Insights into the concept and measurement of health literacy from a study of shared decision-making in a low literacy population

J Health Psychol. 2013 Aug;18(8):1011-22. doi: 10.1177/1359105312468192. Epub 2013 May 15.


This article explores the concept and measurement of health literacy in the context of shared health decision-making. It draws upon a series of qualitative and quantitative studies undertaken in the development and evaluation of a bowel cancer screening decision aid for low literacy populations. The findings indicate that different types of health literacy (functional, interactive and critical) are required in decision-making and present a set of instruments to assess and discriminate between higher level health literacy skills required for engagement in decision-making. It concludes that greater sophistication in both the definition and measurement of health literacy in research is needed.

Keywords: adults; bowel cancer screening; cancer screening; health literacy; intervention; low literacy; measurement; shared decision-making.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making*
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / standards*
  • Health Literacy / classification
  • Health Literacy / methods
  • Health Literacy / standards*
  • Humans
  • Vulnerable Populations / psychology*