Developments in health literacy over time: A longitudinal qualitative research study

Abstract

Introduction Conceptualising 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. Aims The overall aim of this study is to examine how health literacy develops over time in the management of health and illness among a group of individuals attending a structured cardiovascular risk reduction programme. The study also examines the facilitators and barriers in that process. Methods A longitudinal qualitative study design was undertaken to address the study aims. A semi-structured interview guide, informed by Sørensen’s conceptual model of health literacy, was used to explore the development of health literacy and to identify changes in knowledge, attitudes and experiences over time at three separate time points. The HLS-EU-Q47 was used to provide a guide on the health literacy level of participants at Phases 1 and 3 of the study. Twenty-six participants were purposefully selected from a cardiovascular risk reduction programme. Thematic analysis and longitudinal question interpretive and analytic frameworks were used in data analysis. Results Results from the study showed developments in health literacy across the functional, interactive and critical levels of health literacy. The health care provider provided a crucial role for individuals in the development of all aspects of health literacy. While, in the main, individuals reported perceptions of increased feelings of empowerment and control related to managing health and illness, these developments could be adversely impacted by both psychological and structural barriers.

Conclusions Positive developments in health literacy capacities are important for the self-management of health and illness. Longitudinal findings underscore the importance of healthcare providers in supporting the development of health literacy. These findings lend support to the need to integrate health literacy into health care interventions and to incorporate health literacy into medical training and other curricula for health professionals.