Huhta Anna-Maija, Hirvonen Noora, Huotari Maija-Leena
Department of Information Studies, Faculty of Humanities, University of Oulu, Oulu, Finland.
Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
J Med Internet Res. 2018 Dec 19;20(12):e10273. doi: 10.2196/10273.
Health literacy research seems to lack a consensus on what aspects to include into literacy in the context of health and on how to operationalize these concepts for measurement purposes. In addition to health literacy, several other concepts, such as electronic health (eHealth) literacy and mental health literacy, have been developed across disciplines. This study examines how these different concepts are used when studying health-related competencies in Web contexts.
This study systematically reviews health literacy concepts and definitions and their operationalization in studies focused on Web-based health information environments.
A systematic literature search was conducted in April 2016 in 6 electronic databases with a limitation to articles in English published between January 2011 and April 2016. Altogether, 1289 unique records were identified and screened according to the predefined inclusion criteria: (1) original, peer-reviewed research articles written in English; (2) the topic of the article concerned literacy in the context of health; (3) informants of the study were lay people, not health professionals or students of the field; and (4) the focus of the study was placed on an Web-based information environment. In total, 180 full texts were screened, of which 68 were included in the review. The studies were analyzed with an emphasis on the used health literacy concepts and measures.
On the basis of the included studies, several concepts are in use when studying health-related literacy in Web environments, eHealth literacy and health literacy being the most common ones. The reviewed studies represent a variety of disciplines, but mostly medical sciences. Typically, quantitative research methods are used. On the basis of the definitions for health literacy, 3 thematic categories were identified: general and skill-based, multidimensional, and domain-specific health literacy. Most studies adopted a domain-specific concept, followed by the ones that used a general and skill-based concept. Multidimensional concepts occurred least frequently. The general health literacy concepts were usually operationalized with reading comprehension measures, the domain-specific concepts with self-efficacy measures, and multidimensional concepts with several types of measures. However, inconsistencies in operationalization were identified.
The results show that in studies conducted in Web-based information environments, several different health literacy concepts are in use, and there is no clear consensus on the definitions for these concepts. Future studies should place emphasis on the conceptual development of health literacy in Web contexts to gain better results on operationalization for measurement. Researchers are encouraged to provide clear operational definitions for the concepts they use to ensure transparency in reporting.
健康素养研究似乎在健康背景下应将哪些方面纳入素养以及如何将这些概念用于测量目的的操作化方面缺乏共识。除了健康素养，还跨学科开发了其他几个概念，如电子健康（eHealth）素养和心理健康素养。本研究探讨在网络环境中研究与健康相关的能力时如何使用这些不同的概念。
本研究系统回顾了在关注基于网络的健康信息环境的研究中健康素养的概念、定义及其操作化。
2016年4月在6个电子数据库中进行了系统的文献检索，检索范围限于2011年1月至2016年4月发表的英文文章。总共识别出1289条独特记录，并根据预先定义的纳入标准进行筛选：（1）用英文撰写的原创、经过同行评审的研究文章；（2）文章主题涉及健康背景下的素养；（3）研究对象为非专业人士，而非健康专业人员或该领域的学生；（4）研究重点放在基于网络的信息环境上。总共筛选了180篇全文，其中68篇纳入综述。对这些研究进行了分析，重点关注所使用的健康素养概念和测量方法。
根据纳入的研究，在网络环境中研究与健康相关的素养时使用了几个概念，电子健康素养和健康素养是最常见的。综述的研究涵盖了多个学科，但大多是医学领域。通常使用定量研究方法。根据健康素养的定义，确定了3个主题类别：一般和基于技能的、多维的以及特定领域的健康素养。大多数研究采用特定领域的概念，其次是使用一般和基于技能的概念的研究。多维概念出现的频率最低。一般健康素养概念通常通过阅读理解测量进行操作化，特定领域概念通过自我效能测量进行操作化，多维概念通过几种类型的测量进行操作化。然而，发现了操作化方面的不一致性。
结果表明，在基于网络的信息环境中进行的研究中，使用了几种不同的健康素养概念，并且对于这些概念的定义没有明确的共识。未来的研究应侧重于网络背景下健康素养的概念发展，以在测量的操作化方面取得更好的结果。鼓励研究人员为他们使用的概念提供明确的操作定义，以确保报告的透明度。
