Table 1 Evolution of the constructs and scales to define health literacy
Initial construct descriptor | Overarching theme | Draft scales tested in calibration sample* | Refined scales tested in replication sample** | Final scale ** | Response options |
|---|---|---|---|---|---|
1. Characteristics of relationships with providers (regular, trust) | 1 About self | 1 Healthcare provider support [9] | 1 Healthcare provider support [6] | 1. Feeling understood and supported by healthcare providers [4] | Agree/ disagree |
2. Dealing with providers (2nd opinion/ assertiveness/ communication/ questions/ listens), difference between new and familiar providers | 2 Dealing with outside world | 2 Agency in relationships with providers [8] | 2 Agency in relationships with healthcare providers [5] | 6. Ability to actively engage with healthcare providers [5] | Difficulty |
3. Skills of using health system | 2 Dealing with outside world | 3 Skills for using the health system [6] | 3 Navigating the health system [6] | 7. Navigating the health system [6] | Agree/ disagree |
4. Practicalities of accessing health system | 2 Dealing with outside world | 4 Practicalities of accessing the health system [9] | [Re-classified as checklist assessment] | Â | Difficulty |
5. Cognitive barriers/strategies. memory; organisation; judgement; not getting overwhelmed and confused | 1 About self | [Subsumed into Critical appraisal] | Â | Â | Â |
6. Understanding and critical appraisal | 3 Being resourced | 5 Critical appraisal [7] | 4 Critical appraisal [6] | 5. Appraisal of health information [5] | Agree/ disagree |
7. Skills/options for accessing information | 1 About self | 6 Ability to access information [10] | 5 Ability to access information [5] | 8. Ability to find good quality health information [5] | Difficulty |
8. Having condition related information, information and knowledge adequacy | 3 Being resourced | 7 Perceived information adequacy [7] | 6 Perceived information adequacy [7] | 2. Having sufficient information [4] | Difficulty |
9. Self management/ motivation/ prioritisation | 2 Dealing with outside world | 8 Taking responsibility for health [10] | 7 Taking responsibility for health [5] | 3. Actively managing my health [5] | Difficulty |
10. Being health focused. Where your head is (psych/ emotional state/ self discipline/ will power/ acceptance of condition) | 1 About self | 9 Health focused [9] | 8 Health focused [6] | Engagement in decisions. [Scale removed due to items not having sufficient difficulty range] | Â |
11. Social support | 3 Being resourced | 10 Social support [7] | 9 Social support [5] | 4. Social support for health [5] | Agree/ disagree |
12. Literacy and numeracy | 2 Dealing with outside world | 11 Understanding health and healthcare [8] | 10 Reading and writing health information [5] | 9. Understand health information well enough to know what to do [5] | Agree/ disagree |
13. Beliefs and values | 1 About self | [Inventory style assessment] | Â | Â | Â |