promoting patient engagement: accumulation, amplification, facilitation, cascade, and convergence strategies. In addition, we provide a theoretical foundation to facilitate the development of interventions to enhance health literacy and ultimately increase patient engagement.
  
  
  
  The practice implications of adopting a broader social ecological perspective to address low health literacy shifts the field from thinking about individual educational interventions to how individual interventions may be augmented or supported by interventions at additional levels of influence. The potential benefit of adopting a multilevel intervention approach is that combining interventions could produce synergies that are greater than interventions that only utilize one level of influence.
authors.affiliation: Center for Communication Science, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 12194, United States. Electronic address: lmac@rti.org.
authors.forename: Lauren
authors.initials: L
authors.lastname: McCormack
authors.affiliation: Center for Communication Science, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 12194, United States. Electronic address: vthomas@rti.org.
authors.forename: Veronica
authors.initials: V
authors.lastname: Thomas
authors.affiliation: Center for Communication Science, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 12194, United States. Electronic address: melewis@rti.org.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Lewis
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, United States. Electronic address: rrudd@hsph.harvard.edu.
authors.forename: Rima
authors.initials: R
authors.lastname: Rudd
mesh_terms: D057220:Health Literacy; D006801:Humans; D010358:Patient Participation; D012931:Social Environment
keywords: Health literacy; Intervention; Multilevel; Patient engagement; Social ecological model