title: The relevance of context in understanding health literacy skills: Findings from a qualitative study.
abstract: Conceptualizing health literacy as a relational concept, which involves how individuals interact with complex health and social systems, requires a greater understanding of the context of people's health experiences.
  
  
  
  To describe individuals' experiences of accessing, understanding, appraising and applying health information; explore the barriers and facilitators to using these skills; and to describe the experience of information exchange in health consultations.
  
  
  
  A longitudinal qualitative methodology with thematic analysis of interviews was used. Health literacy levels were assessed using the HLS-EU-47-Item Questionnaire. Findings are presented from the first round of data collection.
  
  
  
  Twenty-six participants purposefully selected from a CVD risk reduction programme at three separate time points.
  
  
  
  Four key themes identified: using health literacy capacities for managing health; psychological and structural factors that impact on these capacities; and the relationship quality with the health-care provider (HCP). Although limited health literacy was prevalent across the sample (65%), all individuals were very proactive in attempting to utilize health literacy skills. Findings emphasize the importance of contextual factors such as the quality of communication with the health-care provider, perceptions of control, attitudes to family medical history, navigating structural barriers and being supported in managing treatment and medication side-effects.
  
  
  
  Findings are relevant for health-care providers in order to enhance the patient-provider relationship and to ensure optimum health outcomes for all individuals regardless of health literacy levels.
authors.affiliation: Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland, Galway, Ireland.
authors.forename: Verna B
authors.identifier: 0000-0002-3402-3871
authors.initials: VB
authors.lastname: McKenna
authors.affiliation: Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland, Galway, Ireland.
authors.forename: Jane
authors.initials: J
authors.lastname: Sixsmith
authors.affiliation: Health Promotion Research Centre, Discipline of Health Promotion, National University of Ireland, Galway, Ireland.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Barry
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D054626:Consumer Health Information / Q000379:methods*; D057220:Health Literacy; D006801:Humans; D057226:Information Seeking Behavior; D008137:Longitudinal Studies; D008487:Medical History Taking; D008875:Middle Aged; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012959:Socioeconomic Factors
keywords: health experiences; health literacy; health-care provider communication; qualitative