Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Heath, Cardiff CF14 4XN, UK.
BMC Public Health. 2012 Feb 14;12:130. doi: 10.1186/1471-2458-12-130.
Inadequate health literacy has been associated with poor management of long-term health conditions and has been identified as a key social determinant of health outcomes. However, little is understood about how health literacy might develop over time or the processes by which people may become more health literate. Our objectives were to describe how patients with a long-term condition practice health literacy in the management of their health and communication with health professionals, how they become more health literate over time and their experience of using health services. We also sought to identify and describe the motivations, facilitators and barriers in the practice of health literacy in healthcare consultations.
We designed a longitudinal qualitative study using serial interviews with 18 participants to explore their experiences of learning to manage their condition and their experiences of health literacy when participating in healthcare processes. Participants were recruited from patient education programmes and were interviewed three times over a period of 9 months. A framework approach was used to analyse data.
A model is presented that illustrates the development of health literacy along a trajectory that includes the development of knowledge, health literacy skills and practices, health literacy actions, abilities in seeking options and informed and shared decision making opportunities. Motivations and barriers to developing and practising health literacy skills partly reflected participants' characteristics but were also influenced by health professionals. Some participants developed their health literacy to a point where they became more involved in healthcare processes (including informed and shared decision-making).
Patients with a long-term condition can develop health literacy skills over time and put their skills into practice in becoming more active in healthcare consultations. Our findings have implications for developing health literacy interventions aimed at patient involvement in healthcare processes and improved self-management of long-term conditions.
健康素养不足与长期健康状况管理不善有关，并已被确定为健康结果的关键社会决定因素。然而，人们对健康素养如何随时间发展或人们如何变得更具健康素养的过程知之甚少。我们的目的是描述患有长期疾病的患者如何在管理自己的健康和与卫生专业人员沟通时实践健康素养，他们如何随着时间的推移变得更具健康素养以及他们使用卫生服务的经验。我们还试图确定并描述在医疗保健咨询中实践健康素养的动机、促进因素和障碍。
我们设计了一项纵向定性研究，对 18 名参与者进行了连续访谈，以探讨他们学习管理病情的经验以及在参与医疗保健过程中健康素养的经验。参与者是从患者教育计划中招募的，并在 9 个月的时间内进行了三次采访。使用框架方法分析数据。
提出了一个模型，该模型说明了健康素养的发展沿着一条轨迹进行，包括知识、健康素养技能和实践、健康素养行动、寻求选择的能力以及知情和共同决策机会的发展。发展和实践健康素养技能的动机和障碍部分反映了参与者的特征，但也受到卫生专业人员的影响。一些参与者发展了他们的健康素养，从而更积极地参与医疗保健过程（包括知情和共同决策）。
患有长期疾病的患者可以随着时间的推移发展健康素养技能，并在更积极地参与医疗保健咨询中实践他们的技能。我们的研究结果对制定旨在促进患者参与医疗保健过程和改善长期疾病自我管理的健康素养干预措施具有启示意义。
