École des Hautes Etudes en Sante Publique (EHESP), 35043 Rennes, France.
Laboratory Arènes (UMR CNRS 6051), 35700 Rennes, France.
Int J Environ Res Public Health. 2020 Mar 2;17(5):1601. doi: 10.3390/ijerph17051601.
Health literacy (HL) is increasingly hailed as a strategy to improve the control individuals have over their health. A central critic of HL intervention is its overemphasis on individual level factors, something recognised in the 2008 report of the Commission of Social Determinants of Health (SDoH) that recommended expanding the scope of HL to cover the SDoH. The objective of our study was to assess the extent to which recent progress on HL captures the need for collective action on the SDoH. We conducted a scoping review on PubMed looking for review papers published between 2013-2018 in English and French. Definitions of HL were analysed against two main dimensions (i.e., locus of change of HL strategies and foreseen outcome of HL improvements). Despite a number of authors calling for more research on HL interventions at the community level and an expansion of the definition to cover the SDoH, we found that the recommendation of the Commission has yet to be implemented. Even when the definitions include the capacities of individuals on distal determinants, both the locus of change and outcomes of HL improvement do not go beyond intra individual factors (knowledge, skills, etc.). It is noteworthy that communities were either framed as a setting outside of health care services or as an aggregate of individuals. We found no instance of HL intervention regarding communities as complex systems of actors sharing a common space and dynamic. We conclude by suggesting a new definition of HL and by drawing attention to the research gap in addressing the upstream SDoH through HL actions.
健康素养（HL）越来越被视为提高个人对自身健康控制能力的策略。对 HL 干预的核心批评是其过分强调个体层面的因素，这在 2008 年社会决定因素健康委员会（SDoH）的报告中得到了认可，该报告建议扩大 HL 的范围，以涵盖 SDoH。我们研究的目的是评估最近在 HL 方面取得的进展在多大程度上满足了对 SDoH 采取集体行动的需要。我们在 PubMed 上进行了范围界定审查，寻找了 2013-2018 年期间以英文和法文发表的综述论文。我们根据两个主要维度（即 HL 策略变革的发生点和 HL 改进的预期结果）对 HL 的定义进行了分析。尽管一些作者呼吁在社区层面上对 HL 干预措施进行更多研究，并扩大定义以涵盖 SDoH，但我们发现委员会的建议尚未得到实施。即使定义中包括个人对远端决定因素的能力，HL 改进的发生点和结果也没有超出个体因素（知识、技能等）。值得注意的是，社区要么被构造成医疗服务之外的环境，要么被构造成个人的集合。我们没有发现任何关于社区作为共享共同空间和动态的复杂行为者系统的 HL 干预实例。我们通过提出一个新的 HL 定义，并提请注意通过 HL 行动解决上游 SDoH 的研究空白来结束讨论。
